Research article

Neuroleptic-induced movement disorders in a naturalistic schizophrenia population: diagnostic value of actometric movement patterns

Sven Janno^1,2 , Matti M Holi³ , Katinka Tuisku⁴ and Kristian Wahlbeck^2,5,6

¹Department of Psychiatry, University of Tartu, Raja 31, 50417, Tartu, Estonia

²Department of Psychiatry, University of Helsinki, Tukholmankatu 8 C, 00029, Finland

³Kellokoski Hospital, Hospital District of Helsinki and Uusimaa, FIN-04500 Kellokoski, Finland

⁴Mehiläinen Ltd, Siltasaarenkatu 18A, FIN-00530 Helsinki, Finland

⁵STAKES National Research and Development Centre for Welfare and Health, P.O.Box 220, FIN-00531 Helsinki, Finland

⁶Psychiatric Unit, Vaasa Central Hospital, Hietalahdenkatu 2-4, FIN-65130 Vaasa, Finland

author email corresponding author email

BMC Neurology 2008, 8:10doi:10.1186/1471-2377-8-10

Published:	18 April 2008

Abstract

Background

Neuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry.

Methods

A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV).

Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD.

Results

The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia.

Conclusion

The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.