Extrapyramidal side effects in first-episode schizophrenia treated with flupenthixol decanoate

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Neuroscience

Background:

• Extrapyramidal side effects (EPSEs) are a significant barrier to using long-acting injectable (LAI) antipsychotics in first-episode schizophrenia (FES).
• Flupenthixol decanoate, a first-generation antipsychotic, is accessible within South Africa's public healthcare system.

Purpose of the Study:

• To characterize the nature, incidence, and severity of EPSEs.
• To assess the impact of EPSEs over 12 months of flupenthixol decanoate treatment in FES patients.
• To explore the relationship between demographic/clinical factors and EPSEs.

Main Methods:

• A sub-study of 130 FES patients in Cape Town, South Africa, treated with flupenthixol decanoate.
• Utilized the Extrapyramidal Symptom Rating Scale (ESRS) for subjective and objective EPSE assessment.
• Analyzed demographic and clinical risk factors for specific EPSEs.

Main Results:

• Flupenthixol decanoate demonstrated good 12-month tolerability, with EPSEs peaking at month 3.
• Akathisia correlated with increased depressive symptoms; Parkinsonism linked to higher PANSS scores.
• Differential EPSE ratings were observed across ethnic groups, with higher scores in Black and White patients compared to mixed ancestry patients.

Conclusions:

• Flupenthixol decanoate is generally well-tolerated in FES patients.
• Clinical features of schizophrenia and ethnicity appear to influence EPSE risk.
• Further research into environmental, dietary, substance use, and genetic factors affecting psychotropic drug response is warranted.