[Tardive movement disorders with antipsychotics – a case of aripirazole-induced tardive dystonia and review of the literature]

Olanzapine-induced Concurrent Tardive Dystonia and Tardive Dyskinesia in Schizophrenia with Intellectual Disability: A Case Report

Tardive dystonia and tardive dyskinesia (TDs) are rare extrapyramidal side effects that develop after long-term use of antipsychotics, but they are different syndromes and rarely occur at the same time. Olanzapine is an atypical antipsychotic drug associated with a low risk of extrapyramidal side effects in schizophrenia, but its associations with tardive movements are not clear. We present a case of a 19-year-old Asian female patient with schizophrenia and intellectual disabilities who developed concurrent TDs after long-term use of olanzapine. At her 10-month follow-up examination, her concurrent TDs had been treated successfully with clozapine. This case demonstrates that although the use of olanzapine to treat psychosis and behavioral disturbances is increasing due to its high efficacy and low rate of extrapyramidal side effects, concurrent TDs should be carefully assessed after long-term use of this antipsychotic, especially in patients with schizophrenia and intellectual disabilities. Clozapine, by preventing or reversing the debilitating consequences of concurrent TDs, may be an effective treatment for these patients.

The development of monoaminergic neurotransmitter systems in childhood and adolescence

Brain maturation extends throughout adolescence well into early adulthood. Knowledge on developmental changes is crucial for age-appropriate pharmacotherapy. This article reviews data on maturational processes with a focus on the noradrenergic, dopaminergic, and serotonergic neurotransmitter systems.The literature was searched with a focus on studies in humans. However, since data in humans are limited animal studies were also included. All reviewed neurotransmitter systems show age-related development processes that differentiate child and adolescent brain function from those of adult brains. Unfortunately, the state of knowledge surrounding development-related changes remains sufficiently sparse, There is a high need for more studies on pediatric psychopharmacology and its biological underpinnings. Safety and efficacy of psychopharmacological medicines cannot be readily extrapolated from adults.

Serum Level Measurements Optimize Aripriprazole Treatment in Adolescent Patients

21 minors suffering from first-episode psychosis or related disorders were treated with the second-generation antipsychotic aripriprazole with serum levels being monitored over time. A significant variation of serum levels was observed in about half of the patients. Patients from Africa showed high levels of aripriprazole. In seven patients, i. e. ca. 35 % of the sample, aripriprazole treatment had to be stopped for various reasons. Therefore, serum levels of this antipsychotic (which in Germany is still considered off-label treatment before the age of 18) should be regularly monitored particularly in patients from Africa.