Antipsychotic-induced movement disorders among patients with severe mental illness in Africa: A systematic review and meta-analysis.

BACKGROUND: Antipsychotic medications remain the cornerstone of treatment for severe mental illnesses (SMIs), including schizophrenia, bipolar disorder, and related psychotic disorders. However, antipsychotic-induced movement disorders (AIMDs), including both acute extrapyramidal syndromes and tardive syndromes, remain important adverse effects that may negatively affect treatment adherence, functioning, and quality of life. Evidence from African settings remains limited and methodologically heterogeneous. Therefore, this systematic review and meta-analysis aimed to synthesize the available evidence regarding the prevalence and associated factors of AIMDs among individuals with SMI in Africa. METHODS: A systematic literature search was conducted in major electronic databases, including PubMed/MEDLINE, PsycINFO, EMBASE, CINAHL, ScienceDirect, and Cochrane Library. Following screening and eligibility assessment, data were extracted using a standardized Microsoft Excel form and analyzed using STATA version 14.0. A random-effects model was used to estimate pooled outcome measures with corresponding 95% confidence intervals (CIs). Publication bias was assessed using statistical and graphical methods. The review protocol was prospectively registered in PROSPERO (CRD420261351632). RESULT: A total of 22 original studies were included in this systematic review and meta-analysis. The pooled prevalence of AIMDs was 32.2% (95% CI: 24.2-40.2%). Among the identified subtypes, drug-induced Parkinsonism was the most prevalent (22.7%), followed by akathisia (11.9%), tardive dyskinesia (10.7%), and acute dystonia (9.46%). Female sex (OR = 3.6; 95% CI: 2.3-5.9), higher antipsychotic dose (OR = 3.2; 95% CI: 2.1-4.9), longer treatment duration (OR = 2.2; 95% CI: 1.4-3.2), and current substance use (OR = 2.8; 95% CI: 2.2-3.6) were identified as significant predictors of AIMDs. CONCLUSION: AIMDs remain common among individuals with SMI in African settings, affecting nearly one-third of treated patients. Female sex, higher antipsychotic dose, longer treatment duration, and current substance use were associated with increased risk. These results underscore the continued clinical burden of AIMDs and the need for cautious prescribing, routine monitoring, and integrated management of modifiable risk factors, including substance use.