Incidence and correlates of tardive dyskinesia in first episode schizophrenia

Chakos, Miranda; Alvir, J.; Bilder, Robert M.; Woerner, Margaret G.; Kane, John M.; Koreen, A.; Geisler, Stephan; Lieberman, J.

doi:10.1016/0920-9964(95)95633-k

Cited by 30 publications

(43 citation statements)

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“…1,2 Several clinical variables such as aging, duration of antipsychotic treatment and female gender are associated with an increased propensity to develop TD, but their precise role in the pathophysiology of TD remains uncertain. 3 The high prevalence of TD and its disabling and poten-tially irreversible clinical course constitute an important limitation for treatment with typical antipsychotics.…”

Section: Introductionmentioning

confidence: 99%

A functional polymorphism of the cytochrome P450 1A2 (CYP1A2) gene: association with tardive dyskinesia in schizophrenia

et al. 2000

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Section: Introductionmentioning

confidence: 99%

A functional polymorphism of the cytochrome P450 1A2 (CYP1A2) gene: association with tardive dyskinesia in schizophrenia

et al. 2000

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“…We did not find an association between pre-treatment EPS and risk for developing tardive dyskinesia related to typical antipsychotic drugs. A similar observation was made in the Hillside Hospital study [16,36]. In the Hong Kong cohort, baseline EPS appeared to decline over the first 6 months of typical antipsychotic treatment.…”

Section: Discussionmentioning

confidence: 51%

First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

et al. 2011

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Extrapyramidal movement disorders are common in chronic schizophrenia, and may be an intrinsic feature of the illness as well as related to antipsychotic drug treatment. Similar dysfunctions at illness onset may have implications for outcome, and for understanding the mechanisms of illness. The objectives were to examine the clinical correlates of pre-treatment movement disorders at first episode of psychosis, and determine associations with neuropsychological function and striatal structure. Never medicated subjects were recruited from consecutive admissions to Early Psychosis Programs with defined catchment areas in Hong Kong, China, and Halifax, Canada. Standardized clinical, neuropsychological and brain imaging assessments were carried out at baseline and following acute and long term treatment with typical or atypical antipsychotic drugs. At the Hong Kong site, we studied 84 subjects with first episode psychosis (n = 10 with EPS). At the Halifax site, we studied 40 subjects with first episode psychosis (n = 17 with EPS), and 23 healthy comparison subjects. Subjects with movement disorders prior to treatment (EPS+) had higher total PANSS scores at baseline (mean elevation 19.9% Hong Kong, P = 0.016; 14.7% Halifax, P = 0.049). In subjects treated with atypical antipsychotics (all Halifax), EPS+ status at baseline predicted more movement disorders at long term follow up (P = 0.0005). In both cohorts, EPS+ subjects had poorer acute symptomatic treatment response assessed with the PANSS (Hong Kong P = 0.005; Halifax P = 0.017). Neuropsychological impairment related to executive dysfunction appeared greater in a small sample of EPS+ subjects (Hong Kong, effect size 0.26-0.27, P < 0.05). Caudate volumes were 4.5% larger in EPS+ compared with EPS-subjects (Halifax P = 0.042), and correlations between striatal volumes and age were different in the EPS+ group. In conclusion, pre-treatment EPS is present in a substantial minority of subjects with first episode psychosis, appears to persist at long term follow up, and is associated with poorer response of symptoms to treatment. Selective impairment of executive function and striatal enlargement provides evidence of abnormalities of brain function and structure associated with this aspect of early psychosis. schizophrenia, movement disorder, basal ganglia, antipsychotics, cognitive, psychosis Citation:Honer W G, Lang D J, Kopala L C, et al. First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment.

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“…Higher prevalence rates for women have been frequently, although not consistently, reported, with sex differences most often found for samples of older people (Yassa and Jeste, 1997). However, none of the previous prospective studies of FGAs, including our own, reported higher incidence rates for women, (Glazer et al, 1999;Woerner et al, 1998;Morgenstern and Glazer, 1993;Chakos et al, 1996) and one reported higher rates for men in an elderly sample (Yassa et al, 1992). Nevertheless, our study is relatively unique in that 70% of the participants were females, which is in contrast to an almost similar predominance of male schizophrenia trials and which possibly enhanced our power to assess TD risk in females.…”

Section: Discussionmentioning

confidence: 77%

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

Woerner

Correll

Alvir

et al. 2011

Neuropsychopharmacol

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Tardive dyskinesia (TD) rates with second-generation antipsychotics (SGAs) are considered to be low relative to first-generation antipsychotics (FGAs), even in the particularly vulnerable elderly population. However, risk estimates are unavailable for patients naïve to FGAs. Therefore, we aimed to determine the TD incidence in particularly vulnerable, antipsychotic-naïve elderly patients treated with the SGA risperidone or olanzapine. The present work describes a prospective inception cohort study of antipsychotic-naïve elderly patients aged X55 years identified at New York Metropolitan area in-patient and out-patient geriatric psychiatry facilities and nursing homes at the time of risperidone or olanzapine initiation. At baseline, 4 weeks, and at quarterly periods, patients underwent assessments of medical and medication history, abnormal involuntary movements, and extra-pyramidal signs. TD was classified using Schooler-Kane criteria. Included in the analyses were 207 subjects (age: 79.8 years, 70.0% female, 86.5% White), predominantly diagnosed with dementia (58.9%) or a major mood disorder (30.9%), although the principal treatment target was psychosis (78.7%), with (59.4%) or without (19.3%) agitation. With risperidone (n ¼ 159) the cumulative TD rate was 5.3% (95% confidence interval (CI): 0.7, 9.9%) after 1 year (mean dose: 1.0±0.76 mg/day) and 7.2% (CI: 1.4, 12.9%) after 2 years. With olanzapine (n ¼ 48) the cumulative TD rate was 6.7% (CI: 0, 15.6%) after 1 year (mean dose: 4.3±1.9 mg/day) and 11.1% (CI: 0, 23.1%) after 2 years. TD risk was higher in females, African Americans, and patients without past antidepressant treatment or with FGA co-treatment. The TD rates for geriatric patients treated with risperidone and olanzapine were comparable and substantially lower than previously reported for similar patients in direct observation studies using FGAs. This information is relevant for all patients receiving antipsychotics, not just the especially sensitive elderly.

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Incidence and correlates of tardive dyskinesia in first episode schizophrenia

Cited by 30 publications

References 0 publications

A functional polymorphism of the cytochrome P450 1A2 (CYP1A2) gene: association with tardive dyskinesia in schizophrenia

A functional polymorphism of the cytochrome P450 1A2 (CYP1A2) gene: association with tardive dyskinesia in schizophrenia

First episode psychosis with extrapyramidal signs prior to antipsychotic drug treatment

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

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