Objective: To describe the prevalence and nature of movement disorders (MD) in a large sample of patients treated with antipsychotic medication.

Background: Although there are a number of studies of MD related to antipsychotic medication, many used older screening and rating instruments that may have underestimated the true prevalence of MD and not characterised its phenomenology in depth. Furthermore, MD in community psychiatric patients is not usually assessed by neurologists who have sub-specialised in this field.

Methods: Patients aged ≥18 years with a diagnosis of schizophrenia, schizophreniform disorder, schizoaffective disorder or delusional disorder, who had been exposed to at least one first or second generation antipsychotic drug for at least 3 months, were assessed by a neurologist with MD expertise. Subjects were recruited from acute and rehabilitation wards, outpatient clinics and supported housing.

Results: This is a continuing study and full data of 500 patients will be presented at the meeting. The preliminary impression of 247 patients suggests that most patients had a MD. Tremor seemed to be the commonest MD, either in isolation or as part of a Parkinsonian syndrome. Postural tremor was more frequent than rest tremor, whereas position specific tremor was rare. Dyskinesia was the second most frequent MD, and mainly affecting tongue or lower face. Not all of those who looked Parkinsonian (hypomimia, global lack of spontaneous movement) had true bradykinesia. Of those who had bradykinesia, only a proportion exhibited rigidity or a rest tremor. Micrographia and freezing were rare. There was an even distribution of symmetric and asymmetric presentations. Other MD noted to variable extents were akathisia, stereotypies (mostly ‘pill-rolling’, or tapping of thumb and index finger), dystonia, tics, and a mild, distal action myoclonus of the hands.

Conclusions: Preliminary data from this continuing study suggest that the vast majority of patients treated with antipsychotic medication develops MD. Thus, despite the introduction of second-generation antipsychotics, stigmatising or incapacitating MD side effects may still represent a clinically relevant phenomenon.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-survey-of-movement-disorders-in-a-large-sample-of-patients-treated-with-antipsychotic-medication/