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Woods SW, Morgenstern H, Saksa JR, Walsh BC, Sullivan MC, Money R, Hawkins KA, Gueorguieva RV, Glazer WM. Incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: a prospective cohort study. J Clin Psychiatry 2010; 71:463-74. [PMID: 20156410 PMCID: PMC3109728 DOI: 10.4088/jcp.07m03890yel] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/02/2009] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Most previous studies of the incidence of tardive dyskinesia with atypical antipsychotics compared with conventional antipsychotics have not had tardive dyskinesia as their primary focus. The current study aimed to compare the incidence of tardive dyskinesia with atypical vs conventional antipsychotics using methods similar to those from a previous prospective cohort study at our site in the 1980s. METHOD Three hundred fifty-two initially tardive dyskinesia-free psychiatric outpatients (diagnosed at baseline using the Structured Clinical Interview for DSM-IV) were examined for a new diagnosis of tardive dyskinesia (using the Abnormal Involuntary Movement Scale and Glazer-Morgenstern criteria) every 6 months for up to 4 years at a community mental health center. At baseline, subjects were receiving conventional antipsychotics only (23%), atypicals only (64%), or both (14%). Only 26 subjects had never received conventional antipsychotics. Baseline evaluations were conducted from November 2000 through May 2003. Follow-ups were conducted through February 2005. RESULTS Compared with subjects treated with conventional antipsychotics alone since the previous visit, the adjusted tardive dyskinesia incidence rate-ratio for subjects treated with atypical antipsychotics alone was 0.68 (95% CI, 0.29-1.64). The incidence and prevalence of tardive dyskinesia was similar to previous findings at this site in the 1980s. CONCLUSIONS The incidence of tardive dyskinesia with recent exposure to atypical antipsychotics alone was more similar to that for conventional antipsychotics than in most previous studies. Despite high penetration of atypical antipsychotics into clinical practice, the incidence and prevalence of tardive dyskinesia appeared relatively unchanged since the 1980s. Clinicians should continue to monitor for tardive dyskinesia, and researchers should continue to pursue efforts to treat or prevent it.
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Affiliation(s)
- Scott W. Woods
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - John R. Saksa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Barbara C. Walsh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Michelle C. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Roy Money
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Keith A. Hawkins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057
| | - Ralitza V. Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA. Dr. Woods may be reached at 34 Park Street, New Haven, CT, USA 06519, tel 203 974-7038, fax 203 974-7057, Department of Epidemiology and Public Health, Biostatistics Division, Yale University School of Medicine
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Abstract
The use of psychotropic medication among children and adolescents is increasing with a concomitant increase in the incidence of drug-related movement disorders. This class of adverse reactions to medications can be divided into those that are acute in onset, others that are continuous as long as the offending drug is administered, and a final category consisting of symptoms that are persistent, even after the causative agent has been discontinued. Within these three categories, this review discusses the epidemiology, risk factors, clinical features and treatment of acute dystonic reactions, drug-induced parkinsonism, neuroleptic malignant syndrome, serotonin syndrome, acute akathisia, and the tardive syndromes. In addition, drugs that commonly cause tremor, chorea, or myoclonus are included.
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Affiliation(s)
- Robert L Rodnitzky
- University of Iowa, Department of Neurology, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Blayac JP, Pinzani V, Peyrière H, Hillaire-Buys D. Mouvements anormaux d’origine médicamenteuse : les syndromes tardifs. Therapie 2004; 59:113-9. [PMID: 15199677 DOI: 10.2515/therapie:2004022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persistent drug-induced movement disorders (tardive syndromes) remain an important clinical problem and consist of a variety of involuntary movements appearing in a patient exposed to a dopamine-blocking agent. The current state of knowledge on this topic is summarised in this article. Clinical aspects (tardive dyskinesia, tardive dystonia and other forms), prevalence, risk factors, prevention and management are discussed.
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Affiliation(s)
- Jean-Pierre Blayac
- Service de Pharmacologie Médicale et Toxicologie, Hôpital Lapeyronie, CHU de Montpellier, 34295 Montpellier, France.
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Abstract
The increased use of stimulants, antipsychotic agents, and antidepressant drugs in children by primary care physicians, psychiatrists, and neurologists has inevitably led to increased numbers of pediatric patients manifesting the side effects of these agents, many of which are movement disorders. Unlike the isolated abnormal involuntary movements associated with drugs prescribed for epilepsy or asthma, movement syndromes (eg, acute dystonic reaction, neuroleptic malignant syndrome, serotonin syndrome, tardive dyskinesia) associated with psychotropic drugs are complex, difficult to recognize, and potentially seriously disabling. Accurate clinical identification of these drug-induced syndromes is critical to engaging the proper therapeutic intervention for them.
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Abstract
A variety of hyperkinetic movement disorders has been associated with the use of neuroleptics (dopamine receptor blocking drugs), but tardive tremor has not been previously documented. We describe five patients in whom tremor occurred after chronic treatment with neuroleptics, was aggravated by and persisted after neuroleptic withdrawal, and improved after treatment with the dopamine depleting drug tetrabenazine. This involuntary oscillatory movement, with a frequency range of 3-5 Hz, was most prominent during maintenance of a posture, but was also present at rest and during a goal-directed movement. The tremor was accompanied by other tardive movement disorders, including akathisia, chorea, dystonia, myoclonus, and stereotypy. There was no family history or other explanation for tremor in these patients. We suggest that this hitherto unreported movement disorder is best termed "tardive tremor."
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Affiliation(s)
- M Stacy
- Department of Neurology, Baylor College of Medicine, Houston, Texas 77030
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