Factors associated with extrapyramidal side effects of first-generation antipsychotics: a cross- sectional study in Ugandan tertiary hospitals

Abstract Introduction: Extrapyramidal side effects (EPS) are a significant concern in the treatment of psychiatric disorders with first generation antipsychotic medications. They reduce the adherence to drugs, impairing the quality of life and are related to relapse. This study aimed to investigate the prevalence, patterns of presentation and factors associated with EPS among patients receiving first generation antipsychotics at two teaching hospitals in Uganda. Understanding these aspects can help improve the clinical management and quality of life for individuals receiving this treatment Methods This study utilized a cross-sectional hospital based design involving 385 patients diagnosed with various psychiatric disorders and prescribed first generation antipsychotics at Kampala International University hospital (KIU-TH) and Jinja Regional Referral Hospital (JRRH) in Uganda. Data were collected through structured interviews, medical chart reviews and validated EPS Rating scales. Results The study revealed a substantial prevalence of EPS among patients treated with first generation antipsychotics at two teaching hospitals. In this study, 54.5% (210/385) of participants presented with EPS while on FGAs in both psychiatric centers. Among 210, 90(23.4%) were from KIU-TH and 120(31.1%) were from JRRH. Common presentations of EPS included dystonia (17%), Parkinsonism (16.1%), dyskinesia (13%) and akathisia (6.5%). Factors associated with an increased risk of developing EPS included: Male gender: 82%, longer treatment duration was associated with a higher risk of EPS, Smoking: (75%) increased the risk of having EPS, Psychiatric diagnosis: Schizophrenia (54%) was associated with a higher risk of EPS. Conclusion The prevalence of extrapyramidal side effect among patient on first generation antipsychotic drugs was relatively high in KIU-TH and JRRH psychiatric unities. Dystonia, Parkinsonism, dyskinesia and akathisia were the common extrapyramidal side effects observed in the study. On the other hand, smoking, previous episodes of EPS, long standing on antipsychotics drugs and schizophrenia were the main factors significantly associated with occurrence of EPS. These insights contribute to improving the overall management and care of patients receiving first generation antipsychotic treatments in psychiatric settings