Prevalence and associated factors of antipsychotic-induced extrapyramidal symptoms in the Tigray region

Extrapyramidal symptoms affect an average of 37%, with a maximum prevalence of 71.4%, among individuals on antipsychotics. About one in five patients experiences Parkinsonism, and more than one in ten experiences akathisia. These symptoms can significantly increase relapse rates, elevate healthcare costs (approximately $27,408), and contribute to stigmatization. In Tigray, where antipsychotic use is rising, data on Extrapyramidal symptoms are limited. This study aimed to fill this research gap to better patient care and management. The aim of this study was to determine the prevalence of Extrapyramidal symptoms associated with antipsychotic medications. Additionally, it sought to identify factors contributing to these side effects among patients. This study was conducted across five public hospitals in the Tigray region, utilizing a comprehensive approach that included face-to-face interviews, direct observations, card reviews, and physical examinations. A total of 834 participants were selected through a multistage sampling technique to ensure representativeness, using the Extra Pyramidal Symptom Rating Scale (ESRS) for standardized evaluation. Data collected were analyzed using SPSS version 27. The study findings showed that the prevalence rates of Parkinsonism, Akathisia, Dystonia, and Tardive Dyskinesia were 9.9%, 6.9%, 5.0%, and 2.4%, respectively. The multivariate analysis revealed several common risk factors associated with these extrapyramidal symptoms. Both Parkinsonism and Akathisia were significantly associated with various factors, including the type of antipsychotic medication, illness relapse, comorbid medical conditions, anticholinergic medication, perceived stigma, and current khat use. Additionally, Parkinsonism was associated with the type of mental illness. Dystonia was also associated with marital status, anticholinergic medication, perceived stigma, and tobacco use. Lastly, Tardive Dyskinesia was associated with educational status and medication adherence. Although Extrapyramidal symptoms were reported at lower rates than in previous studies, psychiatry professionals should routinely screen for EPS and tailor treatment to patient-specific factors. Efforts to reduce stigma around these side effects are also essential to improve patient outcomes.