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Comparison of Extrapyramidal Symptoms Among Outpatients With Schizophrenia on Long-Acting Injectable Antipsychotics. J Clin Psychopharmacol 2022; 42:475-479. [PMID: 35977035 DOI: 10.1097/jcp.0000000000001580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extrapyramidal symptoms (EPSs) are adverse effects of antipsychotics. Different risks of EPSs have been attributed to the 3 classes of antipsychotics. This study aimed to assess EPS in a clinical sample of schizophrenia patients who are on LAI and compare the severity of EPSs among the following 3 antipsychotic groups: (1) partial agonist, (2) second-generation antipsychotics, and (3) first-generation antipsychotics. METHODS Ninety-two patients were recruited from the Schizophrenia Program Injection Clinic. Using the Extrapyramidal Symptom Rating Scale (ESRS), severity of EPS was assessed and information regarding factors associated with risk of EPS, including coprescriptions, comorbidities, and demographics, was obtained from medical charts. Group differences in ESRS scores and subscores were analyzed using 1-way analyses of variances. RESULTS Among the 3 groups, there was no significant difference in total ESRS scores and subscores. Risperidone was associated with higher ESRS scores when compared with paliperidone, aripiprazole, and flupenthixol. Doses above maximum were commonly used in the paliperidone group, and there was no significant difference in total ESRS scores between the low, average, or above-maximum doses of paliperidone. CONCLUSIONS Our results demonstrated a comparative risk of EPS across all 3 antipsychotic classes. Risperidone was associated with more EPS compared with other medications. A higher threshold for the "maximum dose" of paliperidone could be considered and higher doses used with the same cautions as low-average doses.
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Lugg W. Antipsychotic-induced supersensitivity - A reappraisal. Aust N Z J Psychiatry 2022; 56:437-444. [PMID: 34144649 DOI: 10.1177/00048674211025694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced 'supersensitivity', albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity. CONCLUSIONS Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.
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Affiliation(s)
- William Lugg
- Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Willems AE, Mentzel CL, Bakker PR, Van Os J, Tenback DE, Gelan P, Daantjes E, Matroos GE, Hoek HW, Van Harten PN. Movement Disorders and Mortality in Severely Mentally Ill Patients: The Curacao Extrapyramidal Syndromes Study XIV. Schizophr Bull 2022; 48:766-773. [PMID: 35486807 PMCID: PMC9212096 DOI: 10.1093/schbul/sbac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS There is a substantial gap in life expectancy between patients with severe mental illness (SMI) and the general population and it is important to understand which factors contribute to this difference. Research suggests an association between tardive dyskinesia (TD) and mortality; however, results are inconclusive. In addition, studies investigating associations between parkinsonism or akathisia and mortality are rare. We hypothesized that TD would be a risk factor for mortality in patients with SMI. STUDY DESIGN We studied a cohort of 157 patients diagnosed predominantly with schizophrenia on the former Netherlands Antilles. TD, parkinsonism, and akathisia were assessed with rating scales on eight occasions over a period of 18 years. Twenty-four years after baseline, survival status and if applicable date of death were determined. Associations between movement disorders and survival were analyzed using Cox regression. Sex, age, antipsychotics, antidepressants and benzodiazepines at each measurement occasion were tested as covariates. STUDY RESULTS Parkinsonism was a significant risk factor with an HR of 1.02 per point on the motor subscale of the Unified Parkinson's Disease Rating Scale (range 0-56). TD and akathisia were not significantly associated with mortality. CONCLUSIONS Parkinsonism may be an important risk factor for mortality in SMI patients. This finding calls for more follow-up and intervention studies to confirm this finding and to explore whether treatment or prevention of parkinsonism can reduce excess mortality.
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Affiliation(s)
- Anne E Willems
- To whom correspondence should be addressed; GGz Centraal, Zon & Schild, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands; tel: 31-6-22332116, e-mail:
| | - Charlotte L Mentzel
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands,School for Mental Health and NeuroScience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | | | - Jim Van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands,King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Diederik E Tenback
- Veldzicht Centre for Transcultural Psychiatry, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Balkbrug, The Netherlands,FPC de Oostvaarderskliniek, Custodial Institutions Agency (DJI), Ministry of Justice and Security, Almere, The Netherlands
| | - Petra Gelan
- Capriles Psychiatric Clinic, GGz Curaçao, Groot Kwartier, Curaçao
| | - Erna Daantjes
- Capriles Psychiatric Clinic, GGz Curaçao, Groot Kwartier, Curaçao
| | - Glenn E Matroos
- Capriles Psychiatric Clinic, GGz Curaçao, Groot Kwartier, Curaçao
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands,Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands,Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Peter N Van Harten
- Research Department, Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands,School for Mental Health and NeuroScience (MHeNS), Maastricht University, Maastricht, The Netherlands
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Pieters LE, Nadesalingam N, Walther S, van Harten PN. A systematic review of the prognostic value of motor abnormalities on clinical outcome in psychosis. Neurosci Biobehav Rev 2021; 132:691-705. [PMID: 34813828 DOI: 10.1016/j.neubiorev.2021.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/09/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
Schizophrenia spectrum disorders have heterogeneous outcomes and currently no marker predicts the course of illness. Motor abnormalities (MAs) are inherent to psychosis, the risk of psychosis, symptom severity, and brain alterations. However, the prognostic value of MAs is still unresolved. Here, we provide a systematic review of longitudinal studies on the prognostic role of MAs spanning individuals at clinical high risk for psychosis (CHR), patients with first-episode psychosis (FEP), and chronic schizophrenia. We included 68 studies for a total of 23,630 subjects that assessed neurological soft signs (NSS), hypo- or hyperkinetic movement disorders and/or catatonia as a prognostic factor on clinical and functional outcomes. We found increased levels of MAs, in particular NSS, parkinsonism, and dyskinesia, were related to deteriorating symptomatic and poor functional outcome over time. Collectively, the findings emphasize the clinical, prognostic and scientific relevance of MA assessment and detection in individuals with or at risk of psychosis. In the future, instrumental measures of MA are expected to further augment detection, early intervention and treatment strategies in psychosis.
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Affiliation(s)
- Lydia E Pieters
- Psychiatric Center GGz Centraal, Amersfoort, Research Department, Postbus 3051, 3800 DB Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, CH-3000 Bern 60, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, CH-3000 Bern 60, Switzerland
| | - Peter N van Harten
- Psychiatric Center GGz Centraal, Amersfoort, Research Department, Postbus 3051, 3800 DB Amersfoort, The Netherlands; Department of Psychiatry, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Misgana T, Yigzaw N, Asfaw G. Drug-Induced Movement Disorders and Its Associated Factors Among Patients Attending Treatment at Public Hospitals in Eastern Ethiopia. Neuropsychiatr Dis Treat 2020; 16:1987-1995. [PMID: 32884274 PMCID: PMC7443022 DOI: 10.2147/ndt.s261272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/01/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Antipsychotic medications have both beneficial and undesired effects at a dose used for treatment purposes. Among undesired effects caused by antipsychotics, movement disorders are prevalent. However, there is no study done to determine the prevalence of movement disorders that occurred due to antipsychotics and their determinants in eastern Ethiopia. OBJECTIVE This study aimed to find out the prevalence of drug-induced movement disorders and its determinants among patients who had been on follow-up at public hospitals in eastern Ethiopia. METHODS A cross-sectional study was conducted from May to June 2018 at HFSUH and Jugal hospital. Extrapyramidal symptom rating scale (ESRS) was used to identify patients with drug-induced movement disorders in a sample of 411 outpatients. A systematic random sampling method was used to select the sample. Logistic regression was done to identify factors associated. RESULTS A drug-induced movement disorder was found in 44% of the participants: Of this, 27.3% had drug-induced pseudo-Parkinsonism, 21.2% had drug-induced akathisia, 9.5% had drug-induced tardive dyskinesia, and 3.4% had drug-induced tardive dystonia. Being female was associated with pseudo-Parkinsonism (AOR=3.6, 95% CI: 2.03, 6.35), akathisia (AOR=4.9, 95% CI: 2.73, 8.78), and tardive dyskinesia (AOR=2.51, 95% CI: 1.08, 5.86) and being male with tardive dystonia (AOR=4.6, 95% CI: 1.8, 18.5). Alcohol use was associated with tardive dyskinesia (AOR= 5.89, 95% CI: 2.20, 15.69). CONCLUSION Drug-induced movement disorder in this study was high and nearly half of patients on antipsychotic treatment were experiencing it. Age, sex, and doses of antipsychotics were factors associated with all of the types of drug-induced movement disorders.
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Affiliation(s)
- Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Niguse Yigzaw
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getachew Asfaw
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
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6
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Antipsychotic-evoked dopamine supersensitivity. Neuropharmacology 2020; 163:107630. [DOI: 10.1016/j.neuropharm.2019.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
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Volavka J, Vevera J. Very long-term outcome of schizophrenia. Int J Clin Pract 2018; 72:e13094. [PMID: 29691957 DOI: 10.1111/ijcp.13094] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The principal aim is to review recent data concerning the very long-term outcome of schizophrenia and schizophrenia spectrum disorders. We examine factors that influence outcome, including therapeutic interventions. METHOD PubMed and Scopus databases were searched for papers published between 2008 and 2017 reporting on prospective studies of schizophrenia or schizophrenia spectrum with a follow-up period ≥5 years with adequate outcome information. Additional publications were found in reference lists and authors' reference libraries. RESULTS The average proportion of patients with symptomatic remission at follow-up ranged between 16.4% in never-treated patients to 37.5% in patients who were systematically treated with antipsychotics. Good outcomes at follow-up were observed in schizophrenia and schizophrenia spectrum patients on low doses of antipsychotics and in patients with no pharmacological treatment at that time. Early detection and intensive treatment of the first episode as well as the availability of continued psychosocial treatment and support over subsequent years appeared associated with better outcomes. CONCLUSION The long-term outcome of schizophrenia is highly variable, depending on access to mental healthcare, early detection of psychosis and pharmacological treatment. Recent data support the effectiveness of low-dose antipsychotic treatment for long-term maintenance in some patients. A proportion of first-episode schizophrenia patients, perhaps 20%, do not need long-term maintenance antipsychotic treatment. That proportion may be higher in schizophrenia spectrum patients. The reasons why these patients do not need the long-term treatment are not well understood. Methods to predict the membership in this subgroup are not yet good enough for clinical use in individual patients.
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Affiliation(s)
- Jan Volavka
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Murray RM, Quattrone D, Natesan S, van Os J, Nordentoft M, Howes O, Di Forti M, Taylor D. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? Br J Psychiatry 2016; 209:361-365. [PMID: 27802977 DOI: 10.1192/bjp.bp.116.182683] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 07/30/2016] [Indexed: 12/19/2022]
Abstract
Patients who recover from an acute episode of psychosis are frequently prescribed prophylactic antipsychotics for many years, especially if they are diagnosed as having schizophrenia. However, there is a dearth of evidence concerning the long-term effectiveness of this practice, and growing concern over the cumulative effects of antipsychotics on physical health and brain structure. Although controversy remains concerning some of the data, the wise psychiatrist should regularly review the benefit to each patient of continuing prophylactic antipsychotics against the risk of side-effects and loss of effectiveness through the development of supersensitivity of the dopamine D2 receptor. Psychiatrists should work with their patients to slowly reduce the antipsychotic to the lowest dose that prevents the return of distressing symptoms. Up to 40% of those whose psychosis remits after a first episode should be able to achieve a good outcome in the long term either with no antipsychotic medication or with a very low dose.
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Affiliation(s)
- Robin M Murray
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Diego Quattrone
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Sridhar Natesan
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Jim van Os
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Merete Nordentoft
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Oliver Howes
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - Marta Di Forti
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
| | - David Taylor
- Robin M. Murray, FRS, FRCPsych, Diego Quattrone, MD, Sridhar Natesan, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London. UK; Jim van Os, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, London, UK, and Department of Psychiatry and Psychology, Maastricht University Medical Center, The Netherlands; Merete Nordentoft, PhD, Mental Health Center, University of Copenhagen, Denmark; Oliver Howes, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, NIHR Maudsley Biomedical Research Centre, and MRC Clinical Sciences Centre, Imperial College London, London, UK; Marta Di Forti, PhD, MRCPsych, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK; David Taylor, PhD, King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Maudsley Biomedical Research Centre, London, UK
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Walther S. Psychomotor symptoms of schizophrenia map on the cerebral motor circuit. Psychiatry Res 2015; 233:293-8. [PMID: 26319293 DOI: 10.1016/j.pscychresns.2015.06.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/13/2014] [Accepted: 06/24/2015] [Indexed: 12/29/2022]
Abstract
Schizophrenia is a devastating disorder thought to result mainly from cerebral pathology. Neuroimaging studies have provided a wealth of findings of brain dysfunction in schizophrenia. However, we are still far from understanding how particular symptoms can result from aberrant brain function. In this context, the high prevalence of motor symptoms in schizophrenia such as catatonia, neurological soft signs, parkinsonism, and abnormal involuntary movements is of particular interest. Here, the neuroimaging correlates of these motor symptoms are reviewed. For all investigated motor symptoms, neural correlates were found within the cerebral motor system. However, only a limited set of results exists for hypokinesia and neurological soft signs, while catatonia, abnormal involuntary movements and parkinsonian signs still remain understudied with neuroimaging methods. Soft signs have been associated with altered brain structure and function in cortical premotor and motor areas as well as cerebellum and thalamus. Hypokinesia is suggested to result from insufficient interaction of thalamocortical loops within the motor system. Future studies are needed to address the neural correlates of motor abnormalities in prodromal states, changes during the course of the illness, and the specific pathophysiology of catatonia, dyskinesia and parkinsonism in schizophrenia.
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Affiliation(s)
- Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Bolligenstrasse 111, 3000 Bern 60, Bern, Switzerland.
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Abstract
BACKGROUND Tardive dyskinesia is a chronic and disabling abnormal movement disorder affecting the muscles of the face, neck, tongue and the limbs. It is a common side effect of long-term antipsychotic medication use in individuals with schizophrenia and other related psychotic disorders. While there are no known effective treatments for tardive dyskinesia to date, some reports suggest that pyridoxal 5 phosphate may be effective in reducing the severity of tardive dyskinesia symptoms. OBJECTIVES To determine the effectiveness of pyridoxal 5 phosphate (vitamin B6 or Pyridoxine or Pyridoxal phosphate) in the treatment of neuroleptic-induced tardive dyskinesia among people with schizophrenia and other related psychotic disorders. SEARCH METHODS The Cochrane schizophrenia group's register of clinical trials was searched (January 2013) using the phrase: [*Pyridoxal* OR *Pyridoxine* OR *P5P* OR *PLP* OR *tardoxal* OR *Vitamin B6* O *Vitamin B 6* R in title, abstract or index terms of REFERENCE, or interventions of STUDY. References of relevant identified studies were handsearched and where necessary, the first authors of relevant studies were contacted. SELECTION CRITERIA Studies described as randomised controlled trials comparing the effectiveness pyridoxal 5 phosphate with placebo in the treatment of neuroleptic-induced tardive dyskinesia among patients with schizophrenia. DATA COLLECTION AND ANALYSIS The review authors independently extracted data from each selected study. For dichotomous data, we calculated risk ratios (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis based on a fixed-effect model. For continuous data, we calculated mean differences (MD) with 95% CIs, again based on a fixed-effect model. We assessed risk of bias for each included study and used GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to rate quality of evidence. MAIN RESULTS Of the 12 records retrieved by the search, three trials published in 2001, 2003 and 2007, involving 80 inpatients with schizophrenia, aged 18 to 71 years, admitted in a psychiatric facility and followed up for a period nine weeks to 26 weeks, were included. Overall, pyridoxal 5 phosphate produced a significant improvement in tardive dyskinesia symptoms when compared with placebo, assessed by a change in Extrapyramidal Symptoms Rating Scale (ESRS) scores from baseline to the end of the first phase of the included studies (2 RCTs n = 65, RR 19.97, CI 2.87 to 139.19, low quality evidence). The endpoint tardive dyskinesia score (a measure of its severity) assessed with the ESRS, was significantly lower among participants on pyridoxal 5 phosphate compared to those on placebo (2 RCTs n = 60, MD -4.07, CI -6.36 to -1.79, low quality evidence).It was unclear whether pyridoxal 5 phosphate led to more side effects (n = 65, 2 RCTs, RR 3.97, CI 0.20 to 78.59, low quality evidence) or caused deterioration in tardive dyskinesia symptoms when compared to placebo (n = 65, 2 RCTs, RR 0.16, CI 0.01 to 3.14, low quality evidence). Five participants taking pyridoxal 5 phosphate withdrew from the study because they were not willing to take more medications while none of the participants taking placebo discontinued their medications (n = 65, 2 RCTs, RR 8.72, CI 0.51 to 149.75, low quality evidence).There was no significant difference in the endpoint positive and negative psychiatric symptoms scores, measured using the Positive and Negative symptoms Scale (PANSS) between participants taking pyridoxal 5 phosphate and those taking placebo. For the positive symptoms: (n = 15, 1 RCT, MD -1.50, CI -4.80 to 1.80, low quality evidence). For negative the symptoms: (n = 15, 1 RCT, MD -1.10, CI -5.92 to 3.72, low quality evidence). AUTHORS' CONCLUSIONS Pyridoxal 5 phosphate may have some benefits in reducing the severity of tardive dyskinesia symptoms among individuals with schizophrenia. However, the quality of evidence supporting the effectiveness of pyridoxal 5 phosphate in treating tardive dyskinesia is low, based on few studies, short follow-up periods, small sample sizes and inadequate adherence to standardised reporting guidelines for randomised controlled trials among the included studies.
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Affiliation(s)
| | - Olukayode Abayomi
- Ladoke Akintola University Teaching HospitalPsychiatryP.M.B 4007OgbomosoOyoNigeria210214
| | - Tunde Massey‐Ferguson Ojo
- Neuropsychiatric HospitalClinicial Sciences (Resident Doctors Office)PMB 2002ARO, Abeokuta,Ogun StateNigeria234
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Motor Abnormalities and Basal Ganglia in Schizophrenia: Evidence from Structural Magnetic Resonance Imaging. Brain Topogr 2014; 28:135-52. [DOI: 10.1007/s10548-014-0377-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 05/10/2014] [Indexed: 12/13/2022]
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12
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Novel directions for psychiatric diagnosis: from psychopathology to motor function to monitoring technology. Epidemiol Psychiatr Sci 2013; 22:289-95. [PMID: 24074339 PMCID: PMC8367346 DOI: 10.1017/s2045796013000474] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In the light of the recent publication of the DSM-5, there is renewed debate about the relative merit of categorical diagnosis, as laid down in Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) diagnostic manuals. Issues such as validity, usefulness and acceptability of the diagnoses in this manual are increasingly debated. Several alternative possibilities have been suggested including: (i) the introduction of truly cross-cutting dimensional measures, that would facilitate dynamic multidimensional formulations of psychopathology, (ii) the Research Domain Criteria, that may facilitate biological research but move away from clinical symptoms, (iii) a system of personalized diagnosis based on psychopathology as a network of symptoms and contexts, and (iv) enhanced focus on motor alterations, other than catatonia, as a possible additional informative dimension of diagnosis in psychiatry, particularly as a possible marker of underlying neurodevelopmental alterations. We suggest that novel systems of diagnosis are likely to rely more on continuous monitoring of diagnostically relevant information in daily life, complementing retrospective symptom criteria in DSM and ICD. Patients and their families are likely to benefit from these projects, as novel models of diagnosis based on daily life information may be linked more strongly to treatment needs and prognosis.
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Li CT, Chou KH, Su TP, Huang CC, Chen MH, Bai YM, Lin CP. Gray matter abnormalities in schizophrenia patients with tardive dyskinesia: a magnetic resonance imaging voxel-based morphometry study. PLoS One 2013; 8:e71034. [PMID: 23967150 PMCID: PMC3744521 DOI: 10.1371/journal.pone.0071034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/26/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE The pathophysiological mechanism of TD remains unknown. All previous studies, using the region-of-interest method, focused on basal ganglion areas, were with inconsistent results. This whole-brain voxel-based morphometry (VBM) study investigate the grey matter abnormality of TD and its correlates with clinical ratings. METHOD High resolution T1-weighted brain volumetric MRI from 25 schizophrenia patients with TD (TD group), 25 age-, gender-, and handedness-matched schizophrenia patients without TD (non-TD group), and 25 matched healthy subjects (NC group) were analyzed using a VBM approach. Clinical ratings included the Positive and Negative Symptom Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and the Simpson-Angus Scale (SAS). RESULTS The TD group had significantly smaller total gray matter volumes than the NC group (p = 0.05). Compared to the non-TD group, the TD group had significantly higher PANSS negative (p<0.001), SAS (p<0.001), and AIMS (p<0.001) scores; and smaller bilateral inferior frontal gyrus, which correlated negatively with the PANSS negative scores (r = -0.366, p<0.05); and smaller right superior frontal gyrus, which correlated negatively with AIMS scores (r = -0.399, p<0.001), and PANSS general score (r = -0.338, p<0.05). LIMITATIONS The cross-section design can't separate the gray matter change to TD from the context of the illness of schizophrenia, although TD with more severe clinical psychopathology could be a phenotype. CONCLUSIONS The schizophrenia patients with TD had significantly reduced gray matter, mostly at the bilateral inferior frontal gyrus and the right superior frontal gyrus, which correlated with severity of clinical symptoms and involuntary movement, respectively.
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Affiliation(s)
- Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chu-Chung Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
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Zheng X, Bei JX, Xu H, Lee J, Chong SA, Sim K, Liany H, Shyong TE, Liu T, Foo JN, Irwan ID, Teo YY, Liu J. The association between rare large duplication of 16p11.2 and schizophrenia in the Singaporean Chinese population. Schizophr Res 2013; 146:368-9. [PMID: 23510594 DOI: 10.1016/j.schres.2013.02.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/19/2013] [Accepted: 02/24/2013] [Indexed: 11/25/2022]
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Sejil I, Oumaya A, Bouguerra C, Mehdi F, Bellaaj R, Gallali S. [Tardive dyskinesia induced by classical antipsychotic drugs: a Tunisian sample of schizophrenics]. Encephale 2012; 39 Suppl 1:S36-41. [PMID: 23219594 DOI: 10.1016/j.encep.2012.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/08/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The term tardive dyskinesia (TD) is used to describe abnormal movement, primarily associated with typical antipsychotic drugs, which are used to treat psychotic states such as schizophrenia. TD is characterised by repetitive involuntary purposeless muscle contractions that force parts of the body into abnormal, and sometimes painful, movements or postures. These movements are involuntary and are difficult or impossible to control. TD usually begins with the face, mouth, lips and tongue, and includes grimacing, lip-smacking, tongue movements and rapid blinking. It may also involve the rest of the body and produce involuntary gestures, tics and writhing movements. TD is severe physically and socially disabling. Schizophrenia is thought to be the psychiatric diagnosis the most frequently associated with TD. MATERIALS AND METHODS The purpose of this article is to study the characteristics of TD in a Tunisian sample of 157 schizophrenics. A variety of demographic and clinical information was obtained by a questionnaire. Diagnoses of schizophrenia and TD were determined by using DSM-VI-R criteria. TD was assessed using the Abnormal Involuntary Movements Scale (AIMS). RESULTS The average age in this sample was 37 ± 6 years. The intermediate duration of evolution of the disease was 8 ± 3 years with a medium full number of hospitalizations of 4 ± 3. We found 58% of the paranoid sub-type. The intermediate duration of exposure to classical neuroleptics was 7 ± 3 years. The average of daily neuroleptic amount was 572.9 ± 145.3 equivalent milligrams of chlorpromazine. Extended release antipsychotics were used in 64.3% of cases, with fluphenazine deaconate in 90% and haloperidol deaconate in 10%. Anticholinergics were used by 74.5% of patients, with use of biperidene in 96% of cases. Therapeutic observance was good in 89.2% of patients. The prevalence of TD was an estimated 35%. The average of AIMS score was 17 ± 9, with a minimal score of 3 and a maximal one of 34. The distribution of patients according to severity found a prevalence of 52.7% of subjects with moderate TD, 38.2% with light TD and 9.1% with severe TD. The distribution of patients according to type, according to DSM-IV criteria, found 78.4% of cases with choreiform TD, 17.5% of cases with athetosic TD and 4.1% of cases with rhythmic TD. The intermediate duration of evolution of TD was estimated at 18 ± 6 months with a minimal duration of 3 months and a maximum of 72 months. The distribution of subjects according to duration of evolution of TD found that approximately three quarter of patients presented with TD that had evolved since one duration, lower or equal to one year. The average age of patients at the moment of installation of TD was estimated at 36 ± 6 years with 22 years as a minimal and 46 years as a maximal age. Among them, 81.8% of patients were aged over 30 at the time of the installation of TD. CONCLUSION The majority of patients with schizophrenia in Tunisia are still treated with typical antipsychotic drugs, and that's why the prevalence of TD remains relatively high.
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Affiliation(s)
- I Sejil
- Service de psychiatrie générale, faculté de médecine de Tunis, université Tunis El Manar, hôpital militaire principal d'instruction de Tunis, Le Mont Fleury, 1008 Tunis, Tunisie.
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Fallon P, Dursun SM. A naturalistic controlled study of relapsing schizophrenic patients with tardive dyskinesia and supersensitivity psychosis. J Psychopharmacol 2011; 25:755-62. [PMID: 20147573 DOI: 10.1177/0269881109359097] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite advances in treatments, relapses in schizophrenia still occur. The causes of relapse are not always apparent, especially for patients that are compliant with medication. One possibility is that the brain adapts to long-term antipsychotic drug treatment, leading to tolerance and withdrawal symptoms. This has been described as supersensitivity psychosis. Tardive dyskinesia is also thought to occur as a consequence of dopamine supersensitivity caused by chronic treatment with antipsychotics. Another associated feature is sensitivity to life stress. This study investigated the relationship between abnormal movements, life events and drug treatment in patients relapsing on antipsychotics with high potency at the dopamine D2 receptor. Twenty-two patients from a cohort of 128 patients experiencing a psychotic relapse were assessed; of these, seven (32%) met criteria for the presence of abnormal involuntary movements. These subjects were found to be clinically distinct from the subjects without abnormal movements. They tended to be older with a greater duration of illness and higher dosage of antipsychotics but more symptoms of psychosis compared with the other subjects. Relapse was also associated with minor life events. The association between abnormal involuntary movements and high levels of psychotic symptoms suggests that dopamine sensitization/supersensitivity may underlie both phenomena. These results suggest that clinicians may have to consider alternative dosing strategies, novel agents or switching to one of the antipsychotics that have a lower affinity for the D2 receptor.
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Affiliation(s)
- Paul Fallon
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK.
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Caroff SN, Davis VG, Miller DD, Davis SM, Rosenheck RA, McEvoy JP, Campbell EC, Saltz BL, Riggio S, Chakos MH, Swartz MS, Keefe RSE, Stroup TS, Lieberman JA. Treatment outcomes of patients with tardive dyskinesia and chronic schizophrenia. J Clin Psychiatry 2011; 72:295-303. [PMID: 20816031 PMCID: PMC3825701 DOI: 10.4088/jcp.09m05793yel] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 02/15/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We compared the response to antipsychotic treatment between patients with and without tardive dyskinesia (TD) and examined the course of TD. METHOD This analysis compared 200 patients with DSM-IV-defined schizophrenia and TD and 997 patients without TD, all of whom were randomly assigned to receive one of 4 second-generation antipsychotics. The primary clinical outcome measure was time to all-cause treatment discontinuation, and the primary measure for evaluating the course of TD was change from baseline in Abnormal Involuntary Movement Scale (AIMS) score. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to compare treatment discontinuation between groups. Changes in Positive and Negative Syndrome Scale (PANSS) and neurocognitive scores were compared using mixed models and analysis of variance. Treatment differences between drugs in AIMS scores and all-cause discontinuation were examined for those with TD at baseline. Percentages of patients meeting criteria for TD postbaseline or showing changes in AIMS scores were evaluated with χ(2) tests. Data were collected from January 2001 to December 2004. RESULTS Time to treatment discontinuation for any cause was not significantly different between the TD and non-TD groups (χ(2)(1) = 0.11, P = .743). Changes in PANSS scores were not significantly different (F(1,974) = 0.82, P = .366), but patients with TD showed less improvement in neurocognitive scores (F(1,359) = 6.53, P = .011). Among patients with TD, there were no significant differences between drugs in the decline in AIMS scores (F(3,151) = 0.32, P = .811); 55% met criteria for TD at 2 consecutive visits postbaseline, 76% met criteria for TD at some or all postbaseline visits, 24% did not meet criteria for TD at any subsequent visit, 32% showed a ≥ 50% decrease in AIMS score, and 7% showed a ≥ 50% increase in AIMS score. CONCLUSIONS Schizophrenia patients with and without TD were similar in time to discontinuation of treatment for any cause and improvement in psychopathology, but differed in neurocognitive response. There were no significant differences between treatments in the course of TD, with most patients showing either persistence of or fluctuation in observable symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00014001.
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Tenback DE, van Harten PN. Epidemiology and Risk Factors for (Tardive) Dyskinesia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 98:211-30. [DOI: 10.1016/b978-0-12-381328-2.00009-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Incidence of extrapyramidal symptoms and tardive dyskinesia in schizophrenia: thirty-six-month results from the European schizophrenia outpatient health outcomes study. J Clin Psychopharmacol 2010; 30:531-40. [PMID: 20814320 DOI: 10.1097/jcp.0b013e3181f14098] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of treatment-emergent extrapyramidal symptoms (EPSs) and tardive dyskinesia (TD) in schizophrenic patients, and the clinical characteristics associated with an increased risk of developing EPSs and TD were examined. Patients (N = 7728) in the 3-year, prospective, observational Schizophrenia Outpatient Health Outcomes study were examined according to baseline antipsychotic drug exposure. At baseline, 4893 patients (63.3%) had no EPS, and 6921 (89.6%) had no TD. Extrapyramidal symptoms and TD were assessed separately during follow-up: frequency and time to appearance from Kaplan-Meier survival curves and factors associated with time to appearance using Cox proportional hazard regression models. The cumulative incidence of EPS ranged from 7.7% (olanzapine) to 32.8% (depot typical drugs). Compared with olanzapine, patients taking depot typical drugs, oral typical drugs, risperidone, and amisulpride had a significantly higher risk of developing EPS. Differences from clozapine were marginally significant. High baseline clinical severity was associated with a significantly higher risk of developing EPS. The incidence of TD ranged from 2.8% (olanzapine) to 11.1% (depot typical agent). Compared with olanzapine, patients taking depot typical agents, oral typical agents, and risperidone had a significantly higher risk of developing TD. Baseline factors associated with a significantly higher risk of developing TD were age, EPS, a higher negative Clinical Global Impression score, and presence of gynecomastia. In summary, patients treated with typical antipsychotic agents (oral and depot) and risperidone had a higher risk of developing EPS and TD than patients treated with olanzapine. Higher baseline clinical severity was associated with EPS development, whereas age, presence of EPS, a higher negative Clinical Global Impression score, and presence of gynecomastia were associated with TD development.
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Tenback DE, van Harten PN, Slooff CJ, van Os J. Incidence and persistence of tardive dyskinesia and extrapyramidal symptoms in schizophrenia. J Psychopharmacol 2010; 24:1031-5. [PMID: 19487321 DOI: 10.1177/0269881109106306] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although it has been suggested that second-generation antipsychotics (SGA) may reduce the rate of prevalent tardive dyskinesia (TD), little is known about the incidence and outcome of TD in those exposed exclusively to SGA. The incidence and subsequent persistence of TD and extrapyramidal symptoms (EPS) was calculated in a cohort of patients with schizophrenia treated predominantly with SGA. This cohort of more than 10,000 patients with schizophrenia was seen six times over a period of two years. Dichotomous measures of EPS and TD were used to calculate the yearly incidence rates of TD and EPS as well as their subsequent cumulative persistence rate in a subset of 9104 and 6285 patients at risk for TD and EPS, respectively. Of 9104 individuals who did not present with TD at baseline, 138 developed TD, yielding a TD incidence rate of 0.74% (95% CI: 0.62, 0.87) and a subsequent cumulative persistence rate of 80%. Of 6285 individuals without EPS at baseline, 464 developed EPS yielding an incidence rate of 3.7% (95% CI: 3.4, 4.0) and a subsequent cumulative persistence rate of 82%. Incidence rates of TD and EPS may be low in the SGA era. However, once emerged, these disorders prove persistent, suggesting strong moderators effects of underlying predisposing factors.
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Affiliation(s)
- D E Tenback
- Psychiatric Center Symfora Group, 3800 DB Amersfoort, The Netherlands.
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Demily C, Chouinard VA, Chouinard G. [Iatrogenic psychiatric-like symptoms recognition]. Encephale 2010; 36:417-24. [PMID: 21035632 DOI: 10.1016/j.encep.2010.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 09/29/2009] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This article proposes a review of atypical multicentre studies for drug-induced movement disorders (and related psychiatric symptoms) and supersensitivity psychosis. A well-conducted antipsychotic treatment consists of regular attempts to reduce the dose by finding the minimal therapeutic dose. To achieve optimal antipsychotic treatment, it is important to distinguish psychiatric symptoms associated with drug-induced movement disorder(s) (DIMD) or supersensitivity psychosis from true relapse. LITERATURE FINDINGS Persistent DIMD have been found to be a predictor of supersensitivity psychosis or tardive dyskinesia (DT). DIMD-associated psychiatric symptoms can be classified into three types: directly induced by DIMD; resulting from confounding DIMD with psychiatric symptoms; and supersensitivity symptoms associated with DIMD. Without this distinction, the beneficial effects of antipsychotics are masked by emergent DIMD psychiatric symptoms (as was confounded in the CATIE study). DISCUSSION A constant decline in the prevalence of TD (hyperkinetic, involuntary and purposeless movement disorder) has been observed since the introduction of atypical antipsychotics. The neurotoxic effects of classical antipsychotics are well documented and their discontinuation is required. However, the risk of TD still exits with atypical antipsychotics and continued surveillance of emerging cases is very important for clinicians. Moreover, a regular evaluation of DIMD and associated psychiatric symptoms is crucial. It is important to underline the fact that DIMD persists with antipsychotics, with significantly higher total PANSS scores than in patients without DIMD. CONCLUSION Supersensitivity psychosis is a drug-induced psychotic relapse (6 weeks following the decrease or withdrawal of an antipsychotic). Discontinuation syndromes can produce psychiatric symptoms (and be confounded with true relapse), but can be improved more quickly after reintroduction of treatment. Interestingly, various data suggest that lower doses of antipsychotics could prevent such symptoms. Anticonvulsants can be efficient adjuvants in the treatment of psychosis. In the United States, many patients received valproate or gabapentin treatment. These adjuvants, by antikindling effect, can facilitate minimal maintenance drug treatment and be efficient for anxiety. Resistant schizophrenia can be related to supersensitivity psychosis; gabapentin and lamotrigine are effective in this case.
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Affiliation(s)
- C Demily
- Centre de neuroscience cognitive (CNRS UMR 5229 et Université Lyon-1), Bron, France.
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van Rossum I, Tenback D, van Os J. Bipolar disorder and dopamine dysfunction: an indirect approach focusing on tardive movement syndromes in a naturalistic setting. BMC Psychiatry 2009; 9:16. [PMID: 19397831 PMCID: PMC2683829 DOI: 10.1186/1471-244x-9-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Accepted: 04/28/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been suggested that dopamine dysfunction may play a role in bipolar disorder (BD). An indirect approach to examine this issue was developed, focusing on associations between dopamine proxy measures observed in BD (dopamine-related clinical traits using tardive movement syndromes as dopamine proxy measure of reference). METHODS 3459 eligible bipolar patients were enrolled in an observational study. Incidence rates of tardive movement syndromes (tardive dyskinesia and tardive dystonia; TDD) were examined. A priori hypothesized associations between incident TDD and other dopamine proxies (e.g. prolactin-related adverse effects, bipolar symptoms) were tested over a 2 year follow-up period. RESULTS The incidence rate of tardive syndromes was 4.1 %. Incident TDD was independently associated not only with use of antipsychotics, but also with more severe bipolar symptoms, other extrapyramidal symptoms and prolactin-related adverse effects of medication. CONCLUSION Apart from the well-known association with antipsychotics, development of TDD was associated with various other dopamine proxy measures, indirectly supporting the notion of generalised dopamine dysregulation in BD.
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Affiliation(s)
- Inge van Rossum
- Eli Lilly Nederland, Medical Department, Houten, The Netherlands.
| | - Diederik Tenback
- Symfora Group Psychiatric Center, Utrechtseweg 266, 3818 EW Amersfoort, the Netherlands,Department of Psychiatry, University Medical Center Utrecht, Heidelberglaan 100, 3584 GX Utrecht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands,Division of Psychological Medicine, Institute of Psychiatry, London SE5 8AF, UK
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Bai YM, Chou KH, Lin CP, Chen IY, Li CT, Yang KC, Chou YH, Su TP. White matter abnormalities in schizophrenia patients with tardive dyskinesia: a diffusion tensor image study. Schizophr Res 2009; 109:167-81. [PMID: 19261444 DOI: 10.1016/j.schres.2009.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/05/2009] [Accepted: 02/05/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Tardive dyskinesia (TD) is a severe side effect of antipsychotics. While increasing evidence suggests that damaged brain microcircuitry of white matter (WM) is responsible for the clinical symptoms in schizophrenia, no reports of WM abnormality associated with TD were noted. METHOD Brain white matter abnormalities were investigated among 20 schizophrenia patients with TD (Schizophrenia with TD group), 20 age-, gender-, and handedness-matched schizophrenic patients without TD (Schizophrenia without TD group), and 20 matched healthy subjects with magnetic resonance imaging and diffusion tensor imaging analysis. Voxel-wise analysis was used to compare fractional anisotropy (FA) maps of the white matter following intersubject registration to Talairach space. Clinical ratings included the Positive and Negative Symptoms Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and the Simpson-Angus Scale (SAS). RESULTS The study subjects were 75% female with average of 40.1+/-9. 8 years. The Schizophrenia with TD group had significantly higher PANSS total scores (p=0.024), PANSS negative score (p=0.001), SAS (p<0.001) and AIMS (p<0.001) scores; and demonstrated more widespread FA decreases than the Schizophrenia without TD group, especially over the inferior frontal gyrus, temporal sublobar extranuclear WM (around the basal ganglion), parietal precuneus gyrus WM (around somatosensory cortex), and medial frontal gyrus WM (around dorsolateral prefrontal cortex). The AIMS (p<0.01) and SAS (p<0.01) score positively correlated with decreased FA over these areas, and PANSS negative score positively correlated with FA decrease over medial frontal gyrus WM (p<0.01). CONCLUSIONS More widespread abnormality of white matter was noted among schizophrenia patients than those without, especially involved cortico-basal ganglion circuits with clinical symptom correlation of involuntary movements and negative symptoms. Further studies with larger sample size are required to validate the findings.
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Affiliation(s)
- Ya Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
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Chouinard G, Chouinard VA. Atypical antipsychotics: CATIE study, drug-induced movement disorder and resulting iatrogenic psychiatric-like symptoms, supersensitivity rebound psychosis and withdrawal discontinuation syndromes. PSYCHOTHERAPY AND PSYCHOSOMATICS 2008; 77:69-77. [PMID: 18230939 DOI: 10.1159/000112883] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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