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Rekhi G, Tay J, Lee J. Impact of drug-induced Parkinsonism and tardive dyskinesia on health-related quality of life in schizophrenia. J Psychopharmacol 2022; 36:183-190. [PMID: 34979813 DOI: 10.1177/02698811211055812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Both drug-induced Parkinsonism (DIP) and tardive dyskinesia (TD) have been shown to be associated with lower health-related quality of life (HRQOL) in schizophrenia, but few studies have examined their relative impact. AIMS This study aimed to examine and compare the association of DIP and TD with HRQOL in schizophrenia. METHODS In total, 903 patients with schizophrenia were assessed on the Positive and Negative Syndrome Scale (PANSS), Simpson-Angus Scale (SAS), and Abnormal Involuntary Movement Scale (AIMS). EuroQoL five-dimensional (EQ-5D-5L) utility scores were derived from PANSS scores via a previously validated algorithm and used as a measure of HRQOL. RESULTS In total, 160 (17.7%) participants had only DIP, 119 (13.2%) had only TD, and 123 (13.6%) had both DIP and TD. HRQOL was lowest for participants with both DIP and TD, followed by only DIP group, only TD group, and highest in the group with neither condition. HRQOL scores differed significantly between the four groups, F(3, 892) = 13.724, p < 0.001, ηp2 = 0.044). HRQOL of participants having only DIP or both DIP and TD was significantly lower than those having neither condition. There was no significant interaction between the presence of DIP and TD on the association with HRQOL. CONCLUSIONS DIP was the main antipsychotic-induced movement disorder associated with a poorer HRQOL in patients with schizophrenia. Therefore, clinicians should focus on prevention, detection, and effective management of DIP to optimize HRQOL in patients with schizophrenia.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, Singapore
| | - Jenny Tay
- Research Division, Institute of Mental Health, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore.,North Region & Department of Psychosis, Institute of Mental Health, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Ali Z, Roque A, El-Mallakh RS. A unifying theory for the pathoetiologic mechanism of tardive dyskinesia. Med Hypotheses 2020; 140:109682. [PMID: 32200182 DOI: 10.1016/j.mehy.2020.109682] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Chronic treatment with dopamine D2 receptor antagonists has been proposed to lead to dopamine receptor supersensitivity. Frequently, this is conceptualized as upregulation or changes in the structure or function of the post-synaptic D2 receptor. However, the measured 1.4-fold increase in D2 receptor density and the lack of actual receptor supersensitivity are probably inadequate to explain outcomes such as tardive dyskinesia (TD) and dopamine supersensitivity psychosis. HYPOTHESIS Recent data suggest that TD may result from a combination of presynaptic, synaptic, and postsynaptic changes. DISCUSSION Presynaptic increase in dopamine release occurs when super-therapeutic blockade of postsynaptic D2 receptors results in excess synaptic unbound dopamine which ultimately ends up being reuptaken by the presynaptic neuron through the dopamine transporter. The increased availability of recycled dopamine results in higher vesicular dopamine concentrations. Since the quantity of neurotransmitter released (known as quanta) is determined by the number of presynaptic neurotransmitter vesicles, the increase in the number (concentration) of dopamine molecules in the vesicles results in a higher concentration of synaptic dopamine with successive depolarization events. Synaptic changes such as the appearance of perforated synapses which is an early step in new synapse formation have been shown in animal models of TD. Finally, postsynaptic increases in D2 receptor expression without demonstration of increased sensitivity or potency has been demonstrated. CONCLUSION TD likely develops due to changes across the synapse and terminology such as 'dopamine receptor supersensitivity' can be misleading. 'Synaptic upregulation' may be a more correct term.
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Affiliation(s)
- Ziad Ali
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States.
| | - Autumn Roque
- Center for Mindfulness and CBT, 10845 Olive Blvd, St. Louis, MO 63141, United States.
| | - Rif S El-Mallakh
- Mood Disorders Research Program, Depression Center, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, United States
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Pringsheim T, Gardner D, Addington D, Martino D, Morgante F, Ricciardi L, Poole N, Remington G, Edwards M, Carson A, Barnes TRE. The Assessment and Treatment of Antipsychotic-Induced Akathisia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:719-729. [PMID: 29685069 PMCID: PMC6299189 DOI: 10.1177/0706743718760288] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia. METHODS We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework. RESULTS As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT2A antagonists, benzodiazepines, and vitamin B6. CONCLUSION The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - David Gardner
- Department of Psychiatry and Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Francesca Morgante
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | - Lucia Ricciardi
- Institute of Cardiovascular and Cell Sciences, St George's University of London, London, UK
| | - Norman Poole
- Department of Philosophy, King's College London, London, UK
| | - Gary Remington
- Departments of Psychiatry and Psychological Clinical Science, Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
| | - Mark Edwards
- Department of Neurology, St Georges University of London, London, UK
| | - Alan Carson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
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Martino D, Karnik V, Osland S, Barnes TRE, Pringsheim TM. Movement Disorders Associated With Antipsychotic Medication in People With Schizophrenia: An Overview of Cochrane Reviews and Meta-Analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:706743718777392. [PMID: 29758999 PMCID: PMC6299187 DOI: 10.1177/0706743718777392] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Movement disorders associated with antipsychotic medications are relatively common, stigmatising, and potentially disabling. Their prevalence in people with psychosis who are prescribed second-generation antipsychotics (SGAs) is uncertain, as is their level of recognition by clinicinas. We conducted meta-analyses of randomised controlled trials included in the Cochrane Database of Systematic Reviews on schizophrenia and schizophrenia-like psychoses to estimate the prevalence of new-onset dystonia, akathisia, parkinsonism, and tremor with SGAs (amisulpride, asenapine, aripiprazole, clozapine, olanzapine, paliperidone, quetiapine, risperidone, L-sulpiride, and ziprasidone) approved in Canada and the UK, comparing them with haloperidol and chlorpromazine. We used a random effects model because of the heterogeneity between-studies in drug dosage and method of ascertainment of movement disorders. Our systematic search yielded 37 Cochrane systematic reviews (28 for SGAs), which generated 316 informative randomised controlled trials (243 for SGAs). With respect to SGAs, prevalence estimates ranged from 1.4% (quetiapine) to 15.3% (L-sulpiride) for dystonia, 3.3% (paliperidone) to 16.4% (L-sulpiride) for akathisia, 2.4% (asenapine) to 29.3% (L-sulpiride) for parkinsonism, and 0.2% (clozapine) to 28.2% (L-sulpiride) for tremor. Prevalence estimates were not influenced by treatment duration, the use of a flexible or fixed dosing scheme, or whether studies used validated instruments for the screening/rating of movement disorders. Overall, we found high overlap on the prevalence of new-onset movement disorders across different SGAs precribed for established psychoses. Variations in prevalence figures across antipsychotic medications were observed for the different movement disorders. Differences in pharmacological properties, such as for the dopamine D2 R association rate and serotonin 5-HT2A antagonism, could contribute to this variation.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Vikram Karnik
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sydney Osland
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Tamara M. Pringsheim
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Pereira SR, Albert M. Anticholinergic discontinuation for antipsychotic-induced extra-pyramidal symptoms. Hippokratia 2017. [DOI: 10.1002/14651858.cd012525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Simi R Pereira
- Norfolk and Suffolk NHS Foundation Trust; General Adult Psychiatry; Drayton High Road Norwich Norfolk UK NR5 6BE
| | - Michael Albert
- Highbury Hospital; Department of Psychiatry; Nottingham UK
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Monitoring of extrapyramidal side effects in patients on antipsychotic treatment: a completed audit cycle. Ir J Psychol Med 2016; 33:165-169. [PMID: 30115186 DOI: 10.1017/ipm.2015.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Movement disorders are a common problem in those receiving antipsychotic medication. Clinical guidelines recommend that these side-effects are monitored regularly throughout treatment. However, due to a lack of training, clinician confidence levels in assessment are often low and regular monitoring may be neglected. Aims To audit current practice in our services regarding monitoring of extrapyramidal side effects (EPSE) and improve monitoring through education of clinicians. METHOD The clinical records of patients receiving antipsychotic treatment, seen in the outpatient clinic over a 2-week period, were reviewed. Data were collected on whether or not EPSE had been assessed. A re-audit was undertaken following a teaching session. RESULTS Documentation regarding EPSE was present in only 14% of patient records. Following a teaching session, the overall level of documentation of EPSE rose to 42%, with rates of assessment dramatically improving in non-consultant hospital doctors. CONCLUSION In our practice, clinicians are generally poor to assess and record EPSE. However, rates of assessment improved significantly following a teaching session, especially in NCHDs.
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Abstract
Taking into account findings in the literature, the author aimed to test whether specific graphical characteristics of handwriting can distinguish patients diagnosed with schizophrenic disorders from healthy controls. Handwriting samples (one sample from each person) from 60 outpatients (29 women, 31 men; age M = 28.5, SD = 5.4) with paranoid schizophrenia were analyzed by three documents examiners and were compared to samples from 60 controls (30 men, 30 women, age M = 28.0, SD = 3.0) without psychiatric disorders. Document examiners assessed 32 graphical features potentially related to schizophrenia. The comparisons between groups revealed that only 7 out of 32 handwriting properties were significantly different in the handwriting of schizophrenic outpatients from controls: the calligraphic forms of letters, loops in ovals, lacking of dots, tremor, sinusoidal baseline, and irregularities size of lower zone. These findings are discussed in terms of motor disturbances in schizophrenia and in relation to the previous research on handwriting of other mental disorders. Similarities between the graphical patterns of handwriting of schizophrenic patients and those of other mental disorders and/or other mental states have been demonstrated.
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Affiliation(s)
- Barbara Gawda
- Department of Psychology, Maria Curie-Sklodowska University, Lublin, Poland
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Ho RTH, Wan AHY, Au-Yeung FSW, Lo PHY, Siu PJCY, Wong CPK, Ng WYH, Cheung IKM, Ng SM, Chan CLW, Chen EYH. The psychophysiological effects of Tai-chi and exercise in residential schizophrenic patients: a 3-arm randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:364. [PMID: 25262346 PMCID: PMC4189583 DOI: 10.1186/1472-6882-14-364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with schizophrenia are characterized by high prevalence rates and chronicity that often leads to long-term institutionalization. Under the traditional medical model, treatment usually emphasizes the management of psychotic symptoms through medication, even though anti-psychotic drugs are associated with severe side effects, which can diminish patients' physical and psychological well-being. Tai-chi, a mind-body exercise rooted in Eastern health philosophy, emphasizes the motor coordination and relaxation. With these potential benefits, a randomized controlled trial (RCT) is planned to investigate the effects of Tai-chi intervention on the cognitive and motor deficits characteristic of patients with schizophrenia. METHODS/DESIGN A 3-arm RCT with waitlist control design will be used in this study. One hundred and fifty three participants will be randomized into (i) Tai-chi, (ii) exercise or (iii) waitlist control groups. Participants in both the Tai-chi and exercise groups will receive 12-weeks of specific intervention, in addition to the standard medication and care received by the waitlist control group. The exercise group will serve as a comparison, to delineate any unique benefits of Tai-chi that are independent of moderate aerobic exercise. All three groups will undergo three assessment phases: (i) at baseline, (ii) at 12 weeks (post-intervention), and (iii) at 24 weeks (maintenance). All participants will be assessed in terms of symptom management, motor coordination, memory, daily living function, and stress levels based on self-perceived responses and a physiological marker. DISCUSSION Based on a promising pilot study conducted prior to this RCT, subjects in the Tai-chi intervention group are expected to be protected against deterioration of motor coordination and interpersonal functioning. They are also expected to have better symptoms management and lower stress level than the other treatment groups. TRIAL REGISTRATION The trail has been registered in the Clinical Trials Center of the University of Hong Kong (HKCTR-1453).
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Affiliation(s)
- Rainbow Tin Hung Ho
- />Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam Hong Kong, China
- />Department of Social Work and Social Administration, The University of Hong Kong, The University of Hong Kong, Room 534, Jockey Club Tower, The Centennial Campus, Hong Kong, China
| | - Adrian Ho Yin Wan
- />Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam Hong Kong, China
- />Department of Social Work and Social Administration, The University of Hong Kong, The University of Hong Kong, Room 534, Jockey Club Tower, The Centennial Campus, Hong Kong, China
| | - Friendly So Wah Au-Yeung
- />The Providence Garden for Rehab, Hong Kong Sheng Kung Hui Welfare Council Limited, No. 82, Tsun Wen Road, Tuen Mun, New Territories Hong Kong
| | - Phyllis Hau Yan Lo
- />Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam Hong Kong, China
| | - Pantha Joey Chung Yue Siu
- />Department of Social Work and Social Administration, The University of Hong Kong, The University of Hong Kong, Room 534, Jockey Club Tower, The Centennial Campus, Hong Kong, China
| | - Cathy Pui Ki Wong
- />The Providence Garden for Rehab, Hong Kong Sheng Kung Hui Welfare Council Limited, No. 82, Tsun Wen Road, Tuen Mun, New Territories Hong Kong
| | - Winnie Yuen Han Ng
- />The Providence Garden for Rehab, Hong Kong Sheng Kung Hui Welfare Council Limited, No. 82, Tsun Wen Road, Tuen Mun, New Territories Hong Kong
| | - Irene Kit Man Cheung
- />Centre on Behavioral Health, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam Hong Kong, China
| | - Siu Man Ng
- />Department of Social Work and Social Administration, The University of Hong Kong, The University of Hong Kong, Room 534, Jockey Club Tower, The Centennial Campus, Hong Kong, China
| | - Cecilia Lai Wan Chan
- />Department of Social Work and Social Administration, The University of Hong Kong, The University of Hong Kong, Room 534, Jockey Club Tower, The Centennial Campus, Hong Kong, China
| | - Eric Yu Hai Chen
- />Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
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Dickenson R, Momcilovic S, Donnelly L. Anticholinergics versus placebo for neuroleptic-induced parkinsonism. Hippokratia 2014. [DOI: 10.1002/14651858.cd011164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rebecca Dickenson
- Lincolnshire Partnership NHS Foundation Trust; Community Mental Health Team; Beaconfield Centre Beacon Lane Grantham Lincolnshire UK NG31 9DF
| | - Stefan Momcilovic
- The University of Nottingham; 62 Park Road Nottingham Nottinghamshire UK NG7 1JG
| | - Lorna Donnelly
- NHS Lothian; General Adult Psychiatry; Ballenden House 28 Howden Street Edinburgh Midlothian UK EH8 9HL
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Dickenson R, Bethi SK, Srivastava S. Anticholinergics (various) for neuroleptic-induced parkinsonism. Hippokratia 2014. [DOI: 10.1002/14651858.cd011113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rebecca Dickenson
- Lincolnshire Partnership NHS Foundation Trust; Community Mental Health Team; Beaconfield Centre Beacon Lane Grantham Lincolnshire UK NG31 9DF
| | - Shailendhra K Bethi
- TEWV NHS Foundation Trust; Adult Mental Health; Ellis Centre Dean Road Scarborough North Yorkshire UK YO12 7SN
| | - Samir Srivastava
- South London and Maudsley NHS Foundation Trust; Criminal Justice Mental Health Service; London UK
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Lawford BR, Barnes M, Swagell CD, Connor JP, Burton SC, Heslop K, Voisey J, Morris CP, Nyst P, Noble EP, Young RM. DRD2/ANKK1 Taq1A (rs 1800497 C>T) genotypes are associated with susceptibility to second generation antipsychotic-induced akathisia. J Psychopharmacol 2013; 27:343-8. [PMID: 23118020 DOI: 10.1177/0269881112463469] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although the advent of atypical, second-generation antipsychotics (SGAs) has resulted in reduced likelihood of akathisia, this adverse effect remains a problem. It is known that extrapyramidal adverse effects are associated with increased drug occupancy of the dopamine 2 receptors (DRD2). The A1 allele of the DRD2/ANKK1, rs1800497, is associated with decreased striatal DRD2 density. The aim of this study was to identify whether the A1(T) allele of DRD2/ANKK1 was associated with akathisia (as measured by Barnes Akathisia Rating Scale) in a clinical sample of 234 patients who were treated with antipsychotic drugs. Definite akathisia (a score ≥ 2 in the global clinical assessment of akathisia) was significantly less common in subjects who were prescribed SGAs (16.8%) than those prescribed FGAs (47.6%), p < 0.0001. Overall, 24.1% of A1+ patients (A1A2/A1A1) who were treated with SGAs had akathisia, compared to 10.8% of A1- (thus, A2A2) patients. A1+ patients who were administered SGAs also had higher global clinical assessment of akathisia scores than the A1- subjects (p = 0.01). SGAs maintained their advantage over FGAs regarding akathisia, even in A1+ patients who were treated with SGAs. These results strongly suggested that A1+ variants of the DRD2/ANKK1 Taq1A allele do confer an associated risk for akathisia in patients who were treated with SGAs, and these variants may explain inconsistencies found across prior studies, when comparing FGAs and SGAs.
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Affiliation(s)
- B R Lawford
- Division of Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia.
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Kalachnik JE. Applied monitoring for tardive dyskinesia and other extrapyramidal side effects. Ment Health Clin 2012. [DOI: 10.9740/mhc.n92483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
While the rate of tardive dyskinesia (TD) and other extrapyramidal side effects (EPSE) is lower with second generation antipsychotic medications compared to first generation antipsychotic medications, these side effects remain of clinical concern. This paper reviews the basis for the continued concern and the importance of secondary prevention, or early detection, within the primary-secondary-tertiary prevention model. The importance of standardized assessment instruments, education, and training is reviewed. Given the widespread use of antipsychotic drugs, the fact that antipsychotic drugs are the standard of care for several psychiatric conditions (with little indication that the magic bullet is on the immediate horizon to replace current antipsychotic drugs) applied monitoring and the early detection of TD and EPSE takes on added importance.
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Affiliation(s)
- John E. Kalachnik
- Woodward Resource Center, Iowa Department of Human Services, Woodward, IA
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Asenapina: un nuevo enfoque para el tratamiento de la manía. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:101-8. [DOI: 10.1016/j.rpsm.2010.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 01/10/2023]
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Zalsman G, Opler M, Steinberg T, Apter A, Weizman A. Evaluation of side effects using the BARS, SAS and AIMS in pediatric psychopharmacologic studies. Eur Psychiatry 2010; 26:128-9. [PMID: 21036550 DOI: 10.1016/j.eurpsy.2010.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 08/19/2010] [Indexed: 10/18/2022] Open
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Zaidi SHH, Faruqui RA. Aripiprazole is associated with early onset of Tardive Dyskinesia like presentation in a patient with ABI and psychosis. Brain Inj 2009; 22:99-102. [DOI: 10.1080/02699050701822493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bishara D, Taylor D. Upcoming agents for the treatment of schizophrenia: mechanism of action, efficacy and tolerability. Drugs 2009; 68:2269-92. [PMID: 18973393 DOI: 10.2165/0003495-200868160-00002] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the introduction of a group of atypical antipsychotics in the 1990s, there has been a decline in the rate of new antipsychotics being introduced into clinical practice. However, with increasing safety and efficacy concerns over currently available drugs and a dearth of options available for atypical depot formulations, there is a considerable need for the development of new formulations and agents. This review examines the profile of seven antipsychotic drugs currently in the premarketing stage of development and summarizes their mechanism of action, clinical potential and safety.Asenapine is an antipsychotic with activity for multiple receptors and has potential to improve negative and cognitive symptoms of schizophrenia. Bifeprunox is a partial dopamine D2 and serotonin 5-HT(1A) receptor agonist showing a less than convincing efficacy profile, but which may offer safety advantages over available agents by means of a reduced risk of metabolic complications. Iloperidone is a D2 and 5-HT(2A) receptor antagonist requiring further studies to establish its effectiveness. It has a high affinity for alpha(1)-adrenoceptors, which can lead to associated haemodynamic adverse effects. Nemonapride is essentially a typical antipsychotic drug, similar in structure to sulpiride, which has been available for some time in Japan. It has efficacy against positive symptoms and has shown some antidepressant and anxiolytic properties, although efficacy data for it are somewhat limited. Norclozapine (N-desmethylclozapine) is a major metabolite of clozapine formed by its demethylation. Its partial agonist activity at D2 receptors has raised interest in it as an antipsychotic in its own right. In addition, it appears to have muscarinic agonist activity, which is believed to be responsible for the observed positive effects it has on cognition. It was envisaged to be effective as an adjunct to other agents or at high doses in the treatment of refractory schizophrenia, although a recent randomized, controlled study showed that it was no more effective than placebo in patients with schizophrenia experiencing an acute psychotic episode. Olanzapine pamoate depot injection has shown comparable efficacy to oral olanzapine in several studies. However, it has provoked considerable safety concerns by its association with inadvertent intravascular injection events in numerous patients. This accidental intravascular administration of olanzapine pamoate leads to excessive sedation, confusion, dizziness and altered speech. Post-injection observation periods and postmarketing surveillance are planned following the introduction of the depot. Paliperidone palmitate is the palmitate ester of paliperidone, the major metabolite of risperidone, and is formulated as a long-acting injection for intramuscular use. Its pharmacology is comparable to risperidone, having D2 and 5-HT(2A) receptor antagonist activity. Efficacy studies have shown positive results, and because paliperidone has no antagonistic activity at cholinergic receptors, it has low potential for anticholinergic adverse effects, including cognitive dysfunction. However, with higher doses, the frequency of extrapyramidal side effects and orthostatic hypotension have been shown to be greater than with placebo.
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Beirne M, Fenton J. Acute dystonic reaction secondary to prochlorperazine use in the treatment of hyperemesis gravidarum. Ir J Med Sci 2007; 176:53-4. [PMID: 17849526 DOI: 10.1007/s11845-007-0005-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jones M, Bennett J, Gray R, Arya P, Lucas B. Pharmacological management of akathisia in combination with psychological interventions by a mental health nurse consultant. J Psychiatr Ment Health Nurs 2006; 13:26-32. [PMID: 16441390 DOI: 10.1111/j.1365-2850.2006.00908.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.
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Affiliation(s)
- M Jones
- Hillingdon Primary Care Trust and Buckinghamshire and Chilterns University, Riverside Centre, Uxbridge, UK.
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20
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Comparison of educational interventions for mental health consumers receiving psychotropic medication. INT J EVID-BASED HEA 2004. [DOI: 10.1097/01258363-200402000-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Abstract
Akathisia is a syndrome of motor restlessness, principally seen in association with antipsychotic medication. It is characterized by a subjective experience of mental unease and the urge to move, and manifests physically as particular patterns of restless movement. This review focuses on the signs and symptoms of the condition, and its diagnosis and assessment using the Barnes Akathisia Rating Scale. This scale was generated 15 years ago, and was derived from the findings of studies exploring the clinical features of antipsychotic-induced akathisia. Subsequently, its validity and reliability have been established, and it has been used extensively in clinical studies worldwide.
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Affiliation(s)
- Thomas R E Barnes
- Department of Psychological Medicine, Imperial College, Charing Cross Campus, London, UK.
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