| Introduction |
The discovery of antipsychotic medications revolutionized the treatment of schizophrenia, and during the 1960s the notion that antipsychotic agents might alter the course of schizophrenia was enthusiastically greeted. However, this early optimism was tempered by persistently high rates of non-compliance with antipsychotic medication. To this day, non-compliance remains a major public health problem, with some surveys1 reporting that, within two years of discharge, 74% of antipsychotic-responsive schizophrenic outpatients fail to comply with their antipsychotic regimen.
It is now clear that antipsychotic-induced extrapyramidal side-effects (EPS) – namely dystonia, parkinsonism, akathisia and dyskinesia – can be major contributors to poor compliance. These distressing side-effects are seen in up to 90% of antipsychotic-treated patients. In addition to being a major cause of poor compliance, with clear implications for relapse and morbidity, EPS may counteract therapeutic efficacy and have major clinical consequences.
Despite the prevalence, importance, and consequences of EPS, many questions remain unanswered about their epidemiology, classification, differential diagnosis, pathophysiology, and how best to manage or avoid them.
In order to review current knowledge, a distinguished international panel under the chairmanship of Dr David Cunningham Owens, and sponsored by an educational grant from AstraZeneca, met recently in London to review the field and discuss extrapyramidal dysfunction in the context of antipsychotic medication.
The meeting was particularly timely, coinciding with an exciting era in the management of schizophrenia. New treatments currently entering clinical practice hold the promise of lower EPS-inducing potential across a broad dose range. By reducing the troublesome EPS of standard antipsychotics, such treatments should increase the patient’s ability and motivation to participate in treatment and rehabilitation and so improve his/her quality of life.