The Influence of Anticholinergic Treatment on Tardive Dyskinesia Caused by Neuroleptic Drugs:

Abstract

lhe new highpotency neuroleptic drugs used i n t h e long-term treatment of psychiatric p a t i e n t s have v i r t u a l l y eliminated concern about many formerly important adverse effects other than t a r d i v e dyskinesia (TD). It has been postulated that t h e dopaminergic-cholinergic balance influences t h e dyskinetic movements of TD. Anticholinergic drugs have been used i n t h e treatment of parkinsonian as w e l l as acute dystonic symptoms caused by neuroleptic drugs (Paldessarini 1979, Gerlach 1979. C h t h e o t h e r hand, anticholinergic treatment has been observed t o enhance t h e signs of TD (Burnett e t a l . 1980, Hollister 1980). lhe aim of t h i s study was t o examine t h e effect of cessation of a n t icholinergic drugs on t h e TD i n psychiatric p a t i e n t s on long-standing neurol e p t i c medication. 13 chronic psychiatric p a t i e n t s , whose diagnoses were schizophrenia i n 12 and chronic depressive syndrome i n one of t h e cases, were included i n t h e study. lhe mean age of t h e p a t i e n t s was 55,8 years and t h e i r psychia t r i c disease had l a s t e d For an awerage of 26,8 years. e r g i c (AC) as w e l l as t h e neuroleptic treatment had been unchanged f o r a t least two months before t h e study. ?he t a r d i v e dyskinesia syndrome was o r a l i n 7, and generalized type i n 6 of t h e cases. Furthermore, parkinsonian s i g n s were observed i n 4 of t h e 13 cases during AC treatment. lhe AC treatment was biperiden 2-6 mglday i n 10, orphenadine 100-150 mg/day i n 2, and methixene 30 mg/day i n one of t h e 13 p a t i e n t s . 'he indication f o r A C treatment had been manifest parkinsonian s i g n s caused by neuroleptics i n 7 and t h e prophylaxis of these signs i n 6 cases. lhe grade of TD before and 1-2 weeks a f t e r withdrawing t h e anticholine r g i c s w a s estimated using t h e AIMS scale (Fann e t a l . 1980) as demonstrat e d i n Table 1. or' t h e A I K S grades were observed ( p c : 0 , 0 5 ; X t e s t ) , with t o t a l disappearance of t h e dyskinetic movements i n two cases.