Movement disorders emerge as a frequent complication in psychiatric follow-up care in northwest Ethiopia
Psychotropic adverse effects are often treated as a side issue in mental health care, yet they can determine whether a patient continues treatment, tolerates it, or silently drops out. In a cross-sectional study at the University of Gondar Hospital in northwest Ethiopia, psychotropic medication-induced movement disorders affected 38.6% of patients receiving regular psychiatric follow-up, a level high enough to demand routine bedside attention rather than sporadic recognition.
The burden is clinically important because movement disorders do more than produce abnormal motor symptoms. They can bring visible stigma, subjective distress, and the kind of functional discomfort that makes long-term adherence fragile. In chronic psychiatric illness, where treatment success depends on continuity, even modest extrapyramidal symptoms can become the reason a patient stops medication without warning.
Nearly two in five patients screened positive on the Extrapyramidal Symptom Rating Scale
This institution-based cross-sectional study ran from October 1 to November 30, 2025 and used systematic random sampling among patients on regular psychiatric follow-up. Movement disorders were assessed with the Extrapyramidal Symptom Rating Scale and the data were analyzed with logistic regression modeling. The prevalence estimate was 38.6%, with a 95% confidence interval of 33.7% to 43.5%.
That figure is not a marginal signal. It means movement disorders were present in more than one-third of the clinic population evaluated during the study period. In practical terms, a routine follow-up visit in this setting cannot safely assume that an antipsychotic regimen is being tolerated simply because the patient remains engaged in care.
A single prevalence number also reveals how easily these adverse effects can remain under-recognized. Patients may minimize tremor, rigidity, restlessness, or involuntary movements until the symptoms interfere with daily life. Clinicians, meanwhile, may focus on psychosis control, mood symptoms, sleep, or adherence and miss the motor syndrome unfolding in parallel.
Schizophrenia, prolonged illness, and single marital status carried higher odds
Several patient characteristics were independently associated with higher odds of movement disorders. Being single was linked to increased odds, with an adjusted odds ratio of 1.95 and a 95% confidence interval of 1.08 to 3.52. A diagnosis of schizophrenia showed an adjusted odds ratio of 2.62, with a 95% confidence interval of 1.03 to 6.67. Illness duration longer than 10 years carried an adjusted odds ratio of 3.65, with a 95% confidence interval of 1.05 to 12.70.
These findings fit the clinical profile of chronic psychotic illness. Schizophrenia often requires prolonged antipsychotic exposure, which increases cumulative dopamine blockade and, with it, the likelihood of extrapyramidal toxicity. Longer illness duration may simply mark longer exposure, repeated medication changes, or a more severe disease course with less physiologic buffer against adverse effects.
Single marital status may be acting as a marker for reduced day-to-day support, weaker symptom monitoring, or delayed help-seeking when abnormal movements first appear. In psychiatric care, the social context matters because early detection often depends on another person noticing subtle changes before the patient names them.
Antipsychotic class remained the strongest medication-linked signal
Medication exposure showed a clear association with movement disorders. Compared with antidepressant use, first-generation antipsychotic use was associated with an adjusted odds ratio of 5.42, with a 95% confidence interval of 1.47 to 19.95. Second-generation antipsychotic use was also associated with elevated odds, with an adjusted odds ratio of 3.22 and a 95% confidence interval of 1.19 to 8.68.
The biology is straightforward. Antipsychotics reduce dopaminergic signaling in pathways that regulate movement, and when that receptor blockade becomes excessive or prolonged, extrapyramidal symptoms follow. First-generation agents have long been recognized for stronger movement-related toxicity, but this study reinforces that second-generation antipsychotics do not eliminate the problem. They may lower risk relative to older agents in many settings, yet they still carry enough dopaminergic impact to produce clinically meaningful motor adverse effects.
The comparison with antidepressant use is also important. It frames antipsychotic exposure as the dominant pharmacologic driver in this cohort, which is exactly where screening should be concentrated. A patient on antipsychotics who complains of stiffness, restlessness, facial grimacing, tremor, or slow movements needs direct assessment, not reassurance by default.
Routine surveillance could prevent avoidable treatment failure
The study’s clinical message is direct: movement disorders were common, and the highest-risk patients were identifiable. People with schizophrenia, those with illness lasting more than a decade, and those receiving first- or second-generation antipsychotics deserve repeated screening for extrapyramidal toxicity at follow-up visits. In a setting where psychiatric resources are often stretched, targeted monitoring can capture the patients most likely to benefit from early intervention.
The downstream consequences of missing these effects are predictable. Symptoms can erode trust in treatment, reduce adherence, and worsen overall psychiatric stability. A patient who quietly develops motor side effects may not volunteer them unless asked in specific terms, and by then the adverse effects may already be entrenched.
This is why a scale such as the Extrapyramidal Symptom Rating Scale has practical value in routine care. It turns a subjective complaint into a structured clinical observation and gives clinicians a repeatable way to follow symptom burden over time. In low-resource settings, where access to specialist movement-disorder expertise may be limited, simple systematic screening can function as the first line of prevention.
The Ethiopian clinic data point to a broader prescribing challenge
Although the study was observational and limited to one hospital-based sample, its signal is difficult to ignore. The prevalence estimate is high, the associated factors are biologically plausible, and the medication effect aligns with known antipsychotic pharmacology. The sample came from patients already engaged in regular follow-up, which means the burden may be even more concerning among patients who are not consistently retained in care.
Participants who were identified with medication-induced movement disorders were referred to the psychiatry outpatient clinic for further evaluation and management. That referral pathway is important, but it also hints at the larger problem: detection without systematic prevention still leaves many patients exposed to ongoing motor toxicity.
The study does not settle questions about which specific psychotropic agents, doses, or treatment durations contribute most strongly to risk, but it does show where routine psychiatric practice must pay closer attention. In northwest Ethiopia, movement disorders are not rare complications of psychotropic treatment; they are part of the everyday clinical workload of chronic mental illness care.