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. 2024 Aug;21(8):822-831.
doi: 10.30773/pi.2023.0417. Epub 2024 Aug 8.

Exploring the Relationships Between Antipsychotic Dosage and Voice Characteristics in Relation to Extrapyramidal Symptoms

Hyeyoon Kim  1 , Seoyoung Kim  2 , Subin Lee  3 , Kyogu Lee  3 , Euitae Kim  1   2   4
Affiliations

Exploring the Relationships Between Antipsychotic Dosage and Voice Characteristics in Relation to Extrapyramidal Symptoms

Hyeyoon Kim et al. Psychiatry Investig. 2024 Aug.

Abstract

Objective: Extrapyramidal symptoms (EPS) are common side effects of antipsychotic drugs. Despite the growing interest in exploring objective biomarkers for EPS prevention and the potential use of voice in detecting clinical disorders, no studies have demonstrated the relationships between vocal changes and EPS. Therefore, we aimed to determine the associations between voice changes and antipsychotic dosage, and further investigated whether speech characteristics could be used as predictors of EPS.

Methods: Forty-two patients receiving or expected to receive antipsychotic drugs were recruited. Drug-induced parkinsonism of EPS was evaluated using the Simpson-Angus Scale (SAS). Participants' voice data consisted of 16 neutral sentences and 2 second-long /Ah/utterances. Thirteen voice features were extracted from the obtained voice data. Each voice feature was compared between groups categorized based on SAS total score of below and above "0.6." The associations between antipsychotic dosage and voice characteristics were examined, and vocal trait variations according to the presence of EPS were explored.

Results: Significant associations were observed between specific vocal characteristics and antipsychotic dosage across both datasets of 1-16 sentences and /Ah/utterances. Notably, Mel-Frequency Cepstral Coefficients (MFCC) exhibited noteworthy variations in response to the presence of EPS. Specifically, among the 13 MFCC coefficients, MFCC1 (t=-4.47, p<0.001), MFCC8 (t=-4.49, p<0.001), and MFCC12 (t=-2.21, p=0.029) showed significant group differences in the overall statistical values.

Conclusion: Our results suggest that MFCC may serve as a predictor of detecting drug-induced parkinsonism of EPS. Further research should address potential confounding factors impacting the relationship between MFCC and antipsychotic dosage, possibly improving EPS detection and reducing antipsychotic medication side effects.

Keywords: Antipsychotics; Diagnosis; Drug side effects; Parkinsonism.

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Conflict of interest statement

Conflicts of Interest

Euitae Kim, a contributing editor of the Psychiatry Investigation, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
Diagram illustrating the overall study design. TVF, Target Voice Features; EPS, extrapyramidal symptoms.
Figure 2.
Figure 2.
Among the mean values of MFCC coefficient that showed significant associations between total olanzapine equivalent dose and Target Voice Features, features showing significant differences according to the presence or absence of EPS. A: Association with total olanzapine equivalent dose (left) and difference based on presence of EPS (right) of MFCC1. B: Association with total olanzapine equivalent dose (left) and difference based on presence of EPS (right) of MFCC8. C: Association with total olanzapine equivalent dose (left) and difference based on presence of EPS (right) of MFCC12. MFCC, Mel-Frequency Cepstral Coefficients; EPS, extrapyramidal symptoms.
Figure 3.
Figure 3.
Statistical features other than the mean value of MFCC coefficients that showed a significant difference based on the presence and absence of EPSs regarding sentences 1 to 16. All the statistical features of MFCC1, MFCC3, MFCC7, MFCC8, MFCC9, MFCC11, MFCC12 were higher in patients with EPSs compared to patients without EPSs, whereas MFCC5 showed a lower tendency. MFCC, Mel-Frequency Cepstral Coefficients; EPS, extrapyramidal symptom.
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References

    1. Horacek J, Bubenikova-Valesova V, Kopecek M, Palenicek T, Dockery C, Mohr P, et al. Mechanism of action of atypical antipsychotic drugs and the neurobiology of schizophrenia. CNS Drugs. 2006;20:389–409. - PubMed
    1. Sykes DA, Moore H, Stott L, Holliday N, Javitch JA, Lane JR, et al. Extrapyramidal side effects of antipsychotics are linked to their association kinetics at dopamine D2 receptors. Nat Commun. 2017;8:763. - PMC - PubMed
    1. Blair DT, Dauner A. Extrapyramidal symptoms are serious side-effects of antipsychotic and other drugs. Nurse Pract. 1992;17:56, 62–64, 67. - PubMed
    1. D’Souza RS, Hooten WM. Extrapyramidal symptoms. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK534115. Accessed September, 10, 2023.
    1. Mathews M, Gratz S, Adetunji B, George V, Mathews M, Basil B. Antipsychotic-induced movement disorders: evaluation and treatment. Psychiatry (Edgmont) 2005;2:36–41. - PMC - PubMed

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