Dyskinesia and Neuroleptic Exposure in Elderly Psychiatric Inpatients

Abstract

A wide variation in prevalence rates of tardive dyskinesia and spontaneous orofacial dyskinesia has been reported in the elderly. To clarify these discrepancies, we studied 45 patients over the age of 60 years admitted to a short-term psychiatric unit. Standardized criteria for the diagnosis of dyskinesia were used. We found a rate of tardive dyskinesia of only 21% (7/33) in our patients having a history of neuroleptic exposure. We found no cases (0/12) of spontaneous orofacial dyskinesia. There was a significant association between tardive dyskinesia and psychiatric diagnosis, with the highest rate of tardive dyskinesia in those patients with schizophrenic disorders, followed by those with organic disorders and mood disorders, respectively. There was also a significant association between the presence of tardive dyskinesia and radiographic evidence of cortical atrophy, and a trend towards an association with leukoencephalopathy. Our results suggest that published rates of tardive and spontaneous dyskinesia in the elderly may overestimate the prevalence of these disorders, especially among geriatric patients with acute psychiatric presentations.

Schizophrenia in Late Life: Elderly Patients Admitted to an Acute Care Psychiatric Hospital

“…The Geriatric Clinical Research Unit (GCRU) is a 26-bed acute care unit for the assessment and treatment of late-life mental disorders at Western Psychiatric Institute and Clinic, a teaching psychiatric hospital that provides psychiatric care to a large urban catchment area and serves as a referral center for psychiatric patients from suburban and rural southwestern Pennsylvania. All patients age 50 or older who are admitted to the unit for at least 4 days receive a comprehensive evaluation performed by a multidisciplinary team consisting of an attending psychiatrist, a social worker, a physician’s assistant (under the supervision of a geriatrician), an occupational therapist, a psychiatric nurse, and a trained research clinician, all with expertise in geriatric psychiatry (Sweet et al 1992; Zubenko et al 1992; Kunik et al 1993). This diagnostic evaluation includes a psychiatric history and mental status examination, a social history, a medical history and physical examination, a battery of blood tests, a chest x-ray, an electrocardiogram, an electroencephalogram (EEG), CNS imaging—(magnetic resonance imaging [MRI] or computed tomography [CT] scan—when MRI is contraindicated because of the presence of metal parts or when the patient is unable to cooperate with the MRI procedures), and other tests as indicated by the patient’s history or examination.…”

Tardive and spontaneous dyskinesia incidence in the general population

“…Most studies have used cross-sectional (or prevalence) data on patients with schizophrenia or other psychoses, but some have used retrospective cohort data and a small number have used prospective cohort data [3,4,8-10,21,22]. The purpose of the current study was to determine the incidence of all types of dyskinesia in general population and also to examine its connection to underlying medical conditions such as diabetes independent of antipsychotic medication use, and in association with use of first-generation antipsychotic drugs and metoclopramide.…”

Variables Associated With Tardive Dyskinesia in Geropsychiatric Outpatients

“…TD is more persistent and may occur more frequently in the elderly than in the younger population (Jeste et al, 1990). Prevalence estimates vary from 0.5% to 56% (Saltz et al, 1991), with one study noting average rates of over 40% (Sweet et al, 1992) significantly greater than the 25% prevalence rates for young adults (Jeste et al, 1990; Kane et ul., 1988).A number of risk factors have been identified for the development of TD in the elderly, including age, sex, race, depression, cognitive impairment, psychiatric diagnosis and neuroleptic dosage and duration, but some controversy continues.Most researchers agree that increasing age is the most consistent variable associated with higher …”

“…Little TD research has examined communitybased (Sweet et al, 1992) and outpatient elderly populations (Chacko et al, 1985). This study is an attempt to identify specific variables associated with TD in patients attending a geropsychiatric outpatient clinic.…”