Dyskinesia is most centrally situated in an estimated network of extrapyramidal syndrome in Asian patients with schizophrenia: findings from research on Asian psychotropic prescription patterns for antipsychotics

Park SC 1 , Kim GM 1 , Kato TA 2 , Chong MY 3 , Lin SK 4 , Yang SY 5 Show all authors , Avasthi A 6 , Grover S 6 , Kallivayalil RA 7 , Xiang YT 8 , Chee KY 9 , Tanra AJ 10 , Tan CH 11 , Sim K 12 , Sartorius N 13 , Shinfuku N 14 , Park YC 15 , Inada T 16

Affiliations 

  • 1 Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
  • 2 Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
  • 3 Chang Gung Memorial Hospital, Chiayi, Taiwan
  • 4 Department of Psychiatry, Taipei City Hospital, Songde Branch, Taipei, Taiwan
  • 5 Department of Pharmacy, Tapei City Hospital, Songde Branch, Tapei, Taiwan
  • 6 Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • 7 Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
  • 8 Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
  • 9 Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  • 10 Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
  • 11 Department of Pharmacology, National University Hospital, Singapore, Singapore
  • 12 West Region, Institute of Mental Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 13 Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
  • 14 Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
  • 15 Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
  • 16 Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan
Nord J Psychiatry, 2021 Jan;75(1):9-17.
PMID: 32580668 DOI: 10.1080/08039488.2020.1777462

Abstract

BACKGROUND: Network analysis provides a new viewpoint that explicates intertwined and interrelated symptoms into dynamic causal architectures of symptom clusters. This is a process called 'symptomics' and is concurrently applied to various areas of symptomatology.

AIMS: Using the data from Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), we aimed to estimate a network model of extrapyramidal syndrome in patients with schizophrenia.

METHODS: Using data from REAP-AP, extrapyramidal symptoms of 1046 Asian patients with schizophrenia were evaluated using the nine items of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). The estimated network of the ordered-categorical DIEPSS items consisted of nodes (symptoms) and edges (interconnections). A community detection algorithm was also used to identify distinctive symptom clusters, and correlation stability coefficients were used to evaluate the centrality stability.

RESULTS: An interpretable level of node strength centrality was ensured with a correlation coefficient. An estimated network of extrapyramidal syndrome showed that 26 (72.2%) of all possible 35 edges were estimated to be greater than zero. Dyskinesia was most centrally situated within the estimated network. In addition, earlier antipsychotic-induced extrapyramidal symptoms were divided into three distinctive clusters - extrapyramidal syndrome without parkinsonism, postural instability and gait difficulty-dominant parkinsonism, and tremor-dominant parkinsonism.

CONCLUSIONS: Our findings showed that dyskinesia is the most central domain in an estimated network structure of extrapyramidal syndrome in Asian patients with schizophrenia. These findings are consistent with the speculation that acute dystonia, akathisia, and parkinsonism could be the risk factors of tardive dyskinesia.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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