1
|
Weng J, Zhang L, Yu W, Zhao N, Zhu B, Ye C, Zhang Z, Ma C, Li Y, Yu Y, Li H. Risk factors, clinical correlates, and social functions of Chinese schizophrenia patients with drug-induced parkinsonism: A cross-sectional analysis of a multicenter, observational, real-world, prospective cohort study. Front Pharmacol 2023; 14:1077607. [PMID: 36937864 PMCID: PMC10020528 DOI: 10.3389/fphar.2023.1077607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Drug-induced parkinsonism (DIP) is the most prevalent neurological side effect of antipsychotics in the Chinese population. Early prevention, recognition, and treatment of DIP are important for the improvement of treatment outcomes and medication adherence of schizophrenia patients. However, the risk factors of DIP and the impact on the clinical syndromes of schizophrenia remain unknown. Aim: The goal of this study was to explore the risk factors, clinical correlates, and social functions of DIP in Chinese schizophrenia patients. Methods: A cross-sectional analysis of a multicenter, observational, real-world, prospective cohort study of the Chinese schizophrenia population with a baseline assessment was conducted from the year 2012 to 2018. Participants were recruited from four mental health centers in Shanghai and totaled 969 subjects. Sociodemographic data, drug treatment, and clinical variables were compared between the DIP group and the non-DIP group. Variables that correlated with the induction of DIP, and with p≤ 0.1, were included in the binary logistic model for analyzing the risk factors of DIP. First generation antipsychotics (FGA)/second generation antipsychotics (SGA) model and high and low/medium D2 receptor antipsychotics were analyzed respectively to control the bias of co-linearity. All risk factors derived from the a forementioned models and clinical variables with p≤ 0.1 were included in the multivariate analysis of clinical correlates and social function of DIP patients. The Positive and Negative Syndrome Scale (PANSS) model and the personal and social performance (PSP) model were analyzed separately to control for co-linearity bias. Results: Age (OR = 1.03, p< 0.001), high D2 receptor antagonist antipsychotic dose (OR = 1.08, p = 0.032), and valproate dose (OR = 1.01, p = 0.001) were the risk factors of DIP. FGA doses were not a significant contributor to the induction of DIP. Psychiatric symptoms, including more severe negative symptoms (OR = 1.09, p< 0.001), lower cognition status (OR = 1.08, p = 0.033), and lower excited symptoms (OR = 0.91, p = 0.002), were significantly correlated with DIP induction. Social dysfunction, including reduction in socially useful activities (OR = 1.27, p = 0.004), lower self-care capabilities (OR = 1.53, p< 0.001), and milder disturbing and aggressive behavior (OR = 0.65, p< 0.001), were significantly correlated with induction of DIP. Valproate dose was significantly correlated with social dysfunction (OR = 1.01, p = 0.001) and psychiatric symptoms (OR = 1.01, p = 0.004) of DIP patients. Age may be a profound factor that affects not only the induction of DIP but also the severity of psychiatric symptoms (OR = 1.02, p< 0.001) and social functions (OR = 1.02, p< 0.001) of schizophrenia patients with DIP. Conclusion: Age, high D2 receptor antagonist antipsychotic dose, and valproate dose are risk factors for DIP, and DIP is significantly correlated with psychiatric symptoms and social performance of Chinese schizophrenia patients. The rational application or discontinuation of valproate is necessary. Old age is related to psychotic symptoms and social adaption in Chinese schizophrenic patients, and early intervention and treatment of DIP can improve the prognosis and social performance of schizophrenia patients. Clinical Trial Registration: Identifier: NCT02640911.
Collapse
Affiliation(s)
- Jiajun Weng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Zhongshan Hospital, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zhao
- Shanghai Pudong District Mental Health Center, Shanghai, China
| | - Binggen Zhu
- Shanghai Pudong District Mental Health Center, Shanghai, China
| | - Chengyu Ye
- Shanghai Zhongshan Hospital, Shanghai, China
- Shanghai Jiading District Mental Health Center, Shanghai, China
| | - Zhanxing Zhang
- Shanghai Clinical Research Center for Mental Health, Shanghai, China
| | - Changlin Ma
- Shanghai Jiading District Mental Health Center, Shanghai, China
| | - Yan Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Yiming Yu, ; Huafang Li,
| | - Huafang Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Clinical Research Center for Mental Health, Shanghai, China
- *Correspondence: Yiming Yu, ; Huafang Li,
| |
Collapse
|
2
|
Bergman H, Walker DM, Nikolakopoulou A, Soares-Weiser K, Adams CE. Systematic review of interventions for treating or preventing antipsychotic-induced tardive dyskinesia. Health Technol Assess 2018; 21:1-218. [PMID: 28812541 DOI: 10.3310/hta21430] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Antipsychotic medication can cause tardive dyskinesia (TD) - late-onset, involuntary, repetitive movements, often involving the face and tongue. TD occurs in > 20% of adults taking antipsychotic medication (first-generation antipsychotics for > 3 months), with this proportion increasing by 5% per year among those who continue to use these drugs. The incidence of TD among those taking newer antipsychotics is not different from the rate in people who have used older-generation drugs in moderate doses. Studies of TD have previously been found to be limited, with no treatment approach shown to be effective. OBJECTIVES To summarise the clinical effectiveness and safety of treatments for TD by updating past Cochrane reviews with new evidence and improved methods; to undertake public consultation to gauge the importance of the topic for people living with TD/the risk of TD; and to make available all data from relevant trials. DATA SOURCES All relevant randomised controlled trials (RCTs) and observational studies. REVIEW METHODS Cochrane review methods, network meta-analysis (NMA). DESIGN Systematic reviews, patient and public involvement consultation and NMA. SETTING Any setting, inpatient or outpatient. PARTICIPANTS For systematic reviews, adults with TD who have been taking a stable antipsychotic drug dose for > 3 months. INTERVENTIONS Any, with emphasis on those relevant to UK NHS practice. MAIN OUTCOME MEASURES Any measure of TD, global assessments and adverse effects/events. RESULTS We included 112 studies (nine Cochrane reviews). Overall, risk of bias showed little sign of improvement over two decades. Taking the outcome of 'TD symptoms improved to a clinically important extent', we identified two trials investigating reduction of antipsychotic dose [n = 17, risk ratio (RR) 0.42, 95% confidence interval (CI) 0.17 to 1.04; very low quality]. Switching was investigated twice in trials that could not be combined (switching to risperidone vs. antipsychotic withdrawal: one RCT, n = 42, RR 0.45, 95% CI 0.23 to 0.89; low quality; switching to quetiapine vs. haloperidol: one RCT, n = 45, RR 0.80, 95% CI 0.52 to 1.22; low quality). In addition to RCTs, six observational studies compared antipsychotic discontinuation with decreased or increased dosage, and there was no clear evidence that any of these strategies had a beneficial effect on TD symptoms (very low-quality evidence). We evaluated the addition to standard antipsychotic care of several treatments, but not anticholinergic treatments, for which we identified no trials. We found no clear effect of the addition of either benzodiazepines (two RCTs, n = 32, RR 1.12, 95% CI 0.6 to 2.09; very low quality) or vitamin E (six RCTs, n = 264, RR 0.95, 95% CI 0.89 to 1.01; low quality). Buspirone as an adjunctive treatment did have some effect in one small study (n = 42, RR 0.53, 95% CI 0.33 to 0.84; low quality), as did hypnosis and relaxation (one RCT, n = 15, RR 0.45, 95% CI 0.21 to 0.94; very low quality). We identified no studies focusing on TD in people with dementia. The NMA model found indirect estimates to be imprecise and failed to produce useful summaries on relative effects of interventions or interpretable results for decision-making. Consultation with people with/at risk of TD highlighted that management of TD remains a concern, and found that people are deeply disappointed at the length of time it has taken researchers to address the issue. LIMITATIONS Most studies remain small and poorly reported. CONCLUSIONS Clinicians, policy-makers and people with/at risk of TD are little better informed than they were decades ago. Underpowered trials of limited quality repeatedly fail to provide answers. FUTURE WORK TD reviews have data from current trials extracted, tabulated and traceable to source. The NMA highlights one context in which support for this technique is ill advised. All relevant trials, even if not primarily addressing the issue of TD, should report appropriate binary outcomes on groups of people with this problem. Randomised trials of treatments for people with established TD are indicated. These should be large (> 800 participants), necessitating accrual through accurate local/national registers, including an intervention with acceptable treatments and recording outcomes used in clinical practice. STUDY REGISTRATION This study is registered as PROSPERO CRD4201502045. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
| | - Dawn-Marie Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Desai N, Patel PB, Shah S, Patel TK, Shah SN, Vatsala E. Prevalence and pattern of antipsychotic induced movement disorders in a tertiary care teaching hospital in India - a cross-sectional study. Int J Psychiatry Clin Pract 2018; 22:101-108. [PMID: 28952832 DOI: 10.1080/13651501.2017.1381268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess prevalence and pattern of movement disorders among patients taking antipsychotic medications. METHODS This cross-sectional, intensive monitoring (patient interview, case record form review and clinical examination) study was conducted in patients taking antipsychotic drugs irrespective of duration for the development of movement disorders. The psychiatrist used Modified Simpson-Angus Scale score (10-item scale), Barnes' rating scale and Abnormal Involuntary Movement Scale to diagnose parkinsonism, akathisia and tardive dyskinesia, respectively. We assessed movement disorders for the preventability and seriousness. RESULTS The overall prevalence of antipsychotic induced movement disorders was 5.67% (95% CI: 4.19-7.62). The prevalence of parkinsonism, akathisia and tardive dyskinesia was 5.10% (95% CI: 3.71-6.98), 0.85% (95% CI: 0.39-1.84) and 0.57% (95% CI: 0.22-1.45), respectively. There was a trend of high proportions of movement disorders in extreme of age group, female gender, patients treated with conventional antipsychotics, on poly therapy, patients of epilepsy with psychosis, schizophrenia and bipolar mood disorder. The movement disorder was lowest with quetiapine (2.02%). CONCLUSIONS The higher use of atypical antipsychotics had reduced the occurrence of movement disorders in our setup.
Collapse
Affiliation(s)
- Nimisha Desai
- a Department of Psychiatry , GMERS General Hospital and Medical College , Vadodara , India
| | - Parvati B Patel
- b Department of Pharmacology , GMERS Medical College , Vadodara , India
| | - Sandip Shah
- a Department of Psychiatry , GMERS General Hospital and Medical College , Vadodara , India
| | - Tejas K Patel
- b Department of Pharmacology , GMERS Medical College , Vadodara , India
| | - Saurabh N Shah
- a Department of Psychiatry , GMERS General Hospital and Medical College , Vadodara , India
| | - Ela Vatsala
- a Department of Psychiatry , GMERS General Hospital and Medical College , Vadodara , India
| |
Collapse
|
4
|
Mentzel CL, Bakker PR, van Os J, Drukker M, Matroos GE, Tijssen MAJ, van Harten PN. Blink rate is associated with drug-induced parkinsonism in patients with severe mental illness, but does not meet requirements to serve as a clinical test: the Curacao extrapyramidal syndromes study XIII. J Negat Results Biomed 2017; 16:15. [PMID: 28841828 PMCID: PMC6888915 DOI: 10.1186/s12952-017-0079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug-induced parkinsonism (DIP) has a high prevalence and is associated with poorer quality of life. To find a practical clinical tool to assess DIP in patients with severe mental illness (SMI), the association between blink rate and drug-induced parkinsonism (DIP) was assessed. METHODS In a cohort of 204 SMI patients receiving care from the only mental health service of the previous Dutch Antilles, blink rate per minute during conversation was assessed by an additional trained movement disorder specialist. DIP was rated on the Unified Parkinson's Disease Rating Scale (UPDRS) in 878 assessments over a period of 18 years. Diagnostic values of blink rate were calculated. RESULTS DIP prevalence was 36%, average blink rate was 14 (standard deviation (SD) 11) for patients with DIP, and 19 (SD 14) for patients without. There was a significant association between blink rate and DIP (p < 0.001). With a blink rate cut-off of 20 blinks per minute, sensitivity was 77% and specificity was 38%. A 10% percentile cut-off model resulted in an area under the ROC curve of 0.61. A logistic prediction model between dichotomous DIP and continuous blink rate per minute an area under the ROC curve of 0.70. CONCLUSIONS There is a significant association between blink rate and DIP as diagnosed on the UPDRS. However, blink rate sensitivity and specificity with regard to DIP are too low to replace clinical rating scales in routine psychiatric practice. TRIAL REGISTRATION The study was started over 20 years ago in 1992, at the time registering a trial was not common practice, therefore the study was never registered.
Collapse
Affiliation(s)
- Charlotte L Mentzel
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. .,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands.
| | - P Roberto Bakker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Marjan Drukker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
| | | | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.,Psychiatric Centre GGZ Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands
| |
Collapse
|
5
|
High Incidence and Prevalence of Drug-Related Movement Disorders in Young Patients With Psychotic Disorders. J Clin Psychopharmacol 2017; 37:231-238. [PMID: 28141621 DOI: 10.1097/jcp.0000000000000666] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Drug-related movement disorders (DRMDs) reduce quality of life and contribute to medication noncompliance of patients with psychotic disorders. Little is known about the epidemiology of DRMDs in relatively young patients a few years after onset of psychosis. This is an important period to study, as the impact of the antipsychotic treatment on the long-term potentiation of the neural pathways associated with psychotic disorders and DRMDs is still minimal. This study investigated the prevalence, incidence, persistence, and clinical correlates of DRMDs in patients during their first years after disease onset. METHODS The Genetic Risk and Outcome of Psychosis study is a longitudinal study of 1120 relatively young patients with nonaffective psychosis and a mean age and illness duration of 27 and 4 years, respectively. The following drug-related movement disorders were assessed at baseline and at the 3-year follow-up: parkinsonism, akathisia, tardive dyskinesia, and tardive dystonia. We determined prevalence, incidence, and persistence and investigated clinical correlates at and over the baseline and follow-up assessment. RESULTS Patients' mean age and illness duration at baseline were 27.1 and 4.3 years, respectively. In 4 patients, 1 developed a DRMD over the 3-year study period. Prevalence, incidence, and persistence rates were highest for parkinsonism (32%, 21%, and 53%) followed by akathisia (9%, 5%, and 17%) and tardive dyskinesia (4%, 3%, and 20%). Significant associations were found between DRMDs and the patients' age, IQ, and psychopathology. CONCLUSIONS The prevalence, persistence, and incidence of DRMDs in this sample were high despite the relatively young age, recent onset of the disorder, and treatment primarily with second-generation antipsychotics. These findings emphasize that screening, diagnosis, and treatment of DRMDs are still important.
Collapse
|
6
|
Mentzel TQ, Lieverse R, Levens A, Mentzel CL, Tenback DE, Bakker PR, Daanen HAM, van Harten PN. Reliability and validity of an instrument for the assessment of bradykinesia. Psychiatry Res 2016; 238:189-195. [PMID: 27086232 DOI: 10.1016/j.psychres.2016.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/17/2015] [Accepted: 02/10/2016] [Indexed: 11/25/2022]
Abstract
Bradykinesia is associated with reduced quality of life and medication non-compliance, and it may be a prodrome for schizophrenia. Therefore, screening/monitoring for subtle bradykinesia is of clinical and scientific importance. This study investigated the validity and reliability of such an instrument. Included were 70 patients with psychotic disorders. Inertial sensors captured mean cycle duration, amplitude and velocity of four movement tasks: walking, elbow flexion/extension, forearm pronation/supination and leg agility. The concurrent validity with the Unified Parkinson's Disease Rating Scale (UPDRS) bradykinesia subscale was determined using regression analysis. Reliability was investigated with the intra-class correlation coefficient. The duration, amplitude and velocities of the four tasks measured by the instrument explained 67% of the variance on the UPDRS bradykinesia subscale. The instrument test-retest reliability was high. The instrument investigated in this study is a valid and reliable alternative to observer-rated scales. It is an ideal tool for monitoring bradykinesia as it requires little training and experience to achieve reliable results.
Collapse
Affiliation(s)
- Thierry Q Mentzel
- Psychiatric Centre GGz Centraal, Innova, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Ritsaert Lieverse
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Amar Levens
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Charlotte L Mentzel
- Psychiatric Centre GGz Centraal, Innova, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Diederik E Tenback
- Psychiatric Centre GGz Centraal, Innova, Amersfoort, The Netherlands; Department of Psychiatry, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - P Rob Bakker
- Psychiatric Centre GGz Centraal, Innova, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Hein A M Daanen
- MOVE Research Institute, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands; Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO) [Dutch Organization for Applied Scientific Research], Soesterberg, The Netherlands.
| | - Peter N van Harten
- Psychiatric Centre GGz Centraal, Innova, Amersfoort, The Netherlands; Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|