Evolution of neuroleptic-induced extrapyramidal syndromes under long-term neuroleptic treatment

Modestin, Jiří; Wehrli, Marianne Vogt; Stephan, Patrik Lukas; Agarwalla, Puspa

doi:10.1016/j.schres.2007.10.018

Cited by 33 publications

(21 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the study by Modestin and colleagues [47] the prevalence of parkinsonism in 1995 and 2003/4 was 17% and 29%, respectively. Janno and colleagues [19] estimated the prevalence of parkinsonism at 23.2% and 72.7%, according to DSM-IV criteria and Simpson-Angus Scale criteria, respectively.…”

Section: Discussionmentioning

confidence: 92%

Long-Stay Psychiatric Patients: A Prospective Study Revealing Persistent Antipsychotic-Induced Movement Disorder

Bakker

Groot

et al. 2011

PLoS ONE

View full text Add to dashboard Cite

ObjectiveThe purpose of this study was to assess the frequency of persistent drug-induced movement disorders namely, tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia in a representative sample of long-stay patients with chronic severe mental illness.MethodNaturalistic study of 209, mainly white, antipsychotic-treated patients, mostly diagnosed with psychotic disorder. Of this group, the same rater examined 194 patients at least two times over a 4-year period, with a mean follow-up time of 1.1 years, with validated scales for TD, parkinsonism, akathisia, and tardive dystonia.ResultsThe frequencies of persistent movement disorders in the sample were 28.4% for TD, 56.2% for parkinsonism, 4.6% for akathisia and 5.7% for tardive dystonia. Two-thirds of the participants displayed at least one type of persistent movement disorder.ConclusionsPersistent movement disorder continues to be the norm for long-stay patients with chronic mental illness and long-term antipsychotic treatment. Measures are required to remedy this situation.

show abstract

Section: Discussionmentioning

confidence: 92%

Long-Stay Psychiatric Patients: A Prospective Study Revealing Persistent Antipsychotic-Induced Movement Disorder

Bakker

Groot

et al. 2011

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…This, in addition to the relative sparing of extrapyramidal side effects (EPS), made SGAs first-line medications in the treatment of schizophrenia in older adults. In contrast to the increased risk of TD and parkinsonism associated with aging, the prevalence of akathisia is consistent across the life span (∼14%) [20,21], and antipsychotic-induced dystonia is rarely observed in older adults (∼2%, compared with upward of 30% in younger adults) [22]. Not surprisingly given the autonomic adverse effects of some of these drugs, some evidence also suggests that atypical antipsychotic use (in addition to that of clozapine) is associated with a higher risk for falls [23].…”

Section: Adverse Effectsmentioning

confidence: 99%

Sensitivity to Antipsychotic Drugs in Older Adults

Leon

Gerretsen

Uchida

et al. 2010

Curr Psychiatry Rep

View full text Add to dashboard Cite

Antipsychotic medications are widely used to manage psychotic and behavioral disorders in older adults, including primary psychotic disorders such as schizophrenia, and psychosis and behavioral disturbances associated with dementia. These two broad diagnostic indications are associated with contrasting recommended treatment durations, with the former requiring indefinite treatment across the life span. Antipsychotic drug dosing for schizophrenia is based primarily on studies of younger patients and thus may not apply to older adults. It is critically important to address the effects of aging on antipsychotic dosing given the recent emergence of data that suggest a critical role for age-related sensitivity to these drugs. Antipsychotic drugs are not only associated with somatic and neurological adverse effects but also increased all-cause mortality and sudden cardiac death in this vulnerable population. This review focuses on the sensitivity of older adults to adverse effects from antipsychotic medications and the current pharmacokinetic and pharmacodynamic explanatory models of susceptibility. Implications of recent research findings for individualized pharmacotherapy are discussed.

show abstract

“…The studies examining reversibility have been conducted mostly in schizophrenic patients who continued to receive neuroleptics, while few studies have examined remission of TD after complete discontinuation of the offending agents [46,47]. For instance, in the study reporting 62 % resolution [45], and in other studies [48], patients were still treated with neuroleptic agents, and TD remission was associated with worsening parkinsonism. It is possible that the neuroleptic treatment partially masked ongoing TD [1].…”

Section: Is Td Reversible?mentioning

confidence: 99%

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

2014

View full text Add to dashboard Cite

Tardive dyskinesia (TD) is a serious, often disabling, movement disorder that is caused by medications that block dopamine receptors (i.e., neuroleptics, anti-emetics). There is currently no standard treatment approach for physicians confronted with such patients. This may be the result of notions that TD is disappearing because of the switch to secondgeneration antipsychotic agents and that it is largely reversible.In this article we demonstrate that second-generation antipsychotics do, indeed, cause TD and, in fact, the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years. In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn. Furthermore, neuroleptic agents are often utilized to treat TD, despite prolonged exposure being a risk factor for irreversibility. The outcome of these trends is a growing population afflicted with TD. We review non-neuroleptic agents that have shown positive results in small, early-phase, blinded trials, including tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba. Other options, such as botulinum toxin and deep brain stimulation, will also be discussed, and a suggested treatment algorithm is provided. While these agents are reasonable treatment options at this time there is a need, with a concerted effort between neurology and psychiatry, for full-scale drug development, including multicenter, randomized, blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones.

show abstract

Evolution of neuroleptic-induced extrapyramidal syndromes under long-term neuroleptic treatment

Cited by 33 publications

References 32 publications

Long-Stay Psychiatric Patients: A Prospective Study Revealing Persistent Antipsychotic-Induced Movement Disorder

Long-Stay Psychiatric Patients: A Prospective Study Revealing Persistent Antipsychotic-Induced Movement Disorder

Sensitivity to Antipsychotic Drugs in Older Adults

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

Contact Info

Product

Resources

About