Extrapyramidal side effects in first-episode schizophrenia treated with flupenthixol decanoate.

Francois-Pierre Joubert,Laila Asmal,Bonginkosi Chiliza,Robin Emsley

doi:10.4102/sajpsychiatry.v27i0.1568

Abstract

BackgroundConcern for the development of extrapyramidal side effects (EPSEs) represents a barrier to the routine use of long-acting injectable (LAI) antipsychotic medication in patients with first-episode schizophrenia (FES). Flupenthixol decanoate is a first-generation antipsychotic, which is readily available in the public healthcare system in South Africa.AimThe aim of this study was to describe the nature, occurrence and severity of EPSEs and their impact on patients with FES over 12 months of treatment with flupenthixol decanoate (fluanxol depot).SettingThe study was based in Cape Town, South Africa, and patients with FES were recruited from inpatient services at Stikland and Tygerberg Hospitals and surrounding psychiatric clinics. This was a sub-study of a larger study, which examined several outcomes in patients with FES treated with the lowest effective dose of flupenthixol decanoate.MethodsThe Extrapyramidal Symptom Rating Scale (ESRS) was used to assess both subjective experience and objective measures of EPSEs in a cohort of patients with FES (N = 130). The relationship between demographic and clinical risk factors for individual subsets of EPSEs was also determined.ResultsIn the context of an overall good 12-month tolerability, EPSEs peaked at month 3. Patients with akathisia were more likely to have greater symptoms of depression, and Parkinsonism was predicted by higher Positive and Negative Syndrome Scale scores (independent of medication dosage). Black and white patients showed higher total ESRS and higher subjective ESRS scores, compared with patients of mixed ancestry, and white patients scored higher on Parkinsonism ratings.ConclusionFlupenthixol decanoate is well tolerated in patients with FES. Certain clinical features of schizophrenia may be related to EPSEs. Ethnicity is a socio-cultural construct, and hence the differential risk of EPSEs should be interpreted according to ethnicity. Variations in the environment, diet, substance use and genetics may all affect the pharmacokinetics and pharmacodynamics of psychotropic drugs and warrant further investigation.

Highlights

There is a growing interest in the use of long-acting injectable (LAI) antipsychotics in patients with first-episode schizophrenia (FES).[1,2] These offer the advantage of explicit adherence combined with effectiveness and low costs, in the case of first-generation antipsychotic (FGA) depots.[1,2] Flupenthixol decanoate is a first-generation LAI antipsychotic, which displays certain atypical qualities.[3]
Like other LAI antipsychotics, flupenthixol decanoate is highly effective in treatment, but remains underutilised clinically in part because of the familiar problem of extrapyramidal side effects (EPSEs),[5] which patients with FES are especially sensitive to.[6]
Given the concern that EPSEs might be a deterrent to the use of LAI antipsychotics in patients with FES, the aim of this study was to describe the nature, occurrence and severity of EPSEs and their impact on patients with FES over 12 months of treatment with flupenthixol decanoate

Summary

Introduction

There is a growing interest in the use of long-acting injectable (LAI) antipsychotics in patients with first-episode schizophrenia (FES).[1,2] These offer the advantage of explicit adherence combined with effectiveness and low costs, in the case of first-generation antipsychotic (FGA) depots.[1,2] Flupenthixol decanoate is a first-generation LAI antipsychotic, which displays certain atypical qualities.[3] It has a half-life of approximately 3 weeks, is highly protein bound (99%) and is mostly excreted by the liver.[4] Like other LAI antipsychotics, flupenthixol decanoate is highly effective in treatment, but remains underutilised clinically in part because of the familiar problem of extrapyramidal side effects (EPSEs),[5] which patients with FES are especially sensitive to.[6]. Concern for the development of extrapyramidal side effects (EPSEs) represents a barrier to the routine use of long-acting injectable (LAI) antipsychotic medication in patients with first-episode schizophrenia (FES). Flupenthixol decanoate is a first-generation antipsychotic, which is readily available in the public healthcare system in South Africa

Objectives

Results

Discussion

Conclusion