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Several risk factors for drug-induced parkinsonism has emerged for patients with schizophrenia, including age and cognition status.¹

A team, led by Jiajun Weng, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, explored the risk factors, clinical correlates, and social functions of drug-induced parkinsonism in patients with schizophrenia in China.

Side Effects

Currently, the most prevalent neurological side effect of antipsychotics in the Chinese population is drug-induced parkinsonism. Hoi

However, early prevention, recognition, and treatment are crucial to the improvement of outcomes and medication adherence for patients with schizophrenia.

And this is largely unable to be done because the risk factors of drug-induced parkinsonism and the impact on the clinical syndromes of schizophrenia are largely understudied and unknown.

Analyzing the Data

In the cross-sectional analysis of a multicenter, observational, real-world, prospective cohort, the investigators examined 969 patients with a baseline assessment between 2012-2018 from 4 mental health centers in Shanghai.

The team compared sociodemographic data, drug treatment, and clinical variables between the drug-induced parkinsonism and non-drug-induced parkinsonism group and analyzed first generation antipsychotics (FGA)/second generation antipsychotics (SGA) model and high and low/medium D2 receptor antipsychotics to control the bias of co-linearity.

Finally, they analyzed the Positive and Negative Syndrome Scale (PANSS) model and the personal and social performance (PSP) model separately to control for co-linearity bias.

Risk Factors

In the results, the investigators identified several risk factors for drug-induced parkinsonism, including age (odds ratio [OR], 1.03; P <0.001), high D2 receptor antagonist antipsychotic dose (OR, 1.08, P = 0.032), and valproate dose (OR, 1.01; P = 0.001).

Various psychiatric symptoms, including more severe negative symptoms (OR, 1.09; P <0.001), lower cognition status (OR, 1.08; P = 0.033), and lower excited symptoms (OR, 0.91; P = 0.002) were significantly linked to drug-induced parkinsonism induction and valproate dose was significantly associated with social dysfunction (OR, 1.01; P = 0.001) and psychiatric symptoms (OR, 1.01; P = 0.004) of patients with drug-induced parkinsonism.

Most of all, age could be a factor that affects both the induction of drug-induced parkinsonism and the severity of psychiatric symptoms (OR, 1.02; P <0.001) and social functions (OR, 1.02; P <0.001).

On the other hand, first generation antipsychotics dose was not associated with drug-induced parkinsonism.

“Age, high D2 receptor antagonist antipsychotic dose, and valproate dose are risk factors for DIP, and DIP is significantly correlated with psychiatric symptoms and social performance of Chinese schizophrenia patients. The rational application or discontinuation of valproate is necessary,” the authors wrote. “Old age is related to psychotic symptoms and social adaption in Chinese schizophrenic patients, and early intervention and treatment of DIP can improve the prognosis and social performance of schizophrenia patients.”

References:

Weng J, Zhang L, Yu W, Zhao N, Zhu B, Ye C, Zhang Z, Ma C, Li Y, Yu Y, Li H. Risk factors, clinical correlates, and social functions of Chinese schizophrenia patients with drug-induced parkinsonism: A cross-sectional analysis of a multicenter, observational, real-world, prospective cohort study. Front Pharmacol. 2023 Mar 3;14:1077607. doi: 10.3389/fphar.2023.1077607. PMID: 36937864; PMCID: PMC10020528.