The effect of antipsychotic medication on neuromotor abnormalities in neuroleptic-naive nonaffective psychotic patients: a naturalistic study with haloperidol, risperidone, or olanzapine

Abstract

Objective: To examine the effect of antipsychotic medication on neuromotor abnormalities in a sample of psychotic patients never exposed to antipsychotic drugs.

Method: One hundred psychotic patients were assessed (from January 1998 to December 2002) using DSM-IV criteria for parkinsonism, dyskinesia, akathisia, catatonia, and dystonia at baseline and after 4 weeks of treatment with haloperidol (n = 23), risperidone (n = 52), or olanzapine (n = 25). We examined change scores in neuromotor ratings over the treatment period across treatment groups and rates of drug-responsive and drug-emergent neuromotor syndromes in patients with and without preexisting neuromotor abnormalities.

Results: Overall time effects revealed a worsening of parkinsonism (P = .002) and akathisia (P = .002) ratings and an improvement of dyskinesia (P = .001) and catatonia (P < .001) ratings. Main treatment effects revealed that patients taking haloperidol had a significant mean increase in akathisia scores compared with those of patients taking risperidone (P = .002) or olanzapine (P < .001). A significantly greater percentage of olanzapine-treated patients experienced remission of preexisting parkinsonism than did the other treatment groups (P = .047). Patients without preexisting motor abnormalities were more likely to experience drug-emergent parkinsonism if they were treated with haloperidol or risperidone than with olanzapine (P = .001) and were more likely to experience drug-emergent dystonia (P = .014) and akathisia (P = .013) if they were treated with haloperidol than with risperidone or olanzapine.

Conclusions: The relationship between antipsychotic medication and neurologic abnormalities is more complex than previously acknowledged since antipsychotic drugs may both improve preexisting abnormalities and cause "de novo" neurologic syndromes. Overall, olanzapine has a more favorable neuromotor profile than risperidone, which in turn has a more favorable profile than haloperidol.

Figure 1

Change in Neuromotor Scores After 4 Weeks of Treatment With Haloperidol, Risperidone, or Olanzapine^{a a}For each motor domain, scores were evaluated among treatment groups using an analysis of covariance model that included baseline score as a covariate.

Figure 1

Change in Neuromotor Scores After 4 Weeks of Treatment With Haloperidol, Risperidone, or Olanzapine^{a a}For each motor domain, scores were evaluated among treatment groups using an analysis of covariance model that included baseline score as a covariate.

Figure 1

Change in Neuromotor Scores After 4 Weeks of Treatment With Haloperidol, Risperidone, or Olanzapine^{a a}For each motor domain, scores were evaluated among treatment groups using an analysis of covariance model that included baseline score as a covariate.

Figure 1

Change in Neuromotor Scores After 4 Weeks of Treatment With Haloperidol, Risperidone, or Olanzapine^{a a}For each motor domain, scores were evaluated among treatment groups using an analysis of covariance model that included baseline score as a covariate.

Figure 2

Number of Patients With Neuromotor Abnormalities at Baseline and Over 4 Weeks of Antipsychotic Treatment in 100 Psychotic Patients ^aRate change significant at P < .001. ^bRate change significant at P = .02. ^cRate change significant at P = .002. ^dRate change significant at P = .004.

Figure 3

Treatment Response Pattern of Neuromotor Abnormalities in 100 Psychotic Patients

Figure 4

Proportion of Patients in Each Treatment Group With Drug-Responsive Neuromotor Syndromes ^aP = .047; olanzapine vs haloperidol and risperidone. ^bP = .032; haloperidol vs olanzapine and risperidone.

Figure 5

Proportion of Patients in Each Treatment Group With Drug-Emergent Neuromotor Syndromes ^aP = .001; haloperidol and risperidone vs olanzapine. ^bP = .013; haloperidol vs risperidone and olanzapine. ^cP = .014; haloperidol vs risperidone and olanzapine.