A study of the acute neurological side effects in hospitalized psychiatric patients receiving neuroleptic drug treatment.
Neuroleptic drugs are essential in the treatment of schizophrenia and many other psychiatric disorders. These drugs do however cause a wide range of side effects which can be very distressing to patients. In particular the acute neurological side effects of parkinsonism, akathisia and dystonia, which are termed extrapyramidal syndromes, can be a limiting factor in the use of these drugs (Weiden et al 1987). Fort Napier Hospital is a large psychiatric referral hospital and the majority of patients admitted require neuroleptic drug treatment. Extrapyramidal side effects are regularly seen amongst these patients. This study was designed to discover the incidence of parkinsonism, akathisia and dystonia amongst patients treated with neuroleptic drugs and what specific factors were responsible for these side effects. Relevant literature on this topic was reviewed and comparable studies done in America, Europe and South Africa are discussed. The study sample consisted of one hundred patients who were examined regularly over a two week period for signs of parkinsonism, akathisia, or dystonia which were rated quantitatively according to specific rating scales. Patient and drug variables were then analysed to assess what factors were responsible for these side effects. The incidence of drug-induced parkinsonism was 29%, akathisia 35% and dystonia 20%. Combinations of these three syndromes were observed resulting in an overall incidence of 47%. High potency drugs such as haloperidol and trifluoperazine were responsible for a large percentage of all the side effects, while of the low potency drugs, thioridazine produced less side effects than chlorpromazine. Oral drugs combined with intramuscular depot drugs resulted in a high incidence of side effects. The phase of treatment was clinically important with dystonia occurring more often within the first three days of treatment, akathisia within ten days and parkinsonism after ten to fourteen days. Other factors that were studied included the patients age, sex and prior history of neuroleptic-induced neurological side effects. Due to the predominantly young patient population in this study, the mean age of those patients who developed parkinsonism was 26,7 years, akathisia 27,5 years and dystonia 25,8 years. These side effects were seen more commonly in males than in females. Of the 27 patients in this study who had a prior history of neurological side effects, 15 (56%) developed similar side effects following re-exposure to neuroleptic drugs. Conclusions derived from this study include the need for clinicians to select the correct type and dose of neuroleptic for individual patients in order to minimize the development of neurological side effects. Accurate, early diagnosis of side effects by regular examination of patients is necessary for effective patient management. Clinicians should be made more aware of the side effects that can develop with the use of neuroleptic drugs and the effect these side effects have on patients.