Extrapyramidal Side Effects of Intramuscular Antipsychotics in Psychosis and Substance Use Disorders, Occurrence and Predictive Factors



This retrospective study aims to determine the occurrence of extrapyramidal symptoms (EPS) after intramuscular (IM) antipsychotic treatment at emergency services and the predictive factors among acute psychotic patients with substance use disorders (SUD). We randomly selected medical records of acute psychotic patients with SUD, free of initial EPS needing IM antipsychotic drugs. The occurrence of EPS and relevant data were collected. The occurrence of EPS was 7.84 %. The proportion of patients with co-morbidities, light smokers who were treated with IM haloperidol and zuclopenthixol were significantly higher in the EPS group (p = 0.009, p = 0.012 and p = 0.011) while the proportion of those with high intensity amphetamine dependence were significantly lower in the EPS group (p = 0.044). However, IM haloperidol with zuclopenthixol was the only predictive factor of EPS (OR = 13.39, p = 0.043). Our results showed a lower risk of EPS in SUD patients compared to 9.8 % in non SUD patients. It was supported by previous findings showing that substance dependence caused persistent high DA concentration after abstinence and probably a decreased risk of EPS in SUD patients. A combination of a typical antipsychotic drug and benzodiazepine is the safer alternative for nonresponsive SUD patients.


Extrapyramidal symptoms, substance use disorders, acute psychosis, intramuscular antipsychotic drug

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