title: Factors associated with expression of extrapyramidal symptoms in users of atypical antipsychotics.
abstract: OBJECTIVE
  The aim of this study was to investigate factors associated with the occurrence of extrapyramidal symptoms (EPS) in users of second-generation antipsychotics (SGA).
  
  
  METHODS
  Observational cross-sectional study based on a random sample of subjects from three outpatient clinics. Inclusion criteria were age between 18 and 65 years, of both genders, with a diagnosis of schizophrenia and under the use of a single SGA agent. Subjects who had received i.m. long-acting antipsychotics in the past were excluded. The families of eligible patients were contacted by phone and, if willing to participate in the study, a household visit was scheduled. Informed consent was obtained from all study subjects and their next of kin. The risk of EPS associated with sociodemographic, clinical features and medications used was analyzed by logistic regression.
  
  
  RESULTS
  The study population consisted of 213 subjects. EPS were observed in 38.0% of subjects. The more commonly used SGA were olanzapine (76, 35.7%), risperidone (74, 34.3%), quetiapine (26, 12.2%), and ziprasidone (23, 10.8%). Among the drugs used as adjunctive therapy for schizophrenia, benzodiazepines were the most prevalent (31.5%), followed by carbamazepine (24.4%) and antidepressants (20.2%). Multivariate analysis showed that the risk of EPS was associated with the use of carbamazepine (odds ratio 3.677, 95% CI 1.627-8.310). We found no evidence that the type of SGA modified the risk of EPS.
  
  
  CONCLUSIONS
  The occurrence of EPS in SGA users is a common finding, with no difference of antipsychotics studied in relation to the risk of extrapyramidal manifestations. The adjunctive use of carbamazepine may predispose the user of SGA to the occurrence of EPS.
authors.affiliation: Postgraduate Program in Pharmaceutical Science, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
authors.forename: Susana Barbosa
authors.initials: SB
authors.lastname: Ribeiro
authors.affiliation: Department of Biophysics and Pharmacology, Universidade Federal do Rio Grande Norte, Natal, RN, Brazil.
authors.forename: Aurigena Antunes
authors.initials: AA
authors.lastname: de Araújo
authors.affiliation: Postgraduate Programs in Biological Science/Postgraduate Programs RENORBIO, Universidade Federal do Rio Grande Norte, Natal, RN, Brazil.
authors.forename: Caroline Addison Xavier
authors.initials: CA
authors.lastname: Medeiros
authors.affiliation: Postgraduate Program in Public Health, Universidade Federal do Rio Grande Norte, Natal, RN, Brazil.
authors.forename: Katarina Melo
authors.initials: KM
authors.lastname: Chaves
authors.affiliation: Postgraduate Program in Public Health, Universidade Federal do Rio Grande Norte, Natal, RN, Brazil.
authors.forename: Maria do Socorro Costa Feitosa
authors.initials: MD
authors.lastname: Alves
authors.affiliation: Pharmacy Department, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil.
authors.forename: Antonio Gouveia
authors.initials: AG
authors.lastname: Oliveira
authors.affiliation: Pharmacy Department, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil. randrandall@gmail.com.
authors.forename: Rand Randall
authors.initials: RR
authors.lastname: Martins
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005116:Extrapyramidal Tracts / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy*
chemical_list: D014150:Antipsychotic Agents
keywords: Adjunctive therapy; Extrapyramidal symptoms; Schizophrenia; Second-generation antipsychotics