Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy

Schwartz, Shaina; Ruekert, Laura; Myers, Jaclyn; Anderson, Dennis L.; Welling, Michael; Cunningham, Elizabeth

doi:10.1097/jcp.0000000000001061

Cited by 22 publications

(12 citation statements)

References 59 publications

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“…Akathisia may have different impact on patients at different stages of illness and according to the duration of treatment (Hansen & Kingdom, 2006), as associations between akathisia and suicidality seem to be strongest in first episode and young patients compared to in treatment resistance (Seemuller et al, 2012). Akathisia may lead to medication non-adherence (Velligan et al, 2017) subsequent worsening of psychotic symptoms, increased suicidality and re-hospitalization (Musco et al, 2019). Consequently, it seems plausible to suggest that early emerging akathisia may be associated with a more complicating treatment course and possibly also a poorer prognosis.…”

Section: Discussionmentioning

confidence: 99%

Akathisia and atypical antipsychotics: relation to suicidality, agitation and depression in a clinical trial

Bjarke

Gjerde

Jørgensen

et al. 2022

Acta Neuropsychiatr.

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Objective: Akathisia is among the most unpleasant side effects related to antipsychotic drug use, and possible associations between akathisia and agitation, depression and suicidal behaviour, respectively, have been described in previous literature. New generation antipsychotics are however regarded less prone to induce this particular adverse effect compared to older drugs, but evidence is incomplete and in need of confirmation from clinically relevant samples and settings. We therefore aim to investigate akathisia at hospital discharge for patients consecutively admitted with acute phase psychosis and treated with second generation antipsychotics according to guideline concordant clinical practice. Methods: This exploratory study is part of a naturalistic randomised controlled study in patients admitted with acute phase psychosis (N = 109). We report cross-sectional data at discharge/first follow-up after acute psychiatric hospital admission for patients with schizophrenia and related psychotic disorders. Results: There were statistically significant positive associations between akathisia and the following; suicidality in men (Beta 0.306, p=0.048), but not in women; agitation in those previously unexposed to antipsychotics (Beta 0.288, p=0.047); and depression in those exposed to antipsychotics before hospital admittance (Beta 0.375, p=0.031). Conclusion: Main findings were that akathisia is still a prevalent side effect in a clinically relevant sample of patients treated with atypical antipsychotics. Our results suggest that akathisia is significantly associated with depression, suicidality, and agitation in different subgroups of patients receiving antipsychotic drugs. Akathisia can be detrimental and the relations between akathisia and depression, suicidality and agitation should be investigated further in prospective, hypothesis-testing studies with larger samples.

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Section: Discussionmentioning

confidence: 99%

Akathisia and atypical antipsychotics: relation to suicidality, agitation and depression in a clinical trial

Bjarke

Gjerde

Jørgensen

et al. 2022

Acta Neuropsychiatr.

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“…EPS includes disturbances in movement, tone, and/or posture, dystonia, parkinsonian signs, tardive dyskinesia, and tardive akathisia [ 16 , 17 ]. EPS occurs due to disturbances in the dopaminergic neurons in the central nervous system [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Neurology Case Report: Rapidly Progressive Dementia and Extrapyramidal Symptoms as the First Presentation of Leptomeningeal Carcinomatosis

Alhubayshi¹,

Alasmari²,

Almahdi³

et al. 2022

Cureus

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Leptomeningeal carcinomatosis (LC) is a rare complication of primary malignancy that spreads to leptomeninges and cerebrospinal fluid (CSF). Due to its rarity, it is often diagnosed as a late complication of an advanced tumor. This report presents a case study of a 72-year-old nonsmoking female with multiple comorbidities with two-week rapidly progressive cognitive decline and extrapyramidal symptoms (EPS). She presented with speech difficulties, tension headaches, and episodes of inattention. On examination, she had a masked face, mild bradykinesia, mild rigidity more apparent in the limbs than axially, and slight hyperreflexia in the lower limbs with a normal plantar reflex (down-going). Magnetic resonance imaging (MRI) of the brain with gadolinium showed diffuse leptomeningeal dissemination. CT of the right lower lobe showed lobe apical segment mass lesion with air bronchogram extension to the hilum, which raised the suspicion that the patient had lung cancer. The microscopic analysis of cerebrospinal fluid (CSF) cytology showed poorly differentiated malignant cells favoring adenocarcinoma. Based on these investigations, leptomeningeal dissemination on the MRI led to a wide differential diagnosis; however, given the findings in the CT scan and CSF, the patient was diagnosed with leptomeningeal carcinomatosis secondary to metastatic lung cancer. Although LC is a rare terminal complication that presents with a wide range of symptoms, typically including headache, altered mental status, diplopia, back pain, cerebral signs, and leg weakness, our patient presented with an uncommon presentation, which was EPS. Therefore, this case report highlights the importance of early detection of LC in any patient presenting with unspecific neurological manifestations.

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“…Кроме того, не было обнаружено различий в актуальном психическом состоянии пациентов с акатизией и без акатизии, они имели сопоставимые баллы по PANSS, что бы позволило объяснить назначение комбинированной терапии. Несмотря на то что развитие акатизии у пациентов с шизофренией связывают с назначением антипсихотической терапии, в отношении дозозависимого эффекта и влияния общей антипсихотической нагрузки представлены противоречивые данные [20]. Так, в данном исследовании у больных шизофренией с акатизией и без нее общая антипсихотическая нагрузка в перерасчете на хлорпромазиновый эквивалент не различалась и была одинаковой.…”

Section: Discussionunclassified

The Role of Antypsychotic Therapy in the Development of Akathisia in Patients with Schizophrenia

Goncharova

Kornetova

2020

Psychiatry

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The use of antipsychotic therapy in patients with schizophrenia is associated with the development of a wide range of adverse events, among which akathisia is one of the most common. Objective: to assess the risk of akathisia in patients with schizophrenia receiving various antipsychotic therapy. Patients and methods. A continuous method examined 250 inpatients with a verified diagnosis of schizophrenia. The akathisia assessment was performed using the Barnes Akathisia Rating Scale (BARS). The odds ratio was estimated using the MedCalc® online calculator. Results: akathisia was detected in 92 (36.8%) examined. The combination of two antipsychotic drugs has an increased risk of akathisia in patients with schizophrenia OR = 1.69 (95% CI: 1.0–2.88; p = 0.04), however the use of conventional and atypical drugs was associated with a reduction in risk (OR = 0.45 (95% CI: 0.21–0.95; p = 0.037)). Patients receiving basic therapy zuclopenthixol decanoate had increased risk of akathisia 4 times as compared to haloperidol decanoate (OR = 3.85 (95% CI: 1,26–12,22; p = 0.021)). Conclusions: It was shown that the choice of antipsychotic therapy should be based not only on the actual mental state of the patient, but also considering the potential risk of akathisia.

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Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy

Abstract: Supplemental digital content is available in the text.

Cited by 22 publications

References 59 publications

Akathisia and atypical antipsychotics: relation to suicidality, agitation and depression in a clinical trial

Akathisia and atypical antipsychotics: relation to suicidality, agitation and depression in a clinical trial

Neurology Case Report: Rapidly Progressive Dementia and Extrapyramidal Symptoms as the First Presentation of Leptomeningeal Carcinomatosis

The Role of Antypsychotic Therapy in the Development of Akathisia in Patients with Schizophrenia

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