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Dyskinesia is most centrally situated in an estimated network of extrapyramidal syndrome in Asian patients with schizophrenia: findings from research on Asian psychotropic prescription patterns for antipsychotics.

  • Park, Seon-Cheol1
  • Kim, Gyung-Mee1
  • Kato, Takahiro A2
  • Chong, Mian-Yoon3, 4
  • Lin, Shih-Ku5
  • Yang, Shu-Yu6
  • Avasthi, Ajit7
  • Grover, Sandeep7
  • Kallivayalil, Roy Abraham8
  • Xiang, Yu-Tao9
  • Chee, Kok Yoon10
  • Tanra, Andi Jayalangkara11
  • Tan, Chay Hoon12
  • Sim, Kang13
  • Sartorius, Norman14
  • Shinfuku, Naotaka15
  • Park, Yong Chon16
  • Inada, Toshiya17
  • 1 Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Republic of Korea. , (North Korea)
  • 2 Department of Neuropsychiatry, Graduate School of Medicine, Kyushu University, Fukuoka, Japan. , (Japan)
  • 3 Chang Gung Memorial Hospital, Chiayi, Taiwan. , (Taiwan)
  • 4 School of Medicine, Chang Gung University, Kwei-Shan, Taiwan. , (Taiwan)
  • 5 Department of Psychiatry, Taipei City Hospital, Songde Branch, Taipei, Taiwan. , (Taiwan)
  • 6 Department of Pharmacy, Tapei City Hospital, Songde Branch, Tapei, Taiwan. , (Taiwan)
  • 7 Department of Psychiatry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. , (India)
  • 8 Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India. , (India)
  • 9 Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China. , (China)
  • 10 Tunku Abdul Rahman Institute of Neuroscience, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. , (Malaysia)
  • 11 Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia. , (Indonesia)
  • 12 Department of Pharmacology, National University Hospital, Singapore, Singapore. , (Singapore)
  • 13 West Region, Institute of Mental Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore. , (Singapore)
  • 14 Association for the Improvement of Mental Health Programmes, Geneva, Switzerland. , (Switzerland)
  • 15 Department of Social Welfare, School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan. , (Japan)
  • 16 Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea. , (North Korea)
  • 17 Department of Psychiatry and Psychobiology, Nagoya University, Graduate School of Medicine, Nagoya, Japan. , (Japan)
Published Article
Nordic Journal of Psychiatry
Informa UK (Taylor & Francis)
Publication Date
Jan 01, 2021
DOI: 10.1080/08039488.2020.1777462
PMID: 32580668


Network analysis provides a new viewpoint that explicates intertwined and interrelated symptoms into dynamic causal architectures of symptom clusters. This is a process called 'symptomics' and is concurrently applied to various areas of symptomatology. Using the data from Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP), we aimed to estimate a network model of extrapyramidal syndrome in patients with schizophrenia. Using data from REAP-AP, extrapyramidal symptoms of 1046 Asian patients with schizophrenia were evaluated using the nine items of the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). The estimated network of the ordered-categorical DIEPSS items consisted of nodes (symptoms) and edges (interconnections). A community detection algorithm was also used to identify distinctive symptom clusters, and correlation stability coefficients were used to evaluate the centrality stability. An interpretable level of node strength centrality was ensured with a correlation coefficient. An estimated network of extrapyramidal syndrome showed that 26 (72.2%) of all possible 35 edges were estimated to be greater than zero. Dyskinesia was most centrally situated within the estimated network. In addition, earlier antipsychotic-induced extrapyramidal symptoms were divided into three distinctive clusters - extrapyramidal syndrome without parkinsonism, postural instability and gait difficulty-dominant parkinsonism, and tremor-dominant parkinsonism. Our findings showed that dyskinesia is the most central domain in an estimated network structure of extrapyramidal syndrome in Asian patients with schizophrenia. These findings are consistent with the speculation that acute dystonia, akathisia, and parkinsonism could be the risk factors of tardive dyskinesia.

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