Author information Copyright and License information Disclaimer Dr. Corresponding author. Matrix Medical Communications. All rights reserved. This article has been cited by other articles in PMC. Abstract Objective: The aim of this study was to investigate the tolerability and efficacy of paliperidone palmitate and its effect on the levels of prolactin in patients with schizophrenia.
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Neurological manifestations Abstract Drug-induced Extrapyramidal Symptoms Scale DIEPSS is developed in the era of second-generation antipsychotics and is suitable for evaluation of the low incidence of extrapyramidal symptoms occurring in the treatment of atypical antipsychotics, as well as the relationship between personal and social functioning. Four raters performed the assessment simultaneously, individually rating one assigned item immediately after seeing the video clip.
For the purpose of evaluating test-retest reliability the second assessment of the same material was performed nine months after the first assessment. Inter-rater reliability was high for each individual item, with ICCs ranging from 0. The inter-rater reliability was highest for akathisia item and lowest for dyskinesia. The test-retest reliability was high for each individual item, with ICC ranging from 0.
The test-retest reliability was highest for bradykinesia item and lowest for dystonia. Download PDF Introduction Antipsychotics are used worldwide for the management of a number of mental illnesses. They are used to treat serious mental health conditions such as schizophrenia, bipolar disorders as well as other emotional and mental health conditions. In recent years, evidence from clinical trials has shown that antipsychotics are associated with significant adverse effects and that there is an urgent need for careful evaluation of their use 1 , 2 , 3.
The use of antipsychotics may cause various spectrum of movement disorders, as well as metabolic and cardiac side effects that can lead to early treatment discontinuation as well as poor quality of life 2. If these side effects are poorly controlled, they could dramatically increase the morbidity and the mortality 3.
Treatment monitoring, including effectiveness on the targeted symptoms, tolerance and observance, are major issues in the management of patients treated with antipsychotics. Movement disorders are classified as separate diagnostic category in a section II of the classification system of mental disorders Diagnostic and Statistical Manual of Mental Disorders 5th ed 4 as Medication-induced movement disorders and other adverse effect of medication.
However, in the ICD movement disorders are recognized under the section of extrapyramidal symptoms as neurological disorders 5. Drug-induced movement disorders DIMD have dramatically declined with use of SGA but remain important in clinical practice and for the understanding antipsychotic pharmacology 6. The presence of extrapyramidal symptoms has led to development of various rating scales for evaluation of iatrogenic-induced movement disorders 7.
Generally speaking, rating scales can be divided into those for use in clinical research and those for use in every day clinical practice. The DIEPSS is developed in the era of SGA and is suitable for evaluation of the low incidence of extrapyramidal symptoms occurring in the treatment of atypical antipsychotics 13 , Nowadays, it is widely used for evaluation of drug-induced extrapyramidal symptoms, as well as the relationship between personal and social functioning It consists of eight individual items and one global domain 12 , 14 , 16 , each rated on 5-point scale While some multi-domain scales could be difficult to score, the DIEPSS scale belongs to group with the most valid, reliable, and easy-to-use scales for use in clinical practice Moreover, this scale has good psychometric characteristics The use of first generation antipsychotics FGA has declined in the last few years, not because of the increase in prescriptions of second-generation agents SGA , but because of the side effects that FGA cause very frequently.
Despite of the discovery of the atypical antipsychotics and their favorable extrapyramidal symptom profile, many studies have shown that some patients are at still at high risk of extrapyramidal symptomatology Therefore, clinicians should be aware of the emergency of extrapyramidal symptoms all the time.
With all these factors in mind the DIEPPS scale was developed for screening extrapyramidal symptoms as practical and standardized rating scale in a simple and easy manner for administration. Serbian version of the DIEPSS was created through translation and back-translation from the original English version, with permission of the author. Material was used with kind permission of the author.
It consisted of video clips, recorded from till Total number of patients who appeared in the video clips was , 47 male and 59 female. Mean age was Subjects were diagnosed with schizophrenia 69 patients and mood disorders 37 patients. The ethics committee of Seiwa hospital, Institute of Neuropsychiatry, Tokyo, Japan, approved the experimental protocols used in the current study. Written informed consent was obtained from all participants or legal guardians.
Individual items are gait, bradykinesia, sialorrhea, rigidity, tremor, akathisia, dystonia and dyskinesia. Evaluation of individual items is principally based on objective observations. Global item, overall severity, considers severity and frequency of individual items, subjective distress and influence on daily activities. Each item is rated from normal 0 to severe 4 12 , Global item was excluded considering study design that implied using video clips.
Before the initiation of the study the session was held for all raters to clarify the procedure and to distribute scale and instructions. Raters performed the assessment simultaneously, individually rating one assigned item immediately after seeing the video clip. Raters were blind to one another during assessments. Full size table Discussion Nonadherence to medication can have negative consequences for the patient, the provider, the physician, and even the researchers who are working to establish the value of the medication for the target population.
It is a common problem induced by many factors, including the medication side effects. Nonadherence increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life of patients.
The efficacy of antipsychotic medication in the acute and maintenance treatment of several mental disorders is clear from large meta-analyses of placebo-controlled trials Data from the CATIE trial imply that advantages of SGA in significantly reducing extrapyramidal side effects compared with FGA may be diminished when compared with modest doses of lower-potency first generation drugs.
However, the dichotomy between FGA and SGA may be oversimplified, and CATIE trial showed that antipsychotics could be conceptualized as a single drug class with a spectrum of risk for movement disorders depending upon receptor binding affinities and individual patient susceptibility 7.
Especially, the use of SGAs for populations that were drug naive children, adolescents, elderly and adult population with conditions such as bipolar disorder and major depressive disorder, together with a lack of long-term clinical trials that would precisely indicate the rate of DIMD in these populations, portends an increase in the actual number of cases All mentioned are reasons to develop instruments for easy and fast assessment of side effects, especially drug-induced movement disorders, experienced by patients as very unpleasant and potentially with high nonadherence potential.
Ethnical differences were suggested as possible factor that could alter susceptibility to adverse drug reactions, including extrapyramidal side effects.
Ethnic groupings may account for some of the complex interactions between genetics, environment and society There are results that suggest that East Asian patients have a significantly greater risk of drug induced extrapyramidal symptoms compared with non-East Asian patients Assessment of drug induced extrapyramidal syndrome with DIEPSS in Serbian and other non-East Asian populations could contribute to better understanding of potential differences in incidence and severity of drug induced extrapyramidal syndrome among different populations.
High reliability that is shown could also be related to the use of video recorded material, which provided consistence and stability for rated items. Very high level of inter-rater reliability for akathisia and muscle rigidity ICC value 0.
Present findings are in concordance with previous results confirming that DIEPSS is a valid and reliable measure of extrapyramidal symptoms 2 , Limitations This study excluded global item since study design did not provide assessment of subjective distress. For future research it would be important to evaluate concurrent validity of Serbian version of DIEPSS, comparing it with other rating scales for extrapyramidal symptoms.
Conclusion In conclusion, the results of our study show that the DIEPSS is reliable instrument for identifying extrapyramidal symptoms and it can be used in clinical practice to improve early detection, assessment and treatment. References Schatzberg, A.
Psychiatric Quarterly 85, —
Prolactin Levels After Switching to Paliperidone Palmitate in Patients with Schizophrenia