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Decina P, Mukherjee S, Caracci G, Harrison K. Painful sensory symptoms in neuroleptic-induced extrapyramidal syndromes. Am J Psychiatry 1992; 149:1075-80. [PMID: 1353315 DOI: 10.1176/ajp.149.8.1075] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors tested the hypothesis that neuroleptic-induced extrapyramidal syndromes are associated with painful sensations objectively conforming to the characteristics of primary sensory symptoms as reported in idiopathic and postencephalitic parkinsonism. METHOD The frequency of subjective painful sensory symptoms and their relation to neuroleptic-induced extrapyramidal syndromes were examined in a consecutive series of 107 psychiatric patients newly admitted to acute care units at a teaching hospital. Patients without illnesses or conditions likely to be associated with pain were included in the study if they had a diagnosis other than organic mental syndromes and were receiving psychotropic medications as prescribed by their treating physicians. Structured interviews with a modified version of the McGill Pain Questionnaire to assess sensory complaints and neurological examinations for neuroleptic-induced extrapyramidal syndromes (parkinsonism and akathisia) were conducted independently by two raters blind to each other's findings and patients' medication status. RESULTS Fourteen (23%) of 60 patients receiving neuroleptics reported experiences of spontaneous pain subjectively attributed to pharmacological treatment, compared with only one (2%) of 47 patients receiving psychotropic medications other than neuroleptics. There was no difference between these two groups in subjective complaints of paresthesia (8% versus 9%). Twelve (55%) of the 22 patients with neuroleptic-induced extrapyramidal syndromes reported pain, compared with only two (5%) of the 38 patients who received neuroleptics but did not experience extrapyramidal syndromes. CONCLUSIONS Although consonant with the study hypothesis, these results should be regarded as preliminary and interpreted conservatively in the light of the methodological limitations of the study.
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Levin H, Chengappa KN, Kambhampati RK, Mahdavi N, Ganguli R. Should chronic treatment-refractory akathisia be an indication for the use of clozapine in schizophrenic patients? J Clin Psychiatry 1992; 53:248-51. [PMID: 1353492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND Clozapine, an atypical neuroleptic, is an effective medication in a subgroup of schizophrenic patients who have either failed to respond to the typical neuroleptics or experienced intolerable side effects such as neuroleptic malignant syndrome and disabling tardive dyskinesia. Its efficacy for persistent and disabling akathisia is less clear. Akathisia, especially the chronic and disabling form, can be a treatment dilemma for the clinician and the patient. METHOD We describe three representative case illustrations of schizophrenic patients who had severe, persistent treatment-resistant akathisia. Two of them had refractory psychoses and the third had multiple disabling side effects during treatment with typical neuroleptics. Two had tardive dyskinesia. These patients were treated with clozapine while other neuroleptics were discontinued. RESULTS During a 2-year follow-up, these patients made impressive social and vocational strides coinciding with a fairly rapid remission of akathisia (under 3 months) and a lesser though notable improvement in the psychoses. Tardive dyskinesia also remitted, though over a period of 6 to 12 months. CONCLUSION Our experience leads us to suggest a trial of clozapine in a subgroup of schizophrenic patients, who in addition to refractory psychoses have persistent disabling akathisia. However, given the risk of agranulocytosis with clozapine, we suggest that the usual treatment strategies for akathisia be tried before clozapine is initiated in the approved manner. Future controlled trials of clozapine that specifically investigate persistent akathisia may answer this question more conclusively.
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Kahn EM, Munetz MR, Davies MA, Schulz SC. Akathisia: clinical phenomenology and relationship to tardive dyskinesia. Compr Psychiatry 1992; 33:233-6. [PMID: 1353716 DOI: 10.1016/0010-440x(92)90046-s] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Akathisia and tardive dyskinesia (TD) are disorders of movement that are often associated with administration of antipsychotic medication. We surveyed 196 outpatients in a schizophrenia clinic, all receiving antipsychotic medication, for the presence of these disorders. Clinical global ratings of akathisia were reliable. Akathisia was found in 36% of patients, and TD in 23.5%. Akathisia was disproportionately common in patients receiving high-potency neuroleptics. The data affirmed recent revisions in the dose-equivalence formulas used with fluphenazine decanoate. Akathisia and TD did not seem to be interrelated. Because akathisia is common and often limits medication dose and contributes to noncompliance, psychiatrists must take this into account when prescribing antipsychotic medication.
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Pearlman T. Fluoxetine and suicidality. J Clin Psychiatry 1992; 53:256-7. [PMID: 1639746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Wirshing WC, Van Putten T, Rosenberg J, Marder S, Ames D, Hicks-Gray T. Fluoxetine, akathisia, and suicidality: is there a causal connection? ARCHIVES OF GENERAL PSYCHIATRY 1992; 49:580-1. [PMID: 1627050 DOI: 10.1001/archpsyc.1992.01820070074012] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Sachdev P. Drug-induced movement disorders in institutionalised adults with mental retardation: clinical characteristics and risk factors. Aust N Z J Psychiatry 1992; 26:242-8. [PMID: 1353672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Fifty-three institutionalised adults with mental retardation, the majority (73.5%) moderate to severe, were examined for drug-induced movement disorders. Using a global AIMS score of 2 or more, 16 (34%) of the 47 subjects who had been exposed to neuroleptics had tardive dyskinesia (TD). Three of these had developed the dyskinesia upon withdrawal of neuroleptics. The dyskinetic movements were mainly seen in the lingual, perioral and other facial muscles. Two (33%) out of 6 subjects with no history of exposure to neuroleptics also had similar dyskinetic movements. The total neuroleptic dose significantly, and age marginally, but not sex, brain damage or level of mental retardation, emerged as risk factors for TD. Two (3.7%) subjects had definite akathisia and 16 (30.8%) significant extrapyramidal side effects. This study supports the findings of previous studies of considerable neurological adverse effects of neuroleptics in this patient group and cautions against their injudicious use. It provides further evidence for some putative risk factors for TD and is noteworthy for its lack of support for the contentious issue of brain damage as a risk factor.
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Milne IK. Akathisia associated with carbamazepine therapy. THE NEW ZEALAND MEDICAL JOURNAL 1992; 105:182. [PMID: 1589172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dumon JP, Catteau J, Lanvin F, Dupuis BA. Randomized, double-blind, crossover, placebo-controlled comparison of propranolol and betaxolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 1992; 149:647-50. [PMID: 1349458 DOI: 10.1176/ajp.149.5.647] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Beta-blocking agents, particularly propranolol, are considered effective in the treatment of neuroleptic-induced akathisia, but considerable controversy exists about the involved receptor subtype(s). The authors conducted a randomized, controlled trial comparing the effects of propranolol and betaxolol to determine whether central beta 1-adrenoceptor blockade is sufficient to correct neuroleptic-induced akathisia. METHOD The subjects were 19 patients whose neuroleptic-induced akathisia responded to 20 mg/day of propranolol and subsequently reemerged during a placebo washout period. They were randomly assigned to propranolol (20 or 40 mg/day) or betaxolol (10 or 20 mg/day) and, after another placebo period, were switched to the second beta blocker. RESULTS There was no significant difference in the antiakathisia effects of propranolol and betaxolol. CONCLUSIONS The lack of difference between propranolol and betaxolol suggests that beta 1-adrenoceptor blockade is sufficient to improve neuroleptic-induced akathisia. The results of this explanatory study need therapeutic confirmation.
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Abstract
Although extrapyramidal side effects of two commonly used antiemetics, metoclopramide and prochlorperazine, are well known, it may be difficult for even the experienced practitioner to distinguish some of these extrapyramidal reactions from such psychiatric symptoms as anxiety, depression, or catatonia. Certain patient groups have increased susceptibility to these extrapyramidal reactions, including patients under 30, those with AIDS, those with renal disease, oncology patients, and possibly women. Physicians should maintain a high index of suspicion for depression, anxiety, or catatonia if their patients are taking antiemetics. These symptoms may be extrapyramidal side effects of the antiemetic rather than indications of a primary mental disorder.
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Velamoor VR, Swamy GN, Parmar RS. Confusion, agitation and rigidity: early signs of NMS? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1992; 37:280. [PMID: 1351791 DOI: 10.1177/070674379203700422] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bernstein L, Daviss SR. Organic anxiety disorder with symptoms of akathisia in a patient treated with the immunosuppressant FK506. Gen Hosp Psychiatry 1992; 14:210-1. [PMID: 1376291 DOI: 10.1016/0163-8343(92)90086-p] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Brown KW, White T, Anderson F, McGilp R. Handedness as a risk factor for neuroleptic-induced movement disorders. Biol Psychiatry 1992; 31:746-8. [PMID: 1350923 DOI: 10.1016/0006-3223(92)90287-a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nishimatsu O, Horiguchi J, Inami Y, Innami T, Sasaki A, Kondo K. Nocturnal Myoclonus Observed in a Patient with Neuroleptic-Induced Akathisia. Psychiatry Clin Neurosci 1992; 46:121-6. [PMID: 1353123 DOI: 10.1111/j.1440-1819.1992.tb00826.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An all-night polysomnogram was twice recorded in a patient with neuroleptic-induced akathisia (NIA). The polysomnogram revealed nocturnal myoclonus. After disappearance of akathisia by the administration of clonazepam, we recorded the second polysomnogram. At the second examination, sleep efficacy increased and the total number of nocturnal myoclonus decreased remarkably. The mean inter-movement interval of nocturnal myoclonus prolonged. These findings suggest a close relationship between the mechanisms of neuroleptic-induced akathisia and nocturnal myoclonus.
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Ayd FJ. The present status of akathisia. J Nerv Ment Dis 1992; 180:208-10. [PMID: 1350304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Miller CH, Hummer M, Pycha R, Fleischhacker WW. The effect of ritanserin on treatment-resistant neuroleptic induced akathisia: case reports. Prog Neuropsychopharmacol Biol Psychiatry 1992; 16:247-51. [PMID: 1349760 DOI: 10.1016/0278-5846(92)90076-q] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. The authors report three cases of neuroleptic induced akathisia resistant to treatment with anticholinergics, benzodiazepines and betablockers. 2. All three patients were treated with Ritanserin 10 mg bid and improved rapidly and substantially. 3. Discontinuation of Ritanserin led to a recurrence of akathisia.
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Hermesh H, Aizenberg D, Friedberg G, Lapidot M, Munitz H. Electroconvulsive therapy for persistent neuroleptic-induced akathisia and parkinsonism: a case report. Biol Psychiatry 1992; 31:407-11. [PMID: 1348431 DOI: 10.1016/0006-3223(92)90235-r] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuroleptic-induced akathisia (NIA) and parkinsonism (NIP) continued for 3 months, despite two courses of anticholinergic treatments, a shift to low-potent neuroleptic (NL) and a NL-free period. The two adverse effects responded dramatically to electroconvulsive therapy (ECT) to reemerge 3 months after termination of ECT. The case supports the idea that ECT is effective for both NIA and NIP even when they are resistant.
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Nordström AL, Farde L, Halldin C. Time course of D2-dopamine receptor occupancy examined by PET after single oral doses of haloperidol. Psychopharmacology (Berl) 1992; 106:433-8. [PMID: 1533719 DOI: 10.1007/bf02244811] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Central D2-dopamine receptor occupancy was followed by repeated PET experiments after administration of single oral doses of haloperidol to four healthy men. D2-dopamine receptor occupancy was high already 3 h after administration of 4 and 7.5 mg haloperidol and remained high for at least 27 h. Akathisia appeared when D2-dopamine receptor occupancy was maximal. After initiation of neuroleptic drug treatment several days or weeks may elapse before antipsychotic effect is evident. The results of this study do not indicate that any late onset of the antipsychotic effect is related to an insufficient D2-dopamine receptor occupancy during the first days of treatment.
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Farde L. Selective D1- and D2-dopamine receptor blockade both induces akathisia in humans--a PET study with [11C]SCH 23390 and [11C]raclopride. Psychopharmacology (Berl) 1992; 107:23-9. [PMID: 1534178 DOI: 10.1007/bf02244961] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pharmacological effects were recorded and time course for receptor binding in brain was followed by positron emission tomography after IV injection of the selective D1-dopamine receptor antagonist SCH 23390 in four healthy subjects in doses of 310-810 micrograms. Akathisia, the syndrome of motor restlessness, appeared after the three highest doses. The akathisia was transient and occurred only when [11C]SCH 23390 binding in the basal ganglia was at a high level with a central D1-dopamine receptor occupancy of 45-59%. The D2-dopamine receptor antagonist [11C]raclopride was injected IV into 20 healthy subjects and 13 schizophrenic patients. Akathisia appeared in 14 healthy subjects and 7 patients and coincided with maximal [11C]raclopride binding in the basal ganglia. The findings for [11C]raclopride and [11C]SCH 23390 are the first demonstration of a relationship between time courses for radioligand binding in the human brain and simultaneously induced pharmacological effects.
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Yeragani VK, Pohl R, Balon R, Ramesh C, Weinberg P. Imipramine-induced jitteriness and decreased serum iron levels. Neuropsychobiology 1992; 25:8-10. [PMID: 1603294 DOI: 10.1159/000118801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Jitteriness appears to be a specific side effect of tricyclic antidepressant treatment in panic disorder patients. In addition, the patients with jitteriness have lower serum iron levels compared to those that do not develop jitteriness (p = 0.01).
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Hassanyeh F, Murray RB, Rodgers H. Adrenocortical suppression presenting with agitated depression, morbid jealousy, and a dementia-like state. Br J Psychiatry 1991; 159:870-2. [PMID: 1790462 DOI: 10.1192/bjp.159.6.870] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 66-year-old woman showed profound neuropsychiatric disturbance after withdrawal from prolonged corticosteroid treatment. Reintroduction of an alternative corticosteroid, at low dose, produced a return to premorbid mental state.
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Kastrup O, Eikmeier G, Gastpar M. [Central anticholinergic intoxication syndrome. A contribution to the differential diagnosis of exogenous psychoses]. Dtsch Med Wochenschr 1991; 116:1748-51. [PMID: 1935662 DOI: 10.1055/s-2008-1063813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A withdrawal syndrome in a 50-year-old alcoholic subsided within 5 days in response to treatment with doxepin (150 mg/d). But 2 days later he developed auditory hallucinations which were interpreted as alcohol hallucinations, for which he was additionally given haloperidol, 15 mg/d. He then developed early dyskinesia which was treated with 5 mg biperiden i.v. followed by twice 2 mg/d by mouth, while doxepin and haloperidol were continued. 5 days after detoxification there occurred, under this combination of drugs which included two with marked anticholinergic action, an anticholinergic intoxication syndrome characterized by restlessness, optical hallucinations, dysarthritic speech, mydriasis, urinary retention, fever, tachycardia and red, dry skin. After all previous drugs had been discontinued and clomethiazole started, the intoxication syndrome began to regress within 3 days. The case demonstrates the need to consider a central anticholinergic syndrome, which could end fatally, as a possible cause of otherwise unexplained delirium.
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