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Front. Psychiatry | doi: 10.3389/fpsyt.2018.00172

Neurological soft signs, spontaneous and treatment-emergent extrapyramidal syndromes in Black Africans with first episode schizophrenia

 Akin Ojagbemi1* and Toyin Bello1
  • 1University of Ibadan, Nigeria

Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia.
Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia.
Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate. Pearson’s correlations and Linear regression models, controlling for duration of untreated psychosis (D.U.P) and premorbid adjustments, were used in examining associations.
Results: Among 99 participants in the baseline sample, 91 (91.8%) and 20 (20.2%) had at least one definite NSS and EPS, respectively, before exposure to antipsychotics. Treatment-induced EPS were recorded in 34 (38.6%). Spontaneous EPS was associated with treatment-emergent Akathisia in participants with a longer D.U.P (r=0.75, β=0.70, p=0.008). This association was specific for Parkinsonism (r=0.75, β=0.85, p=0.008) and dyskinesia (r=0.75, β=1.70, p=0.008).
Conclusion: Similar to previous findings for tardive dyskinesia in studies implementing longer-term follow-up, spontaneous EPS may also predict short-term antipsychotic-induced EPS such as akathisia. These results may be important for early identification of patients at risk of treatment-induced Akathisia-linked psychomotor agitation in first episode schizophrenia.

Keywords: neurological examination;, Side effects; Neurodevelopmental defects;, locomotor control;, tardive dyskinesia ;, African ancestry ;

Received: 18 Oct 2017; Accepted: 16 Apr 2018.

Edited by:

Johannes Schröder, Section Geriatric Psychiatry Univ. of Heidelberg

Reviewed by:

Karl Bechter, Universität Ulm, Germany
Anna Comparelli, Sapienza Università di Roma, Italy  

Copyright: © 2018 Ojagbemi and Bello. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Akin Ojagbemi, University of Ibadan, Ibadan, Nigeria,