Movement Disorders Induced by Antipsychotic Drugs: Implications of the CATIE Schizophrenia Trial

Abstract

Synopsis Drug-induced movement disorders have dramatically declined with the widespread use of second generation antipsychotics but remain important in clinical practice and for understanding antipsychotic pharmacology. The diagnosis and management of dystonia, parkinsonism, akathisia, catatonia, neuroleptic malignant syndrome and tardive dyskinesia are reviewed in relation to the decreased liability of the second generation antipsychotics contrasted with evidence from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial. Data from the CATIE trial imply that advantages of second generation antipsychotics in significantly reducing extrapyramidal side effects compared with haloperidol may be diminished when compared with modest doses of lower-potency first generation drugs, that the dichotomy between first and second generation drugs may be oversimplified, and that antipsychotics could be conceptualized as a single drug class with a spectrum of risk for movement disorders depending upon receptor binding affinities and individual patient susceptibility.

Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness

“…While the few randomized controlled trials on treating parkinsonism in patients without SMI had small to moderate effect sizes, [28][29][30] the association between antipsychotic type and dose and parkinsonism symptoms in patients with SMI has also been inconsistent. 7,10 Possible reasons for this are that patients with SMI generally receive such a high dose of antipsychotic medication, 1,30,31 around 2 DDD in our study, that a small dose reduction will have little effect. It is also possible that bradykinesia and parkinsonism symptoms in patients with SMI are not side effects of antipsychotic medication but neurologic soft signs that are part of the endophenotype of the underlying mental disorder.…”

“…[5][6][7][8] The 2 most prevalent movement disorders in this sample are parkinsonism and tardive dyskinesia (TD). 1,9,10 Current treatment guidelines vary for the management of tardive dyskinesia. [11][12][13] For parkinsonism, lowering antipsychotic dose is the recommended first step, followed by switching to a lower dopamine 2 (D 2 ) affinity antipsychotic or an SGA.…”

Risperidone induced angioedema with concurrent EPS symptoms: a case report and review of literature

“…Furthermore, the pathophysiology behind drug induced acute dystonia also remains unclear [13,14]. It has been suggested that there may be a correlation between D2 receptors and the occurrence of dystonia.…”

Das maligne neuroleptische Syndrom (MNS) – Eine systematische Übersicht

“…Die am häufigsten beschriebene Substanz, die ein MNS auslösen kann, ist Haloperidol [21,26], was sicherlich auch auf den häufi-gen und hochdosierten Einsatz insbesondere in den frühen Jahren des Gebrauchs von Antipsychotika zurückzuführen ist. Das MNS kann allerdings auch durch die neueren, sogenannten atypischen Antipsychotika oder durch die Reduktion bzw.…”