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Key message: EPS adversely impact several aspects of antipsychotic efficacy and tolerability, thereby worsening the outcome for the afflicted individuals. Therefore, there are multiple clinical benefits of drugs with low risk of EPS.
Note: ‘Atypical’ (‘second generation’) antipsychotics are associated with a lower risk of EPS compared to older conventional antipsychotics, and are therefore better able to separate the therapeutic antipsychotic effect from EPS.
Background
The costs of EPS are not limited to parkinsonian motor manifestations, but extend to increased negative symptoms and cognitive impairment, more dysphoria, higher likelihood of non-compliance, and greater risk of developing tardive dyskinesia.[Tandon & Jibson, 2002]
- Expression of EPS significantly increases the likelihood of subsequent tardive dyskinesia – tardive dyskinesia, in turn, is associated with increased morbidity and mortality.[Tandon & Jibson, 2002]
- EPS contribute to secondary negative symptoms, increasing the severity of this symptom dimension and attendant dysfunction.[Tandon & Jibson, 2002]
- EPS are associated with cognitive dysfunction.[Tandon & Jibson, 2002]
- Significant EPS may be correlated with dysphoria.[Tandon & Jibson, 2002]
The primary advantage of newer agents is their superior adverse event profiles, particularly with regard to EPS.[Tandon & Jibson, 2002]
The implications of EPS reduction potentially touch virtually every domain of pathology in schizophrenia, including short- and long-term movement disorders, negative symptoms, non-compliance, relapse rate, cognitive dysfunction, and dysphoria.[Tandon & Jibson, 2002]
This EPS advantage of atypical antipsychotics is likely to lead to improved patient compliance and a superior long-term outcome in patients treated with these medications.[Tandon & Jibson, 2002]
Reference:
Tandon R, Jibson MD. Extrapyramidal side effects of antipsychotic treatment: scope of problem and impact on outcome. Ann Clin Psychiatry 2002; 14 (2): 123–129.