Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review

Psychol Med. 2009 Jul;39(7):1065-76. doi: 10.1017/S0033291708004716. Epub 2008 Nov 12.


Background: Spontaneous movement disorders (SMDs), such as spontaneous dyskinesia and parkinsonism, have been described in patients with schizophrenia who have never been treated with antipsychotic medication. Their presence has been documented extensively in chronic schizophrenia but not at the time of illness onset.

Method: We performed a systematic review of studies investigating spontaneous abnormal movements elicited on clinical examination in antipsychotic-naive patients with first-episode psychosis.

Results: We identified a total of 13 studies. Findings suggest a spontaneous dyskinesia median rate of 9% and a spontaneous parkinsonism median rate of 17%. Information on akathisia and dystonia was limited. The presence of SMDs may be associated with negative symptoms and cognitive dysfunction.

Conclusions: These findings support the notion that spontaneous abnormal movements are part of a neurodysfunction intrinsic to the pathogenesis of schizophrenia. Future studies should further investigate the role of basal ganglia and extrapyramidal pathways in the pathophysiology of psychosis, with particular attention to treatment implications.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Akathisia, Drug-Induced / diagnosis*
  • Akathisia, Drug-Induced / epidemiology
  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Comorbidity
  • Cross-Sectional Studies
  • Dyskinesia, Drug-Induced / diagnosis*
  • Dyskinesia, Drug-Induced / epidemiology
  • Dyskinesias / diagnosis*
  • Dyskinesias / epidemiology
  • Dystonia / diagnosis*
  • Dystonia / epidemiology
  • Humans
  • Neurologic Examination / drug effects
  • Parkinsonian Disorders / chemically induced*
  • Parkinsonian Disorders / diagnosis*
  • Parkinsonian Disorders / epidemiology
  • Psychomotor Agitation / diagnosis*
  • Psychomotor Agitation / epidemiology
  • Psychotic Disorders / diagnosis*
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / epidemiology
  • Schizophrenia / diagnosis*
  • Schizophrenia / drug therapy*
  • Schizophrenia / epidemiology


  • Antipsychotic Agents