The inter-relationships of tardive dyskinesia, parkinsonism, akathisia and tardive dystonia: the Curaçao Extrapyramidal Syndromes Study II

A study of the four extrapyramidal syndromes (EPS), tardive dyskinesia, parkinsonism, akathisia and tardive dystonia, was performed in the Netherlands Antilles, a well-defined catchment area with only one psychiatric hospital. The population under study (N = 194; mean age 53.1) was mainly Afro-Caribbean, and most patients were chronic. The severity of each EPS was measured with valid and reliable rating scales. The purpose was to study both the strength of the inter-relationships of EPS and the prevalence of combinations of EPS. The inter-relationships between the EPS were analyzed by means of logistic regression. The adjusted odds ratios between the various EPS revealed strong connections between the hyperkinetic syndromes (tardive dyskinesia, tardive dystonia and akathisia). Parkinsonism was found to be inversely related to tardive dyskinesia and to tardive dystonia. Almost 30% of the patients suffered from two or more EPS. The highest prevalence rates of combinations were: tardive dyskinesia combined with parkinsonism 12.9%, tardive dyskinesia combined with tardive dystonia 9.8%, and tardive dyskinesia combined with akathisia 5.2%. Our findings show a strong positive correlation between hyperkinetic forms of EPS. Furthermore, chronic psychiatric inpatients regularly suffer from combinations of EPS. Different treatment strategies are suggested for various combinations of EPS.

Schizoid personality disorder after prenatal exposure to famine

OBJECTIVE

The authors tested whether early prenatal exposure to famine was associated with schizophrenia spectrum personality disorder in addition to being associated with schizophrenia per se as shown in a previous study.

METHOD

The risk of schizoid personality disorder, as defined by ICD-6 to ICD-9, in men at age 18 years was compared in birth cohorts that were conceived at the height of the Dutch Hunger Winter famine and in unexposed birth cohorts of 1944-1946 in the famine region of Holland.

RESULTS

The exposed cohort had a significantly greater risk (relative risk = 2.01) of schizoid personality disorder.

CONCLUSIONS

Prenatal nutritional deficiency was associated with a greater risk of schizoid personality disorder in men at age 18 years.

The prevalence of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia The Curaçao Extrapyramidal Syndromes Study: I

A prevalence study of extrapyramidal syndromes was conducted among all psychiatric inpatients of the Netherlands Antilles (n = 194; mean age 53.1). The Netherlands Antilles are very suitable for epidemiological research as it is a well-defined catchment area with only one psychiatric hospital and a health care system based on western principles. In this mainly chronic population, the prevalence was measured of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia using respectively the Fahn-Marsden rating scale, the Abnormal Involuntary Movement Scale, the Unified Parkinson Disease Rating Scale and the Barnes Akathisia Rating Scale. The prevalence numbers were for tardive dystonia 13.4%, tardive dyskinesia 39.7%, parkinsonism 36.1%, akathisia 9.3% and pseudoakathisia 12.9%. The most important conclusions were: (1) The prevalence of tardive dystonia was higher than reported in most other studies and (2) extrapyramidal syndromes are very common in this predominantly Negroid population, with three out of four patients suffering of one or more extrapyramidal syndromes.

Schizophrenia after prenatal famine. Further evidence

BACKGROUND

Suggestive findings of an earlier study that prenatal nutritional deficiency was a determinant of schizophrenia prompted us to undertake a second test of the hypothesis using more precise data on both exposure and outcome.

METHODS

Among persons born in the cities of western Netherlands during 1944 through 1946, we compared the risk for schizophrenia in those exposed and unexposed during early gestation to the Dutch Hunger Winter of 1944/1945. The frequency of hospitalized patients with schizophrenia at age 24 to 48 years in the exposed and unexposed birth cohorts was ascertained from a national psychiatric registry.

RESULTS

The most exposed birth cohort, conceived at the height of the famine, showed a twofold and statistically significant increase in the risk for schizophrenia (relative risk [RR] = 2.0; 95% confidence interval [CI] = 1.2 to 3.4; P < .01) in both men (RR = 1.9; 95% CI = 1.0 to 3.7; P = .05) and women (RR = 2.2; 95% CI = 1.0 to 4.7; P = .04). Among all birth cohorts of 1944 through 1946, the risk for schizophrenia clearly peaked in this exposed cohort.

CONCLUSION

Prenatal nutritional deficiency may play a role in the origin of some cases of schizophrenia.

Impact of urbanization on detection rates of eating disorders

OBJECTIVE

The purpose of this study was to examine the incidence of anorexia nervosa and bulimia nervosa among patients in primary care and to evaluate the impact of urbanization, age and sex differences, and changes over time.

METHOD

During 1985-1989, 58 general practitioners, trained in diagnosing eating disorders, registered all of their patients who had diagnoses of anorexia nervosa and/or bulimia nervosa according to strict criteria. The study population (N = 151,781) was 1% of the population of the Netherlands; the distribution of sexes, ages, geographical locations, and degrees of urbanization in the study group was representative of the Dutch population. Main outcome measures were rates of newly detected cases and age-adjusted rate ratios.

RESULTS

The crude annual incidence rate of detected cases in primary care per 100,000 person-years was 8.1 for anorexia nervosa and 11.5 for bulimia nervosa. The incidence of bulimia nervosa was lowest in rural areas, intermediate in urbanized areas, and highest in large cities (6.6, 19.9, and 37.9, respectively, per 100,000 females per year); no rural-urban differences for anorexia nervosa were found. Pronounced sex and age differences in incidence rates were observed. Over the 5-year period, there was no time trend in the incidence of anorexia nervosa, but the incidence of bulimia nervosa tended to increase.

CONCLUSIONS

The incidence rates of eating disorders--as defined by detection rates in primary care--are higher than previously reported. Urbanization seems to be a risk factor for bulimia nervosa but not for anorexia nervosa.

The incidence and prevalence of anorexia nervosa and bulimia nervosa in primary care

General practitioners using DSM-III criteria have studied the incidence and prevalence of anorexia nervosa and bulimia nervosa in a large (N = 151,781) representative sample of the Dutch population. The incidence rate for anorexia nervosa is 6.3 and for bulimia nervosa 9.9 per year per 100,000 population. The prevalence of bulimia nervosa is three times higher in larger cities than in smaller urbanized or rural areas, while anorexia nervosa is found with almost equal frequency in areas with a different degree of urbanization.

Patterns of care of anorexia nervosa

Using a local Psychiatric Case Register we studied patterns of mental health care of patients with anorexia nervosa as the main diagnosis from 1974 to 1982. The incidence rate was 5.0 per year per 100,000 population and 37.1 per year per 100,000 females aged 15 to 24. The patients had an intensive pattern of care compared with other diagnostic groups. Using the national case register of inpatients we studied some characteristics of patients with anorexia nervosa. Patients with anorexia nervosa have a higher degree of education and more general education than average. Patients with anorexia nervosa only are younger, have a higher degree of education and more general education than patients with anorexia nervosa and another psychiatric disorder. The results suggest that in some cases we should consider anorexia nervosa as a symptom, not as a disease entity by itself.