Antipsychotic treatment and extrapyramidal symptoms amongst schizophrenic inpatients

Extrapyramidal symptoms (EPS) are seen in 50-75% of patients treated with typical antipsychotics and are a cause of treatment failure in at least 30% of the patients. Using atypical antipsychotics, the EPS incidence is lower, but a low-dosage strategy using typical antipsychotics is also known to cause fewer EPS. What conclusions can be drawn for the daily clinical practice? A naturalistic study including all schizophrenic inpatients in a psychiatric ward (n=123) analysed the effects of treatment concerning positive/negative symptoms, EPS, number of days to re-hospitalization and inpatient-days in the year after baseline admittance, using atypical and typical antipsychotics as recommended by the Danish Society of Psychiatry. The incidence of EPS was significantly higher in patients who were treated with typical antipsychotics in relation to atypical antipsychotics (46% vs. 12%, P<0.001). Patients with EPS had significantly more negative symptoms and a poorer level of function at discharge. Nevertheless, no difference regarding re-hospitalization and inpatient-days was found, whether the patient was treated with typical or atypical antipsychotics. However, it is important to underline that patients treated with atypical oral antipsychotic do as well as patients on typical depot antipsychotics.