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Cross-sectional examination of extrapyramidal side effects in a specialist palliative care inpatient unit
  1. Hannah O’Brien1,
  2. Fiona Kiely1,
  3. Aileen Barry1 and
  4. Sarah Meaney2
  1. 1 Department of Palliaitve Medicine, Marymount University Hospital and Hospice, Cork, Ireland
  2. 2 National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
  1. Correspondence to Dr Hannah O’Brien, Marymount University Hospital and Hospice, Cork T12 A710, Ireland; hannahobrien201{at}gmail.com

Abstract

Objectives Extrapyramidal side effects (EPSEs) are serious potentially reversible side effects of antipsychotic and other medications that can cause distress for patients. A core principle of palliative care involves optimising quality of life. If side effects of medications are burdensome, it is imperative that we address this issue. The aim of the study was to determine and describe the burden of EPSEs in a specialist inpatient unit.

Methods Consenting patients who met inclusion criteria were assessed for EPSE with two validated screening tests, the Modified Simpson-Angus Scale (MSAS) and Barnes Akathisia Rating Scale (BARS). Additional demographic data were collected including medications associated with EPSE, previous history of EPSE and known risk factors that may predispose a patient to EPSE.

Results 43% inpatients met inclusion criteria. At least 66% of patients were taking regular medications associated with EPSE. Of those, 25% were taking ≥2 medications associated with EPSE. The MSAS revealed 50% scored <3, 44% scored 3–5% and 6% scored 6–11. Seven patients had at least one ‘not rateable score’. In the BARS (sitting±standing), 94% scored 0/5 and 6% scored 1/5. 12.5% of participants were able to stand for 2  min to complete the BARS.

Conclusions 50% screened positive for EPSE. The complete BARS was unsuitable for most participants. The MSAS, while allowing a not rateable score, may underestimate EPSE. The frailty of an inpatient unit population impacts on applicability of screening tools and may therefore underestimate the burden of the problem in this population. Development of a population-specific screening tool warrants further investigation.

  • extra-pyramidal side effects
  • inpatient
  • palliative medicine

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Footnotes

  • Contributors Conception and design: FK, HOB. Planning: FK, HOB, AB. Conduct and acquisition of data: HOB. Reporting: HOB, FK. Analysis and interpretation of data: SM, HOB, FK. Critical revision of the article: FK, HOB, AB, SM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Clinical Research Ethics Committee of the Cork Teaching Hospitals. Ref: ECM 4 (r) 08/11/16.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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