RISK-FACTORS FOR SPONTANEOUS DYSKINESIA IN SCHIZOPHRENIA

Objective: We describe the prevalence, clinical correlates, and progno stic significance of spontaneous dyskinesias among 100 patients with s chizophrenia from the Chestnut Lodge Follow-up Study who had never rec eived treatment with neuroleptic agents up to and including the baseli ne assessment. Design: Extensive case records were screened and descri ptions of abnormal movements were recorded verbatim for blind rating. Neuroleptic-naive patients with and without abnormal oral-facial movem ents were compared across sign and symptom, schizophrenia subtype, and illness natural history variables. Results: Excluding three patients with motor symptoms who had a history of neurologic illness or injury and three who had received prochlorperazine maleate therapy (Compazine ), 23% of patient records documented some form of movement disorder; 1 5% documented oral-facial dyskinesias with sufficient detail so that t heir presence was considered nearly certain. Compared with patients wi th schizophrenia without oral-facial movements, patients with oral-fac ial dyskinesias were more likely to demonstrate a lower IQ score, had more negative symptoms at index admission, and were more symptomatic a t follow-up an average of 23 years later. Both the classic hebephrenic schizophrenia subtype and Carpenter's Criteria for the Deficit Syndro me defined high-risk groups for spontaneous oral-facial dyskinesia. Co nclusions: In previous studies, intellectual impairment and negative s ymptoms have been described as risk factors for neuroleptic-induced ta rdive dyskinesia. The present data, however, suggest that in many case s oral-facial dyskinesias in patients with intellectual impairment and negative symptoms may actually represent spontaneous movement disorde rs associated with hebephrenic or deficit forms of schizophrenia.