Improving Outcome in Schizophrenia: the Potential Importance of EPS and Neuroleptic Dysphoria

Despite half a century of antipsychotic drug treatment, the outcome of therapy in schizophrenia remains disappointing. Relapse, rehospitalization, limited fulfillment of social roles, & suicide remain frequent, & the economic costs are high. Current relapse rates may be 2 or 3 times higher than those that could be achieved with optimal use of therapy. There is some evidence that extrapyramidal symptoms (EPS), particularly akathisia & neuroleptic dysphoria, are associated with poor compliance & poor treatment outcome. Atypical antipsychotics have a lower risk of EPS than do standard antipsychotics. Clozapine & quetiapine have demonstrated a placebo-level incidence of EPS across the dose range. (69 refs)