Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study

Bakker, P. Roberto; Groot, Izaäk W. de; Os, Jim van; Harten, Peter N. van

doi:10.1017/s204579601300019x

Cited by 10 publications

(13 citation statements)

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“…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.…”

Section: 13mentioning

confidence: 84%

“…[2][3][4] Movement disorders are especially prevalent among patients with serious mental illness (SMI), owing to frequent polypharmacy and because more severe symptoms are associated with increased risk of movement disorders. [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.…”

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confidence: 99%

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

Mentzel

Bakker

et al. 2017

J. Clin. Psychiatry

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Objective: To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). Methods: We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D 2 ) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. Results: There was a significant association between reduction in TD severity and starting/switching to an FGA (B = −3.54, P < .001) and starting/switching to a high D 2 affinity antipsychotic (B = −2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = −2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = −7.76, P < .01 in FGA/SGA-switch model; B = −7.74, P < .01 in D 2 affinity switch model), while starting a high D 2 affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D 2 affinity switch model). Conclusions:The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D 2 affinity antipsychotic may reduce the severity of TD.

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Section: 13mentioning

confidence: 84%

mentioning

confidence: 99%

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

Mentzel

Bakker

et al. 2017

J. Clin. Psychiatry

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“…5 Most people needing antipsychotic medication live in low-and middle-income countries, where the highest potency antipsychotic drugs may be the only ones available. TD is with us from treatments of the past, and continues to emerge from treatment practices of the present.…”

Section: Recommendations For Researchmentioning

confidence: 99%

“…4 For example, one recent, well-conducted survey from the Netherlands found that, of 209 people with chronic severe mental illness receiving antipsychotic medication, 28% had TD (yearly incidence rate of TD 19.6%). 5,6 Furthermore, the study reconfirmed that TD was positively associated with age [hazard ratio per year exposure 1.04, 95% confidence interval (CI) 1.02 to 1.06]. 5,6 The large, definitive US randomised trial of antipsychotic treatments for schizophrenia [Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)], with a 4-year period of follow-up, obtained an incidence rate of TD of around 17% and found no significant difference in rates between first-and second-generation (olanzapine, quetiapine, risperidone, ziprasidone) antipsychotics.…”

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confidence: 99%

“…5,6 Furthermore, the study reconfirmed that TD was positively associated with age [hazard ratio per year exposure 1.04, 95% confidence interval (CI) 1.02 to 1.06]. 5,6 The large, definitive US randomised trial of antipsychotic treatments for schizophrenia [Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)], with a 4-year period of follow-up, obtained an incidence rate of TD of around 17% and found no significant difference in rates between first-and second-generation (olanzapine, quetiapine, risperidone, ziprasidone) antipsychotics. 7 A prospective cohort study of 352 psychiatric outpatients confirmed this, 8 but a meta-analysis of nine other studies carried out by the same study authors showed that the yearly TD incidence rate for FGAs was significantly higher than for SGAs; however, many of these studies were not predesigned to detect TD.…”

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confidence: 99%

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Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia

Walker

Nikolakopoulou

Soares‐Weiser

et al. 2017

Health Technol Assess

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BackgroundAntipsychotic medication can cause tardive dyskinesia (TD) – late-onset, involuntary, repetitive movements, often involving the face and tongue. TD occurs in > 20% of adults taking antipsychotic medication (first-generation antipsychotics for > 3 months), with this proportion increasing by 5% per year among those who continue to use these drugs. The incidence of TD among those taking newer antipsychotics is not different from the rate in people who have used older-generation drugs in moderate doses. Studies of TD have previously been found to be limited, with no treatment approach shown to be effective.ObjectivesTo summarise the clinical effectiveness and safety of treatments for TD by updating past Cochrane reviews with new evidence and improved methods; to undertake public consultation to gauge the importance of the topic for people living with TD/the risk of TD; and to make available all data from relevant trials.Data sourcesAll relevant randomised controlled trials (RCTs) and observational studies.Review methodsCochrane review methods, network meta-analysis (NMA).DesignSystematic reviews, patient and public involvement consultation and NMA.SettingAny setting, inpatient or outpatient.ParticipantsFor systematic reviews, adults with TD who have been taking a stable antipsychotic drug dose for > 3 months.InterventionsAny, with emphasis on those relevant to UK NHS practice.Main outcome measuresAny measure of TD, global assessments and adverse effects/events.ResultsWe included 112 studies (nine Cochrane reviews). Overall, risk of bias showed little sign of improvement over two decades. Taking the outcome of ‘TD symptoms improved to a clinically important extent’, we identified two trials investigating reduction of antipsychotic dose [n = 17, risk ratio (RR) 0.42, 95% confidence interval (CI) 0.17 to 1.04; very low quality]. Switching was investigated twice in trials that could not be combined (switching to risperidone vs. antipsychotic withdrawal: one RCT,n = 42, RR 0.45, 95% CI 0.23 to 0.89; low quality; switching to quetiapine vs. haloperidol: one RCT,n = 45, RR 0.80, 95% CI 0.52 to 1.22; low quality). In addition to RCTs, six observational studies compared antipsychotic discontinuation with decreased or increased dosage, and there was no clear evidence that any of these strategies had a beneficial effect on TD symptoms (very low-quality evidence). We evaluated the addition to standard antipsychotic care of several treatments, but not anticholinergic treatments, for which we identified no trials. We found no clear effect of the addition of either benzodiazepines (two RCTs,n = 32, RR 1.12, 95% CI 0.6 to 2.09; very low quality) or vitamin E (six RCTs,n = 264, RR 0.95, 95% CI 0.89 to 1.01; low quality). Buspirone as an adjunctive treatment did have some effect in one small study (n = 42, RR 0.53, 95% CI 0.33 to 0.84; low quality), as did hypnosis and relaxation (one RCT,n = 15, RR 0.45, 95% CI 0.21 to 0.94; very low quality). We identified no studies focusing on TD in people with dementia. The NMA model found indirect estimates to be imprecise and failed to produce useful summaries on relative effects of interventions or interpretable results for decision-making. Consultation with people with/at risk of TD highlighted that management of TD remains a concern, and found that people are deeply disappointed at the length of time it has taken researchers to address the issue.LimitationsMost studies remain small and poorly reported.ConclusionsClinicians, policy-makers and people with/at risk of TD are little better informed than they were decades ago. Underpowered trials of limited quality repeatedly fail to provide answers.Future workTD reviews have data from current trials extracted, tabulated and traceable to source. The NMA highlights one context in which support for this technique is ill advised. All relevant trials, even if not primarily addressing the issue of TD, should report appropriate binary outcomes on groups of people with this problem. Randomised trials of treatments for people with established TD are indicated. These should be large (> 800 participants), necessitating accrual through accurate local/national registers, including an intervention with acceptable treatments and recording outcomes used in clinical practice.Study registrationThis study is registered as PROSPERO CRD4201502045.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Use of Medications in the Treatment of Aggressive Behavior

Charlot

Sheehan²,

Hassiotis³

2019

Handbook of Intellectual Disabilities

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Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study

Cited by 10 publications

References 13 publications

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

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

Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia

Use of Medications in the Treatment of Aggressive Behavior

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