Psychological Medicine

Review Article

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

S. Pappaa1 c1 and P. Dazzana1

a1 Institute of Psychiatry, Division of Psychological Medicine, King's College London, UK


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.

(Received June 13 2007)

(Revised September 11 2008)

(Accepted September 26 2008)

(Online publication November 12 2008)


c1 Address for correspondence: S. Pappa, M.D., Ph.D., Consultant Psychiatrist and Honorary Research Associate, Department of Psychiatry, PO 63, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: