Prevalence and Pattern of Extrapyramidal Side Effects in Patients Receiving Second-Generation Antipsychotics: A Cross-Sectional Study from a Tertiary Care Hospital

Background: Second-generation antipsychotics (SGAs) are widely used in schizophrenia and other psychotic disorders for their perceived lower risk of extrapyramidal side effects (EPSEs) compared to first-generation agents. However, emerging evidence suggests SGAs are not entirely free from EPSEs. This study aimed to determine the prevalence and pattern of EPSEs in patients on SGAs. Materials and Methods: A cross-sectional observational study was conducted from October to December 2024 at the Psychiatry OPD of K.R. Hospital, Mysore. Sixty patients aged ≥18 years with schizophrenia, bipolar disorder, or major depressive disorder with psychotic features, on SGAs for ≥2 weeks, were included. Patients with neurological disorders, concurrent drugs causing movement disorders, substance use, or pregnancy/lactation were excluded. EPSEs were assessed using the Simpson–Angus Scale (SAS) through interviews, clinical examination, and record review. Data were analysed for demographic, clinical, and drug-related associations. Results: The mean age was 20–40 years in 60% of participants; 53.3% were male; 45% had schizophrenia. Risperidone was most prescribed (55%), followed by olanzapine (43%). EPSE prevalence was higher with risperidone (21.2%) than with olanzapine (11.5%). Tremors were the most common EPSE (90.9%), followed by akathisia (9%). Duration of treatment was significantly associated with EPSE occurrence (p = 0.000), with the highest incidence in the first four weeks. All EPSEs were mild (SAS score 1). Conclusion: EPSEs remain clinically relevant with SGAs, especially risperidone. Early treatment duration is a high-risk period, warranting vigilant monitoring and individualized therapy to improve adherence and quality of life.