Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review.
BACKGROUND
Spontaneous movement disorders (SMDs), such as spontaneous dyskinesia and parkinsonism, have been described in patients with schizophrenia who have never been treated with antipsychotic medication. Their presence has been documented extensively in chronic schizophrenia but not at the time of illness onset.


METHODS
We performed a systematic review of studies investigating spontaneous abnormal movements elicited on clinical examination in antipsychotic-naive patients with first-episode psychosis.


RESULTS
We identified a total of 13 studies. Findings suggest a spontaneous dyskinesia median rate of 9% and a spontaneous parkinsonism median rate of 17%. Information on akathisia and dystonia was limited. The presence of SMDs may be associated with negative symptoms and cognitive dysfunction.


CONCLUSIONS
These findings support the notion that spontaneous abnormal movements are part of a neurodysfunction intrinsic to the pathogenesis of schizophrenia. Future studies should further investigate the role of basal ganglia and extrapyramidal pathways in the pathophysiology of psychosis, with particular attention to treatment implications.
Pappa
S
S
Institute of Psychiatry, Division of Psychological Medicine, King's College London, UK. sofia.pappa@iop.kcl.ac.uk
Dazzan
P
P
D017109:Akathisia, Drug-Induced / Q000175:diagnosis* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis* / Q000453:epidemiology; D020820:Dyskinesias / Q000175:diagnosis* / Q000453:epidemiology; D004421:Dystonia / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D009460:Neurologic Examination / Q000187:drug effects; D020734:Parkinsonian Disorders / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000453:epidemiology; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
D014150:Antipsychotic Agents