The association of extrapyramidal symptoms (EPS) with the use of antipsychotics was first discovered in the 1950s. To our knowledge, little research has been conducted with any retrospective observational database to evaluate the comparative risk of EPS between first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) users in the U.S. population. The purpose of the study was to compare EPS risk between FGA and SGA users using propensity score-matching (PSM) and instrumental variable (IV) analyses. A retrospective cohort design with an intention-to-treat (ITT) analysis (where the patients included in the cohort were assumed to take the medications without switching or dropping out) was chosen to examine the relationship between antipsychotic treatment and EPS risk. First-time antipsychotic users (as identified in the MEPS database), during the time frame 2002 to 2009, were included in the cohort. All subjects included in the cohort were followed over time to assess EPS risk. Propensity score-based logistic regression (using the Greedy 5[right arrow]1 digit match technique) was used to compare EPS risk between the SGA and FGA users after adjusting for demographic variables and risk factors (associated with EPS). In order to identify the presence of unobserved confounding, an instrumental variable analysis was attempted. Based on previous research findings, "delay in obtaining prescribed medicines" was selected as the instrument to evaluate the relationship between EPS risk and antipsychotic type. The feasibility of instrumental variable analyses was examined by evaluating the strength of the chosen instrument. The propensity score-based logistic regression analysis showed no difference in EPS risk [OR = 1.77, 95% CI = (0.49, 6.40)] between FGA and SGA users. The strength (partial r² = 0.0002) of the instrument was low. A weak instrument used in a regression model may produce biased estimates while evaluating treatment/outcome relationship; therefore, instrumental variable analysis was not conducted. EPS risk was found not to differ between the FGA and SGA users. However, clinicans may choose to evaluate other side-effects (in addition to EPS) of antipsychotics while making treatment decisions. Evaluation of economic, clinical and humanistic outcomes associated with treatment of antipsychotic-related side-effects (besides EPS) can provide clinicans the rationale for selecting one class of antipsychotics over the other. Interpretation of the study findings should be considered in light of the limitations of the MEPS database. Future research is necessary to identify a strong instrument to assess the presencec of unobserved confounding between antipsychotic exposure and EPS risk. Furthermore, additional research is warranted to assess differences in time to development of EPS between the FGA and SGA users. / text

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Neuroleptic medications are commonly administered in the emergency department but are known to induce extrapyramidal symptoms (EPS) in some patients; typically dystonia and akathisia. This systematic review will examine if adjunctive medications are efficacious when given in conjunction with neuroleptic medications to prevent these extrapyramidal symptoms. The Central, DARE, LILACS, PubMed, CINAHL, and OVID databases were searched for relevant articles between January 2014 and February 2016. Inclusion criteria required the article to be a randomized controlled trial; administer an anticholinergic medication given concurrently or just prior to treatment with medications with known extrapyramidal side effects; and be published in English. The initial search strategy yielded 1222 prospective articles of which 1208 were excluded by title and/or abstract. Fourteen articles were retrieved in full text and independently reviewed by each author. Seven 7 RCTs representing 645 patients were determined to be appropriate for analysis. Meta‐analysis of 5 studies found a significant effect (OR 0.4 with 95% CI 0.23‐0.71) for utilizing anticholinergic adjunct medications in the prevention of EPS for 60 minutes after administration. No reduction was found (OR 1.14 with 95% CI 0.01‐164) in EPS after 60 minutes in meta‐analysis of 2 studies with opposing results. Adjunctive anticholinergic medication was effective in reducing symptoms of dystonia (OR 0.13 with 95% CI 0.04‐0.43) but not in reducing symptoms of akathisia (OR 0.74 with 95% CI 0.27‐1.98). This systematic review found that anticholinergic adjuvant anticholinergic treatment reduced EPS induced by antipsychotic medications during 60 minutes after administration, with the greatest reduction in dystonic symptoms.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-01-27T12:50:08Z No. of bitstreams: 1 arquivototal.pdf: 1442835 bytes, checksum: 6b70176bf31acd5711693f3965397116 (MD5) / Made available in DSpace on 2016-01-27T12:50:08Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1442835 bytes, checksum: 6b70176bf31acd5711693f3965397116 (MD5) Previous issue date: 2015-04-24 / Recommended as Complementary Medicine by World Health Organization (WHO), Aromatherapy is widespread around the world and uses 100% pure essential oils to prevent and/or treat health problems. Thus, these oils extracted from plants can be considered innovative tools for the treatment of certain pathologies, including mental disorders, because there is evidence for theirs effectiveness in treating disorders related to the Central Nervous System (CNS), and also has low toxicity and easy access. The most common mental conditions treated include mood disorders, anxiety, age-related cognitive decline, psychotic disorders, stress symptoms and chronic pain. This study aimed to investigate possible antipsychotic effects of essential oils but also verify whether it is able to relieve extrapyramidal symptoms. Males Swiss mice, albinos, weighing 32-49 grams, with approximately 2 months of age were used as experimental subjects. The essential oil Lavandula angustifólia was used through inhalation route (5 minutes). Data were analyzed using Graph Pad Prism, using the one-way ANOVA and the Kruskal-Wallis tests. In all comparisons, p<0.005 was considered statistically significant. In the hypolocomotion test with lavender oil treatment at concentrations of 2.5%; 5% and 10% we observed that ambulatory movement, rearing, number of jumps, rest (sc), distance (cm), velocity (mm/s), clockwise and counter-clockwise rotation the results showed that, in all parameters, there was a potentiation of the hipolocomotor effect of haloperidol. In the catatonia test induced by haloperidol (1 mg/kg intraperitoneal injection) treatment with the essential oil showed significant result (p<0.05) compared with animals pretreated with Haloperidol+Saline (GC-), being able to reduce time of catatonia. In the catatonia test induced by haloperidol via oral administration,also presented effect of statistical significance, it is possible to observe a decrease in catatonia time (s) of the oil group compared to Haloperidol+Saline (GC-) group. In the hyperlocomotion test induced by amphetamine (3 mg/kg intraperitoneal injection), the same parameters of hypolocomotion were observed, however, no statistically significant results were found when we compared the group treated with lavender and the Amphetamine+Saline (GC-) group in most tests. In the stereotypy test induced by apomorphine (20 mg/kg intraperitoneal injection), the treatment with the oil inhibited the stereotyped behavior with p <0.05. In Climbing test induced by apomorphine (same dose and route of administration) the animals treated with lavender decreased the climb behavior level when compared to animals treated with Haloperidol+Saline (GC-). After analyzing the results we can conclude that the essential oil of lavender, administered by inhalation route, can have a similar profile to antipsychotics because both alter neurotransmission involved in schizophrenia. / Preconizada como Medicina Complementar pela Organização Mundial de Saúde, a Aromaterapia está bastante difundida pelo mundo e utiliza Óleos Essenciais 100% puros para prevenir e/ou tratar problemas relacionados à saúde. Assim, estes óleos obtidos de plantas podem ser considerados ferramentas inovadoras para o tratamento de certas patologias, incluindo transtornos mentais, pois têm mostrado eficácia sobre distúrbios relacionados ao Sistema Nervoso Central (SNC), além de possuir baixa toxidade e facilidade de acesso. As condições mentais mais frequentes tratadas incluem transtornos do humor, ansiedade, declínio cognitivo relacionado com a idade, perturbações psicóticas, sintomas do estresse e dores crônicas. O presente estudo teve como objetivo investigar possíveis efeitos antipsicóticos dos óleos essenciais como também verificar se o mesmo era capaz de aliviar os sintomas extrapiramidais. Foram utilizados camundongos Swiss machos, albinos, pesando de 32-49 g, com aproximadamente 2 meses de idade. O óleo essencial utilizado foi Lavandula angustifólia via inalatória (5 minutos). Os dados foram analisados pelo Graph Pad Prism, sendo utilizado o teste one-way ANOVA e o Kruskall-Wallis, os resultados foram considerados significativos quando apresentaram um nível de significância de 5% (p < 0,05). No teste de Hipolocomoção com tratamento do óleo de lavanda (GE) nas concentrações de 2,5%; 5% e 10% observou-se, movimento ambulatório, rearing, quantidade de pulos, de descanso (s), distância (cm), velocidade (mm/s), rotação horária e anti-horária os resultados mostraram que na maioria dos parâmetros houve uma potenciação do efeito hipolocomotor do haloperidol. No teste de Catatonia induzida por Haloperidol (1 mg/kg via i.p) o tratamento com o óleo essencial mostrou resultado significativo (p < 0,05) quando comparado com os animais pré-tratados com Haloperidol+salina (GC-), mostrando-se capaz de reduzir o tempo (s) da catatonia. No teste de Catatonia induzida por Halperidol via oral, também apresentou efeito significativo estatisticamente, é possível observar uma diminuição do tempo (s) de catatonia do GE em relação ao GC-. No teste de Hiperlocomoção induzida por Anfetamina (3 mg/kg i.p) foram observados os mesmos parâmetros da Hiperlocomoção, contudo, não encontramos resultados estatisticamente significativos em relação aos animais tratados com a lavanda e o grupo Anfetamina+Salina (GC-) na maioria dos testes. No teste de Estereotipia induzida por Apomorfina (20 mg/kg i.p) o tratamento com o óleo inibiu o comportamento estereotipado com p < 0,05. No teste do Climbing induzido por Apomorfina, na mesma dose e via de administração, o nível do comportamento de subida dos animais tratados com a lavanda GE diminuiu em relação aos animais tratados com GC-. Diante da análise dos resultados podemos concluir que o óleo essencial de lavanda, administrado por via inalatória, pode ter um perfil semelhante aos antipsicóticos por alterar a neurotransmissão envolvida na esquizofrenia.

Contexte Autant dans une population schizophrène que non schizophrène, l‘abus de substance a pour conséquence la manifestation de symptômes psychiatriques et neurologiques. Dans les présentes études cas-témoins, nous avons examiné les différences initiales ainsi que les changements suite au traitement de 12 semaines à la quetiapine au niveau de la sévérité de la toxicomanie et des symptômes psychiatriques et neurologiques chez 3 groupes distincts. Ces 3 groupes sont: des patients schizophrènes avec une toxicomanie (double diagnostic: DD), des patients schizophrènes sans toxicomanie concomittante (SCZ) et finalement, des toxicomanes non schizophrènes (SUD). Parallèlement, afin de nous aider à interpréter nos résultats, nous avons mené deux revues systématiques: la première regardait l‘effet d‘antipsychotiques dans le traitement de troubles d‘abus/dépendance chez des personnes atteintes ou non de psychoses, la deuxième comparait l‘efficacité de la quetiapine et sa relation dose-réponse parmi différents désordres psychiatriques. Méthodes Pour nos études cas-témoins, l‘ensemble des symptômes psychiatriques et neurologiques ont été évalués via l‘Échelle du syndrome positif et négatif (PANSS), l‘Échelle de dépression de Calgary, l‘Échelle des symptômes extrapyramidaux (ESRS) ainsi qu‘avec l‘Échelle d‘akathisie de Barnes. Résultats À la suite du traitement de 12 semaines avec la quetiapine, les groupes SCZ et DD recevaient des doses de quetiapine significativement plus élevées (moyenne = 554 et 478 mg par jour, respectivement) par rapport au groupe SUD (moyenne = 150 mg par jour). Aussi, nous avons observé chez ces mêmes patients SUD une plus importante baisse du montant d‘argent dépensé par semaine en alcool et autres drogues, ainsi qu‘une nette amélioration de la sévérité de la toxicomanie comparativement aux patients DD. Par conséquent, à la fin de l‘essai de 12 semaines, il n‘y avait pas de différence significative dans l‘argent dépensé en alcool et drogues entre les deux groupes de toxicomanes iv or, les patients DD présentait, comme au point de départ, un score de toxicomanie plus sévère que les SUD. Étonnamment, aux points initial et final de l‘étude, le groupe DD souffrait de plus de symptômes parkinsoniens et de dépression que le groupe SCZ. Par ailleurs, nous avons trouvé qu‘initiallement, les patients SUD présentaient significativement plus d‘akathisie, mais qu‘en cours de traitement, cette akathisie reliée à l‘abus/dépendance de cannabis s‘est nettement améliorée en comparaison aux patients SCZ. Enfin, les patients SUD ont bénéficié d‘une plus grande diminution de leurs symptômes positifs que les 2 groupes atteints de schizophrénie. Conclusions Bref, l‘ensemble de nos résultats fait montre d‘une vulnérabilité accentuée par les effets négatifs de l‘alcool et autres drogues dans une population de patients schizophrènes. Également, ces résultats suggèrent que l‘abus de substance en combinaison avec les états de manque miment certains symptômes retrouvés en schizophrénie. De futures études seront nécessaires afin de déterminer le rôle spécifique qu‘a joué la quetiapine dans ces améliorations. / Background Psychiatric and neurological symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control studies examined differences in substance abuse/dependence, and psychiatric symptoms and neurological symptoms in substance abusers with [dual diagnosis (DD) group] and without schizophrenia [substance use disorder (SUD) group] and in non-abusing schizophrenia patients (SCZ group) –undergoing 12-week treatment with quetiapine. Furthermore, two systematic reviews were conducted in order help explain our results. The first examined the usefulness of antipsychotics for the treatment of substance abuse/dependence in psychosis and non-psychosis patients. The second examined the dose-response and comparative efficacy of quetiapine across psychiatric disorders. Methods Psychiatric symptoms and neurological symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. Results DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg per day, respectively), relative to SUD patients (mean = 150 mg per day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Conclusions Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

Contexte Autant dans une population schizophrène que non schizophrène, l‘abus de substance a pour conséquence la manifestation de symptômes psychiatriques et neurologiques. Dans les présentes études cas-témoins, nous avons examiné les différences initiales ainsi que les changements suite au traitement de 12 semaines à la quetiapine au niveau de la sévérité de la toxicomanie et des symptômes psychiatriques et neurologiques chez 3 groupes distincts. Ces 3 groupes sont: des patients schizophrènes avec une toxicomanie (double diagnostic: DD), des patients schizophrènes sans toxicomanie concomittante (SCZ) et finalement, des toxicomanes non schizophrènes (SUD). Parallèlement, afin de nous aider à interpréter nos résultats, nous avons mené deux revues systématiques: la première regardait l‘effet d‘antipsychotiques dans le traitement de troubles d‘abus/dépendance chez des personnes atteintes ou non de psychoses, la deuxième comparait l‘efficacité de la quetiapine et sa relation dose-réponse parmi différents désordres psychiatriques. Méthodes Pour nos études cas-témoins, l‘ensemble des symptômes psychiatriques et neurologiques ont été évalués via l‘Échelle du syndrome positif et négatif (PANSS), l‘Échelle de dépression de Calgary, l‘Échelle des symptômes extrapyramidaux (ESRS) ainsi qu‘avec l‘Échelle d‘akathisie de Barnes. Résultats À la suite du traitement de 12 semaines avec la quetiapine, les groupes SCZ et DD recevaient des doses de quetiapine significativement plus élevées (moyenne = 554 et 478 mg par jour, respectivement) par rapport au groupe SUD (moyenne = 150 mg par jour). Aussi, nous avons observé chez ces mêmes patients SUD une plus importante baisse du montant d‘argent dépensé par semaine en alcool et autres drogues, ainsi qu‘une nette amélioration de la sévérité de la toxicomanie comparativement aux patients DD. Par conséquent, à la fin de l‘essai de 12 semaines, il n‘y avait pas de différence significative dans l‘argent dépensé en alcool et drogues entre les deux groupes de toxicomanes iv or, les patients DD présentait, comme au point de départ, un score de toxicomanie plus sévère que les SUD. Étonnamment, aux points initial et final de l‘étude, le groupe DD souffrait de plus de symptômes parkinsoniens et de dépression que le groupe SCZ. Par ailleurs, nous avons trouvé qu‘initiallement, les patients SUD présentaient significativement plus d‘akathisie, mais qu‘en cours de traitement, cette akathisie reliée à l‘abus/dépendance de cannabis s‘est nettement améliorée en comparaison aux patients SCZ. Enfin, les patients SUD ont bénéficié d‘une plus grande diminution de leurs symptômes positifs que les 2 groupes atteints de schizophrénie. Conclusions Bref, l‘ensemble de nos résultats fait montre d‘une vulnérabilité accentuée par les effets négatifs de l‘alcool et autres drogues dans une population de patients schizophrènes. Également, ces résultats suggèrent que l‘abus de substance en combinaison avec les états de manque miment certains symptômes retrouvés en schizophrénie. De futures études seront nécessaires afin de déterminer le rôle spécifique qu‘a joué la quetiapine dans ces améliorations. / Background Psychiatric and neurological symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control studies examined differences in substance abuse/dependence, and psychiatric symptoms and neurological symptoms in substance abusers with [dual diagnosis (DD) group] and without schizophrenia [substance use disorder (SUD) group] and in non-abusing schizophrenia patients (SCZ group) –undergoing 12-week treatment with quetiapine. Furthermore, two systematic reviews were conducted in order help explain our results. The first examined the usefulness of antipsychotics for the treatment of substance abuse/dependence in psychosis and non-psychosis patients. The second examined the dose-response and comparative efficacy of quetiapine across psychiatric disorders. Methods Psychiatric symptoms and neurological symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. Results DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg per day, respectively), relative to SUD patients (mean = 150 mg per day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Conclusions Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

Les antipsychotiques de deuxième génération (ADG) sont de plus en plus employés dans le traitement de troubles psychiatriques. Selon de nombreuses observations cliniques, les effets secondaires reliés à la prise d’ADG diffèrent chez les patients atteints de schizophrénie (SCZ) et de maladies affectives (MA) éprouvent divers. Ainsi, il s’avère nécessaire d’étudier la fréquence et l'intensité des effets secondaires induits par les ADG qui pourraient différer selon le diagnostic. Pour ce faire, nous avons effectué une revue systématique de la littérature afin d’identifier l’ensemble des études rapportant les effets secondaires de cinq ADG (aripiprazole, olanzapine, quétiapine, rispéridone et ziprasidone) dans le traitement de la schizophrénie ou des maladies affectives. Les effets secondaires métaboliques et extrapyramidaux ont été recueillis séparément pour les deux groupes de patients, puis ont été combinés dans une méta-analyse. Des méta-régressions ainsi que des sous-analyses ont également été effectuées dans le but de regarder l’effet de différents modérateurs (i.e. âge, genre, et dose). Dans la présente méta-analyse, 107 études ont été inclues. Les résultats montrent que le traitement avec l’olanzapine a occasionné une plus importante prise de poids chez les patients SCZ comparativement aux patients MA. De plus, le traitement à la quétiapine a amené une hausse significative du taux de LDL et de cholestérol total dans le groupe SCZ par rapport au groupe MA. Selon nos résultats, les symptômes extrapyramidaux étaient plus fréquents dans le groupe MA, excepté pour le traitement à l'olanzapine qui a induit davantage de ces symptômes chez les patients SCZ. Également, nos résultats suggèrent que les patients SCZ seraient plus vulnérables à certains effets métaboliques induits par les ADG dû à une possible susceptibilité génétique ou à la présence de facteurs de risque associés au style de vie. D'autre part, les patients MA en comparaison aux SCZ étaient plus enclins à souffrir de troubles du mouvement induits par les ADG. Bref, les ADG semblent exacerber certains types d’effets secondaires tout dépendant de la maladie dans laquelle on les utilise. / Second generation antipsychotics (SGAs) are extensively prescribed for psychiatric disorders. Based on clinical observations, schizophrenia (SCZ) and affective disorders (AD) patients experience different SGAs side effects. The expanded use of SGAs in psychiatry suggests a need to investigate whether there is a difference in the incidence and severity of side-effects related to diagnosis. A comprehensive literature search was conducted to identify studies reporting side effects of five SGAs (aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone) in the treatment of SCZ or AD. The metabolic and extrapyramidal side effects were collected separately for each group, and then were combined in a meta-analysis. Meta-regression and sub-analyses were also performed to investigate the role of different moderators (e.g., age, dose and gender). One hundred and seven studies were included in the analysis. Olanzapine induced a body weight gain significantly higher in SCZ patients than in AD patients. In addition, quetiapine treatment led to significantly higher LDL and total cholesterol mean change in the SCZ group relative to the AD group. Based on our results, the incidence of extrapyramidal side effects was more frequent in the AD group, except for olanzapine that caused more parkinsonism in SCZ patients. Our results suggest that SCZ patients may be more vulnerable to some SGA-induced metabolic disturbances, in which lifestyle risk factors and a possible inherent genetic vulnerability may play a role. Most of the studied SGAs caused more movement disorders in AD patients than in schizophrenics. It might be that an antipsychotic induces severity of side effect according to the phenotype.

Les antipsychotiques de deuxième génération (ADG) sont de plus en plus employés dans le traitement de troubles psychiatriques. Selon de nombreuses observations cliniques, les effets secondaires reliés à la prise d’ADG diffèrent chez les patients atteints de schizophrénie (SCZ) et de maladies affectives (MA) éprouvent divers. Ainsi, il s’avère nécessaire d’étudier la fréquence et l'intensité des effets secondaires induits par les ADG qui pourraient différer selon le diagnostic. Pour ce faire, nous avons effectué une revue systématique de la littérature afin d’identifier l’ensemble des études rapportant les effets secondaires de cinq ADG (aripiprazole, olanzapine, quétiapine, rispéridone et ziprasidone) dans le traitement de la schizophrénie ou des maladies affectives. Les effets secondaires métaboliques et extrapyramidaux ont été recueillis séparément pour les deux groupes de patients, puis ont été combinés dans une méta-analyse. Des méta-régressions ainsi que des sous-analyses ont également été effectuées dans le but de regarder l’effet de différents modérateurs (i.e. âge, genre, et dose). Dans la présente méta-analyse, 107 études ont été inclues. Les résultats montrent que le traitement avec l’olanzapine a occasionné une plus importante prise de poids chez les patients SCZ comparativement aux patients MA. De plus, le traitement à la quétiapine a amené une hausse significative du taux de LDL et de cholestérol total dans le groupe SCZ par rapport au groupe MA. Selon nos résultats, les symptômes extrapyramidaux étaient plus fréquents dans le groupe MA, excepté pour le traitement à l'olanzapine qui a induit davantage de ces symptômes chez les patients SCZ. Également, nos résultats suggèrent que les patients SCZ seraient plus vulnérables à certains effets métaboliques induits par les ADG dû à une possible susceptibilité génétique ou à la présence de facteurs de risque associés au style de vie. D'autre part, les patients MA en comparaison aux SCZ étaient plus enclins à souffrir de troubles du mouvement induits par les ADG. Bref, les ADG semblent exacerber certains types d’effets secondaires tout dépendant de la maladie dans laquelle on les utilise. / Second generation antipsychotics (SGAs) are extensively prescribed for psychiatric disorders. Based on clinical observations, schizophrenia (SCZ) and affective disorders (AD) patients experience different SGAs side effects. The expanded use of SGAs in psychiatry suggests a need to investigate whether there is a difference in the incidence and severity of side-effects related to diagnosis. A comprehensive literature search was conducted to identify studies reporting side effects of five SGAs (aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone) in the treatment of SCZ or AD. The metabolic and extrapyramidal side effects were collected separately for each group, and then were combined in a meta-analysis. Meta-regression and sub-analyses were also performed to investigate the role of different moderators (e.g., age, dose and gender). One hundred and seven studies were included in the analysis. Olanzapine induced a body weight gain significantly higher in SCZ patients than in AD patients. In addition, quetiapine treatment led to significantly higher LDL and total cholesterol mean change in the SCZ group relative to the AD group. Based on our results, the incidence of extrapyramidal side effects was more frequent in the AD group, except for olanzapine that caused more parkinsonism in SCZ patients. Our results suggest that SCZ patients may be more vulnerable to some SGA-induced metabolic disturbances, in which lifestyle risk factors and a possible inherent genetic vulnerability may play a role. Most of the studied SGAs caused more movement disorders in AD patients than in schizophrenics. It might be that an antipsychotic induces severity of side effect according to the phenotype.