Parkinsonism in drug-naive first-episode schizophrenic patients

Bradykinesia, rigidity, and tremor are found in patients with Parkinsonʹs Disease, retarded major depression, and chronic schizophrenia. The extrapyramidal signs that occur in chronic schizophrenic subjects are attributed to antipsychotic treatment. However, recently there has been a report of tremor and rigidity in unmedicated first-episode patients. We therefore undertook a study of drug-naive first-episode schizophrenic subjects to determine to what extent extrapyramidal symptoms were present prior to initiation of antipsychotic medications. Twenty-three active duty service personnel who gave informed written consent were enrolled in a comprehensive study of first-episode psychosis. Seventeen men and six women, ages 18 to 32 participated. These subjects were unique in that they had a very short mean duration of illness of less than 5 days. A modified version of the Simpson-Angus Scale for Extrapyramidal Effects (SASE), and the Brief Psychiatric Rating Scale (BPRS) was administered by two experienced clinical researchers (RES and EEC) in the drug-naive baseline state (ICC >.75 for all items). Mean SASE total score at baseline was 4.8 (S.D.=3.4; range 0 to 10). Total SASE scores were significantly correlated with BPRS negative symptom ratings (Spearman rank correlation coefficient, P<.0001). There were no correlations with BPRS total or positive symptom scores. In conclusion, we have demonstrated that extrapyramidal symptoms are present at the very onset of psychosis. These extrapyramidal symptoms were significantly correlated with negative symptoms and may provide additional support for an intrinsic neurointegrative defect in schizophrenia.