Skip to main content Accessibility help
×
×
Home

Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review

  • S. Pappa (a1) and P. Dazzan (a1)
Abstract
Background

Spontaneous movement disorders (SMDs), such as spontaneous dyskinesia and parkinsonism, have been described in patients with schizophrenia who have never been treated with antipsychotic medication. Their presence has been documented extensively in chronic schizophrenia but not at the time of illness onset.

Method

We performed a systematic review of studies investigating spontaneous abnormal movements elicited on clinical examination in antipsychotic-naive patients with first-episode psychosis.

Results

We identified a total of 13 studies. Findings suggest a spontaneous dyskinesia median rate of 9% and a spontaneous parkinsonism median rate of 17%. Information on akathisia and dystonia was limited. The presence of SMDs may be associated with negative symptoms and cognitive dysfunction.

Conclusions

These findings support the notion that spontaneous abnormal movements are part of a neurodysfunction intrinsic to the pathogenesis of schizophrenia. Future studies should further investigate the role of basal ganglia and extrapyramidal pathways in the pathophysiology of psychosis, with particular attention to treatment implications.

Copyright
Corresponding author
*Address for correspondence: S. Pappa, M.D., Ph.D., Consultant Psychiatrist and Honorary Research Associate, Department of Psychiatry, PO 63, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: sofia.pappa@iop.kcl.ac.uk)
References
Hide All
Andreasen, NC, Nopoulos, P, O'Leary, DS, Miller, DD, Wassink, T, Flaum, M (1999). Defining the phenotype of schizophrenia: cognitive dysmetria and its neural mechanisms. Biological Psychiatry 46, 908920.
Andreasen, NC, Paradiso, S, O'Leary, DS (1998). ‘Cognitive dysmetria’ as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? Schizophrenia Bulletin 24, 203218.
Baldessarini, RJ (1988). A summary of current knowledge of tardive dyskinesia. Encephale 14, 263268.
Barnes, TR (1989). A rating scale for drug-induced akathisia. British Journal of Psychiatry 154, 672676.
Blowers, AJ, Borison, RL, Blowers, CM, Bicknell, DJ (1981). Abnormal involuntary movements in the elderly. British Journal of Psychiatry 139, 363364.
Bocti, C, Black, DN, Waddington, JL (2003). Dyskinesia in patients with schizophrenia never treated with antipsychotics: conceptual and pathophysiological implications. In Mental and Behavioral Dysfunction in Movement Disorders (ed. Bédard, M. A., Agid, Y., Chouinard, S., Fahn, S., Korczyn, A. and Lesperance, P.), pp. 489498. Humana Press: Totowa.
Bourgeois, M, Boueilh, P, Tignol, J (1980 a). Spontaneous dyskinesia in the elderly and tardive dyskinesia of neuroleptics. A survey among 270 patients. Encephale 6, 3739.
Bourgeois, M, Bouilh, P, Tignol, J, Yesavage, J (1980 b). Spontaneous dyskinesias vs neuroleptic-induced dyskinesias in 270 elderly subjects. Journal of Nervous and Mental Disease 168, 177178.
Brown, KW, White, T (1992). The influence of topography on the cognitive and psychopathological effects of tardive dyskinesia. American Journal of Psychiatry 149, 13851389.
Caligiuri, MP, Bracha, HS, Lohr, JB (1989). Asymmetry of neuroleptic-induced rigidity: development of quantitative methods and clinical correlates. Psychiatry Research 30, 275284.
Caligiuri, MP, Lohr, JB (1997). Instrumental motor predictors of neuroleptic-induced parkinsonism in newly medicated schizophrenia patients. Journal of Neuropsychiatry and Clinical Neurosciences 9, 562567.
Caligiuri, MP, Lohr, JB, Jeste, DV (1993). Parkinsonism in neuroleptic-naive schizophrenic patients. American Journal of Psychiatry 150, 13431348.
Casey, DE (1985). Spontaneous and tardive dyskinesias: clinical and laboratory studies. Journal of Clinical Psychiatry 46, 4247.
Chakos, MH, Alvir, JM, Woerner, MG, Koreen, A, Geisler, S, Mayerhoff, D, Sobel, S, Kane, JM, Borenstein, M, Lieberman, JA (1996). Incidence and correlates of tardive dyskinesia in first episode of schizophrenia. Archives of General Psychiatry 53, 313319.
Chakos, MH, Mayerhoff, DI, Loebel, AD, Alvir, JM, Lieberman, JA (1992). Incidence and correlates of acute extrapyramidal symptoms in first episode of schizophrenia. Psychopharmacology Bulletin 28, 8186.
Chatterjee, A, Chakos, M, Koreen, A, Geisler, S, Sheitman, B, Woerner, M, Kane, JM, Alvir, J, Lieberman, JA (1995). Prevalence and clinical correlates of extrapyramidal signs and spontaneous dyskinesia in never-medicated schizophrenic patients. American Journal of Psychiatry 152, 17241729.
Chong, SA, Subramaniam, M, Verma, S (2005). Spontaneous parkinsonism in antipsychotic-naive patients with first-episode psychosis. Canadian Journal of Psychiatry 50, 429431.
Chorfi, M, Moussaoui, D (1985). Never treated schizophrenic patients have no abnormal movements such as tardive dyskinesia. Encephale 11, 263265.
Chouinard, G, Ross-Chouinard, A, Annable, L, Jones, BD (1980). The Extrapyramidal Symptom Rating Scale. Canadian Journal of Neurological Sciences 7, 233.
Correll, CU, Leucht, S, Kane, JM (2004). Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. American Journal of Psychiatry 161, 414425.
Cortese, L, Caligiuri, MP, Malla, AK, Manchanda, R, Takhar, J, Haricharan, R (2005). Relationship of neuromotor disturbances to psychosis symptoms in first-episode neuroleptic-naive schizophrenia patients. Schizophrenia Research 75, 6575.
Crane, GE (1978). Parkinsonism and tardive dyskinesia. American Journal of Psychiatry 135, 619620.
Crow, TJ (1985). The two-syndrome concept: origins and current status. Schizophrenia Bulletin 11, 471486.
Crow, TJ, Cross, AJ, Johnstone, EC, Owen, F, Owens, DG, Waddington, JL (1982). Abnormal involuntary movements in schizophrenia: are they related to the disease process or its treatment? Are they associated with changes in dopamine receptors? Journal of Clinical Psychopharmacology 2, 336340.
Csernansky, JG, Murphy, GM, Faustman, WO (1991). Limbic/mesolimbic connections and the pathogenesis of schizophrenia. Biological Psychiatry 30, 383400.
Dazzan, P, Morgan, KD, Chitnis, X, Suckling, J, Morgan, C, Fearon, P, McGuire, PK, Jones, PB, Leff, J, Murray, RM (2006). The structural brain correlates of neurological soft signs in healthy individuals. Cerebral Cortex 16, 12251231.
Dazzan, P, Morgan, KD, Orr, KG, Hutchinson, G, Chitnis, X, Suckling, J, Fearon, P, Salvo, J, McGuire, PK, Mallett, RM, Jones, PB, Leff, J, Murray, RM (2004). The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study. Brain 127, 143153.
Draganski, B, Kherif, F, Klöppel, S, Cook, PA, Alexander, DC, Parker, GJ, Deichmann, R, Ashburner, J, Frackowiak, RS (2008). Evidence for segregated and integrative connectivity patterns in the human basal ganglia. Journal of Neuroscience 28, 71437152.
Eastham, JH, Lacro, HP, Jeste, DV (1996). Ethnicity and movement disorders. Mount Sinai Journal of Medicine 63, 314319.
Emsley, R, Turner, HJ, Oosthuizen, PP, Carr, J (2005). Neurological abnormalities in first-episode schizophrenia: temporal stability and clinical and outcome correlates. Schizophrenia Research 75, 3544.
Fenn, DS, Moussaoui, D, Hoffman, WF, Kadri, N, Bentounssi, B, Tilane, A, Khomeis, M, Casey, DE (1996). Movements in never-medicated schizophrenics: a preliminary study. Psychopharmacology 123, 206210.
Fenton, WS (2000). Prevalence of spontaneous dyskinesia in schizophrenia. Journal of Clinical Psychiatry 61 (Suppl. 4), 1014.
Fenton, WS, Wyatt, RJ, McGlashan, TH (1994). Risk factors for spontaneous dyskinesia in schizophrenia. Archives of General Psychiatry 51, 643650.
Friedman, JH (2004). Historical perspective on movement disorders. Journal of Clinical Psychiatry 65 (Suppl. 9), 38.
Gerlach, J, Casey, DE (1988). Tardive dyskinesia. Acta Psychiatrica Scandinavica 77, 369378.
Gerlach, J, Korsgaard, S, Clemmesen, P, Lauersen, AM, Magelund, G, Noring, U, Povlsen, UJ, Bech, P, Casey, DE (1993). The St. Hans Rating Scale for extrapyramidal syndromes: reliability and validity. Acta Psychiatrica Scandinavica 87, 244–52.
Gervin, M, Browne, S, Lane, A, Clarke, M, Waddington, JL, Larkin, C, O'Callaghan, E (1998). Spontaneous abnormal involuntary movements in first-episode schizophrenia and schizophreniform disorder: baseline rate in a group of patients from an Irish catchment area. American Journal of Psychiatry 155, 12021206.
Graybiel, AM (1997). The basal ganglia and cognitive pattern generators. Schizophrenia Bulletin 23, 459469.
Green, AI, Lieberman, JA, Hamer, RM, Glick, ID, Gur, RE, Kahn, RS, McEvoy, JP, Perkins, DO, Rothschild, AJ, Sharma, T, Tohen, MF, Woolson, S, Zipursky, RB; the HGDH Study Group (2006). Olanzapine and haloperidol in first episode psychosis: two-year data. Schizophrenia Research 86, 234243.
Gur, RE, Gur, RC, Skolnick, BE, Caroff, S, Obrist, WD, Resnick, S, Reivich, M (1985). Brain function in psychiatric disorders. III. Regional cerebral blood flow in unmedicated schizophrenics. Archives of General Psychiatry 42, 329334.
Günther, W, Petsch, R, Steinberg, R, Moser, E, Streck, P, Heller, H, Kurtz, G, Hippius, H (1991). Brain dysfunction during motor activation and corpus callosum alterations in schizophrenia measured by cerebral blood flow and magnetic resonance imaging. Biological Psychiatry 29, 535555.
Hernan Silva, I, Jerez, CS, Ruiz, TA, Seguel, LM, Court, LJ, Labarca, BR (1994). Lack of involuntary abnormal movements in untreated schizophrenic patients. Actas Luso Espanolas de Neurologia, Psiquiatria y Ciencias Afines 22, 200202.
Hoffman, W, Kadri, N, Fenn, D, Tilane, A, Green, C, Lakloumi, M, Bousaid, F, Bentounssi, B, Moussaoui, D, Casey, D (1996). Choreo-athetoid movements occur spontaneously in never-medicated patients with schizophrenia. European Neuropharmacology 6, (Suppl. 3), 223.
Honer, WG, Kopala, LC, Rabinowitz, J (2005). Extrapyramidal symptoms and signs in first-episode, antipsychotic exposed and non-exposed patients with schizophrenia or related psychotic illness. Journal of Psychopharmacology 19, 277285.
Hunter, RH, Joy, CB, Kennedy, E, Gilbody, SM, Song, F (2003). Risperidone versus typical antipsychotic medication for schizophrenia. Cochrane Database of Systematic Reviews. Issue no. 2. Art. no. CD000440.
Jager, A (2000). Abnormal movements in first episode psychosis. Australian Psychiatry 8, 3841.
Kane, JM (2004). Tardive dyskinesia rates with atypical antipsychotics in adults: prevalence and incidence. Journal of Clinical Psychiatry 65 (Suppl. 9), 1620.
Kane, JM, Smith, JM (1982). Tardive dyskinesia: prevalence and risk factors, 1959 to 1979. Archives of General Psychiatry 39, 473481.
Kane, JM, Weinhold, P, Kinon, B, Wegner, J, Leader, M (1982). Prevalence of abnormal involuntary movements (‘spontaneous dyskinesias’) in the normal elderly. Psychopharmacology 77, 105108.
Kane, JM, Woerner, M, Lieberman, J (1988). Epidemiological aspects of tardive dyskinesia. Encephale 14, 191194.
Keshavan, MS, Rosenberg, D, Sweeney, JA, Pettegrew, JW (1998). Decreased caudate volume in neuroleptic-naive psychotic patients. American Journal of Psychiatry 155, 774778.
Keshavan, MS, Sanders, RD, Sweeney, JA, Diwadkar, VA, Goldstein, G, Pettegrew, JW, Schooler, NR (2003). Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. American Journal of Psychiatry 160, 12981304.
Klawans, HL, Barr, A (1982). Prevalence of spontaneous lingual-facial-buccal dyskinesias in the elderly. Neurology 32, 558559.
Kopala, LC, Good, KP, Honer, WG (1997). Extrapyramidal signs and clinical symptoms in first-episode schizophrenia: response to low-dose risperidone. Journal of Clinical Psychopharmacology 17, 308313.
Kopala, LC, Good, KP, Milliken, H, Buiteman, C, Woodley, H, Rui, Q, Whitehorn, D, Love, L, Balshaw, R, Kiss, I, Honer, WG (2006). Treatment of a first episode of psychotic illness with quetiapine: an analysis of 2 year outcomes. Schizophrenia Research 81, 2939.
Kraepelin, E (1919). Dementia Praecox. Livingstone: Edinburgh.
Lawrie, SM, Byrne, M, Miller, P, Hodges, A, Clafferty, RA, Cunningham Owens, DG, Johnstone, EC (2001). Neurodevelopmental indices and the development of psychotic symptoms in subjects at high risk of schizophrenia. British Journal of Psychiatry 178, 524530.
Liddle, PF, Lane, CJ, Ngan, ET (2000). Immediate effects of risperidone on cortico-striato-thalamic loops and the hippocampus. British Journal of Psychiatry, 177, 402407.
McCreadie, RG, Latha, S, Thara, R, Padmavathi, R, Ayankaran, JR (1997). Poor memory, negative symptoms and abnormal movements in never-treated Indian patients with schizophrenia. British Journal of Psychiatry 171, 360363.
McCreadie, RG, Ohaeri, JU (1994). Movement disorder in never and minimally treated Nigerian schizophrenic patients. British Journal of Psychiatry 164, 184189.
McCreadie, RG, Srinivasan, TN, Padmavati, R, Thara, R (2005). Extrapyramidal symptoms in unmedicated schizophrenia. Journal of Psychiatric Research 39, 261266.
McCreadie, RG, Thara, R, Kamath, S, Padmavathy, R, Latha, S, Mathrubootham, N, Menon, MS (1996). Abnormal movements in never-medicated Indian patients with schizophrenia. British Journal of Psychiatry 168, 221226.
Mehler-Wex, C, Riederer, P, Gerlach, M (2006). Dopaminergic dysbalance in distinct basal ganglia neurocircuits: implications for the pathophysiology of Parkinson's disease, schizophrenia and attention deficit hyperactivity disorder. Neurotoxicity Research 10, 167179.
Menon, V, Anagnoson, RT, Glover, GH, Pfefferbaum, A (2001). Functional magnetic resonance imaging evidence for disrupted basal ganglia function in schizophrenia. American Journal of Psychiatry 158, 646649.
Montastruc, JL, Llau, ME, Rascol, O, Senard, JM (1994). Drug-induced parkinsonism: a review. Fundamental and Clinical Pharmacology 8, 293306.
Müller, JL, Deuticke, C, Putzhammer, A, Röder, CH, Hajak, G, Winkler, J (2003). Schizophrenia and Parkinson's disease lead to equal motor-related changes in cortical and subcortical brain activation: an fMRI fingertapping study. Psychiatry and Clinical Neurosciences 57, 562568.
Owens, DG (1999). A Guide to the Extrapyramidal Side-effects of Antipsychotic Drugs. Cambridge University Press: Cambridge.
Owens, DG, Johnstone, EC, Frith, CD (1982). Spontaneous involuntary disorders of movement: their prevalence, severity, and distribution in chronic schizophrenics with and without treatment with neuroleptics. Archives of General Psychiatry 39, 452461.
Peralta, V, Cuesta, MJ (1999). Negative parkinsonian, depressive and catatonic symptoms in schizophrenia: a conflict of paradigms revisited. Schizophrenia Research 40, 245253.
Peralta, V, Cuesta, MJ, Martinez-Larrea, A, Serrano, JF (2000). Differentiating primary from secondary negative symptoms in schizophrenia: a study of neuroleptic-naive patients before and after treatment. American Journal of Psychiatry 157, 14611466.
Puri, BK, Barnes, TR, Chapman, MJ, Hutton, SB, Joyce, EM (1999). Spontaneous dyskinesia in first episode schizophrenia. Journal of Neurology, Neurosurgery and Psychiatry 66, 7678.
Rogers, D (1985). The motor disorders of severe psychiatric illness: a conflict of paradigms. British Journal of Psychiatry 147, 221232.
Sandyk, R, Kay, SR (1991 a). Drug-induced parkinsonism: relationship to age at onset of schizophrenia. Functional Neurology 6, 151157.
Sandyk, R, Kay, SR (1991 b). The relationship of tardive dyskinesia to positive schizophrenia. International Journal of Neuroscience 56, 107139.
Sandyk, R, Kay, SR (1992). ‘Positive’ and ‘negative’ movement disorders in schizophrenia. International Journal of Neuroscience 66, 143151.
Schooler, NR, Kane, JM (1982). Research diagnoses for tardive dyskinesia. Archives of General Psychiatry 39, 486487.
Schooler, N, Rabinowitz, J, Davidson, M, Emsley, R, Harvey, PD, Kopala, L, McGorry, PD, Van Hove, I, Eerdekens, M, Swyzen, W, De Smedt, G; Early Psychosis global Working Group (2006). Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. Schizophrenia Research 162, 947953.
Schröder, J, Niethammer, R, Geider, FJ, Reitz, C, Binkert, M, Jauss, M, Sauer, H (1991). Neurological soft signs in schizophrenia. Schizophrenia Research 6, 2530.
Simpson, GM, Angus, JW (1970). A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica (Suppl.) 212, S11S19.
Simpson, GM, Lee, JH, Zoubok, B, Gardos, G (1979). A rating scale for tardive dyskinesia. Psychopharmacology 64, 171179.
Srinivasan, TN, Thara, R, Padmavathi, R, McCreadie, RG (2001). Relationship of extrapyramidal symptoms to age at onset and drug treatment in middle-aged and elderly schizophrenic patients. Schizophrenia Research 47, 6975.
Stahl, SM (2000). Essential Psychopharmacology, 2nd edn. Cambridge University Press: New York.
Tenback, DE, Van Harten, PN, Slooff, CJ, Van Os, J (2006). Evidence that early extrapyramidal symptoms predict later tardive dyskinesia: a prospective analysis of 10,000 patients in the European Schizophrenia Outpatient Health Outcomes (SOHO) study. American Journal of Psychiatry 163, 14381440.
Tomer, R, Mintz, M, Kempler, S, Sigal, M (1987). Lateralized neuroleptic-induced side effects are associated with asymmetric visual evoked potentials. Psychiatry Research 22, 311318.
Torrey, EF (2002). Studies of individuals with schizophrenia never treated with antipsychotic medications: a review. Schizophrenia Research 58, 101115.
Turner, T (1989). Rich and mad in Victorian England. Psychological Medicine 19, 2944.
Utter, A, Basso, M (2008). The basal ganglia: an overview of circuits and function. Neuroscience and Biobehavioral Reviews 32, 333342.
Venkatasubramanian, G, Latha, V, Gangadhar, BN, Janakiramaiah, N, Subbakrishna, DK, Jayakumar, PN, Keshavan, MS (2003). Neurological soft signs in never-treated schizophrenia. Acta Psychiatrica Scandinavica 108, 144146.
Waddington, JL, O'Callaghan, E, Larkin, C, Kinsella, A (1993). Cognitive dysfunction in schizophrenia: organic vulnerability factor or state marker for tardive dyskinesia? Brain and Cognition 23, 5670.
Waddington, JL, Youssef, HA (1985). Late onset involuntary movements in chronic schizophrenia: age-related vulnerability to ‘tardive’ dyskinesia independent of extent of neuroleptic medication. Irish Medical Journal 78, 143146.
Waddington, JL, Youssef, HA (1990). The lifetime outcome and involuntary movements of schizophrenia never treated with neuroleptic drugs. Four rare cases in Ireland. British Journal of Psychiatry 156, 106108.
Waddington, JL, Youssef, HA, Dolphin, C, Kinsella, A (1987). Cognitive dysfunction, negative symptoms, and tardive dyskinesia in schizophrenia. Their association in relation to topography of involuntary movements and criterion of their abnormality. Archives of General Psychiatry 44, 907912.
White, T, Brown, KW, Woods, JP (1991). Tardive dyskinesia and positive symptoms of schizophrenia. Acta Psychiatrica Scandinavica 83, 377379.
Whitehorn, D, Kopala, LC (2002). Neuromotor dysfunction in early psychosis. Annals of Clinical Psychiatry 14, 113121.
Yarden, PE, DiScipio, WJ (1971). Abnormal movements and prognosis in schizophrenia. American Journal of Psychiatry 128, 327–323.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed