Joubert Francois-Pierre, Chiliza Bonginkosi, Emsley Robin, Asmal Laila
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
S Afr J Psychiatr. 2021 Jan 11;27:1568. doi: 10.4102/sajpsychiatry.v27i0.1568. eCollection 2021.
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.
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 (fluanxol depot).
The 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.
The Extrapyramidal Symptom Rating Scale (ESRS) was used to assess both subjective experience and objective measures of EPSEs in a cohort of patients with FES ( = 130). The relationship between demographic and clinical risk factors for individual subsets of EPSEs was also determined.
In 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.
Flupenthixol 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.
锥体外系副作用（EPSEs）的发生风险是长效注射用（LAI）抗精神病药物在首发精神分裂症（FES）患者中常规使用的一个障碍。癸酸氟奋乃静是第一代抗精神病药物，在南非的公共医疗系统中很容易获得。
本研究旨在描述在使用癸酸氟奋乃静（氟哌噻吨长效注射剂）治疗12个月期间，FES患者中EPSEs的性质、发生率、严重程度及其对患者的影响。
该研究以南非开普敦为基地，FES患者从斯蒂克兰德医院和泰格堡医院的住院部以及周边的精神科诊所招募。这是一项更大规模研究的子研究，该研究考察了使用最低有效剂量癸酸氟奋乃静治疗的FES患者的多个结局。
采用锥体外系症状评定量表（ESRS）评估一组FES患者（n = 130）的EPSEs主观体验和客观指标。还确定了EPSEs各个亚组的人口统计学和临床风险因素之间的关系。
在总体12个月耐受性良好的情况下，EPSEs在第3个月达到峰值。静坐不能的患者更有可能出现更严重的抑郁症状，而帕金森症则由更高的阳性和阴性症状量表评分预测（与药物剂量无关）。与混血患者相比，黑人和白人患者的ESRS总分和主观ESRS评分更高，白人患者在帕金森症评定方面得分更高。
癸酸氟奋乃静在FES患者中耐受性良好。精神分裂症的某些临床特征可能与EPSEs有关。种族是一种社会文化结构，因此应根据种族来解释EPSEs的不同风险。环境、饮食、物质使用和基因的差异都可能影响精神药物的药代动力学和药效学，值得进一步研究。
