Psychiatric Bulletin (2007) 31: 76-77. doi: 10.1192/pb.bp.31.2.77
© 2007 The Royal College of Psychiatrists
Documentation of extrapyramidal symptoms
Sabyasachi Mitra, Consultant Psychiatrist
The Calcutta Medical Research Institute, West Bengal, India
Peter Haddad, Consultant Psychiatrist
Bolton, Salford and Trafford Mental Health NHS Trust, Salford, email:
peterhaddad{at}doctors.org.uk
Kuruvilla et al (Psychiatric Bulletin, August 2006,
30, 300–303) reported that a high percentage of respondents in
their survey had not received formal training in the assessment (52%) or
management (36%) of drug-induced movement disorders and mean levels of
confidence in these skills were relatively low. We studied the documentation
of extrapyramidal symptoms (EPS) in patients’ notes at a Manchester
teaching hospital.
A psychiatrist (S.M.) conducted a standardised neurological examination on
a representative group of 25 psychiatric in-patients and out-patients aged
18–65 years with schizophrenia and under several consultants.
Extrapyramidal symptoms were rated on standard rating scales and parkinsonism,
akathisia and tardive dyskinesia were diagnosed using predefined scores.
Twelve of the 18 patients (67%) prescribed an atypical antipsychotic and 6 of
the 7 patients (86%) prescribed a conventional antipsychotic fulfilled
criteria for an extrapyramidal syndrome. A subsequent review of the clinical
notes for the preceding 12 months showed that only half of the patients with
an extra-pyramidal syndrome (9 of 18) had documented evidence of a management
plan to treat the disorder and that only 1 of the 25 patients had a documented
physical examination that recorded the presence or absence of extrapyramidal
signs.
Our study indicates that EPS remain common in clinical practice despite the
widespread use of atypical agents, that half of extrapyramidal syndromes are
untreated and that screening for EPS is not routine. Possible explanations are
that clinicians lack the knowledge, skills and confidence to assess and manage
EPS or that they lack the time to address this aspect of care. We agree with
Kuruvilla et al that clinicians need better education and training in
this area.
