EFFECTS OF NEUROLEPTICS WITH OR WITHOUT ANTI-CHOLINERGICS AMONG SCHIZOPHRENIC PATIENTS OF SOUTH GUJARAT

Abstract

Objective: Neuroleptics (or anti-psychotics) indicated for the treatment of schizophrenia have significant dose-limiting extra-pyramidal side effects (EPS). Literature suggests limited evidence for the efficacy of anticholinergics in the treatment of neuroleptic-induced EPS. Thus, the present study was conducted to understand the effects of anti-cholinergics on EPS among schizophrenics already on neuroleptics (typical and atypical). Methods: This prospective, cross-sectional, observational study was conducted at a tertiary care teaching hospital in South Gujarat for 15 months. A total of 200 participants were included based on selection criteria and distributed equally among four groups (A, B, C, and D) of 50 participants each. The collected data were analyzed for sociodemographic profile, current treatment regimen, type of neuroleptic drug, present complaints of EPS, and addition of any anti-cholinergic agent. An abnormal involuntarily movement scale score was used for examining movement disorders in all study participants. Descriptive statistical analysis was done using Microsoft Excel 2019 and IBM SPSS software version 28, and p<0.05 was considered statistically significant. Results: Hundred patients who were prescribed typical neuroleptics were divided into groups A (with anti-cholinergic) and B (without anti-cholinergic), whereas the remaining 100 patients being prescribed atypical neuroleptics were divided into groups C (with anti-cholinergic) and D (without anti-cholinergic) by simple randomization. The majority of 56% were young adults (18–35 years) with an overall male pre-ponderance (2.14:1). Out of 50 participants in both groups A and B, a higher number of group B participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (48/50 vs. 30/50, 36/50 vs. 6/50, 24/50 vs. 1/50, 36/50 vs. 19/50) as compared to group A, respectively. Similar results were noted with groups C and D, where a higher number of group D participants experienced tremors, rigidity, difficulty in movements, and tardive dyskinesia (TD) (15/50 vs. 5/50, 11/50 vs. 3/50, 18/50 vs. 2/50, and 16/50 vs. 4/50, respectively). All the results were statistically significant (p<0.05). Conclusion: There was a significant reduction in EPS among schizophrenia patients who were prescribed atypical over typical neuroleptics. The addition of one anticholinergic to the drug regimen also significantly reduced the frequency of EPS in schizophrenia patients.