scholarly journals Drug-Drug-Induced Akathisia: Two Case Reports

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Grace Owusu Aboagye ◽  
Daniel Ankrah
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Beta Blockers ◽  
Case Reports ◽  
First Episode ◽  
Extrapyramidal Side Effects ◽  
Drug Induced ◽  
Fluphenazine Decanoate ◽  
Probable Case ◽  
Psychotropic Medicines

Extrapyramidal side effects of psychotropic medicines are usually experienced by patients in the first few weeks of initiating therapy. Patients stabilized on these medications who present with distressing complaints akin to akathisia may be triggered by other factors. This report presents two cases of drug-drug-induced akathisia. Case A is a patient with schizophrenia who was being managed with risperidone 2 mg tablet daily for the past 3 years. She fell ill and reported to a nearby clinic where she was prescribed ciprofloxacin and artemether/lumefantrine tablets for the treatment of an infection and malaria. She presented 7 days later to her psychiatrist with complaints of restlessness, tremor, palpitations, insomnia, and resurgence of obsessive thoughts. Case B is a patient who was diagnosed with first-episode psychotic depression and admitted for 10 days. Her medications on admission were fluphenazine decanoate 25 mg depot injection once, olanzapine 10 mg tablet daily, and fluoxetine 20 mg capsule daily. On discharge, ciprofloxacin 500 mg tablet every 12 hours for 5 days and fluconazole 150 mg capsule once were added to her medications for the treatment of a urinary tract infection. She reported back to the hospital a day after discharge with complaints of restlessness, “seizures,” tremor, abdominal discomfort, and weight gain. Both patients were diagnosed with akathisia using ICD-10 classification and the Barnes akathisia rating scale and managed with anticholinergics, benzodiazepines, and beta blockers. Other measures employed in managing the akathisia included reducing the dose of the antipsychotic and/or switching antipsychotics. Despite these management measures, the symptoms of akathisia persisted and only resolved after 4weeks. Upon the resolution of symptoms, Case A continued treatment on olanzapine 5 mg tablet daily and fluoxetine 20 mg capsule daily while Case B continued treatment on risperidone 2 mg tablet daily and fluoxetine 20 mg capsule daily. Using Naranjo’s adverse drug reaction causality assessment scale, Medscape drug interaction checker, and literature review, a possible and probable case of drug-drug-induced akathisia was made for Case A and Case B. This report is to create more awareness about psychotropic-antimicrobial-induced akathisia. The information underpins the need for health professionals to consider adverse drug-drug interactions as the probable cause of extrapyramidal side effects experienced by patients on antipsychotics.

scholarly journals Extrapyramidal side effects in first-episode schizophrenia treated with flupenthixol decanoate

2021 ◽  
Vol 27 ◽  
Author(s):  
Francois-Pierre Joubert ◽  
Bonginkosi Chiliza ◽  
Robin Emsley ◽  
Laila Asmal
Keyword(s):  
Side Effects ◽  
Subjective Experience ◽  
Rating Scale ◽  
First Episode ◽  
Public Healthcare ◽  
Extrapyramidal Side Effects ◽  
Mixed Ancestry ◽  
First Episode Schizophrenia ◽  
Flupenthixol Decanoate ◽  
White Patients

Background: Concern for the development of extrapyramidal side effects (EPSEs) represents a barrier to the routine use of long-acting injectable (LAI) antipsychotic medication in patients with first-episode schizophrenia (FES). Flupenthixol decanoate is a first-generation antipsychotic, which is readily available in the public healthcare system in South Africa.Aim: The aim of this study was to describe the nature, occurrence and severity of EPSEs and their impact on patients with FES over 12 months of treatment with flupenthixol decanoate (fluanxol depot).Setting: The study was based in Cape Town, South Africa, and patients with FES were recruited from inpatient services at Stikland and Tygerberg Hospitals and surrounding psychiatric clinics. This was a sub-study of a larger study, which examined several outcomes in patients with FES treated with the lowest effective dose of flupenthixol decanoate.Methods: The Extrapyramidal Symptom Rating Scale (ESRS) was used to assess both subjective experience and objective measures of EPSEs in a cohort of patients with FES (N = 130). The relationship between demographic and clinical risk factors for individual subsets of EPSEs was also determined.Results: In the context of an overall good 12-month tolerability, EPSEs peaked at month 3. Patients with akathisia were more likely to have greater symptoms of depression, and Parkinsonism was predicted by higher Positive and Negative Syndrome Scale scores (independent of medication dosage). Black and white patients showed higher total ESRS and higher subjective ESRS scores, compared with patients of mixed ancestry, and white patients scored higher on Parkinsonism ratings.Conclusion: Flupenthixol decanoate is well tolerated in patients with FES. Certain clinical features of schizophrenia may be related to EPSEs. Ethnicity is a socio-cultural construct, and hence the differential risk of EPSEs should be interpreted according to ethnicity. Variations in the environment, diet, substance use and genetics may all affect the pharmacokinetics and pharmacodynamics of psychotropic drugs and warrant further investigation.

scholarly journals Antimicrobial-induced cognitive side effects

2016 ◽  
Vol 6 (4) ◽  
pp. 207-214 ◽  
Author(s):  
Amanda Warstler ◽  
Jennifer Bean
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Side Effects ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Time Frame ◽  
Drug Induced ◽  
Pubmed Search ◽  
Neuropsychiatric Side Effects ◽  
Cognitive Side Effects

Abstract Introduction: Antimicrobial-induced cognitive side effects are often overlooked or underreported. Literature often reports symptoms of antimicrobial-induced cognitive impairment under more general blanket terms, such as neuropsychiatric side effects, neurotoxicity, or drug-induced delirium or encephalopathy. Methods: A PubMed search using terms including antibiotics, antifungals, antivirals, antimalarials, side effects, cognitive, neurotoxicity, encephalopathy, and delirium was conducted. Respectively, symptoms of cognitive impairment were teased out of the multiple neurologic complications presented for each case and reported based on antimicrobial class. Articles were excluded if they focused solely on neuropsychiatric side effects such as seizures, psychosis, hallucinations, or mood disturbances, were conducted in animals, or involved antiretroviral medication therapies. Results: Of over 50 case reviews, case reports, retrospective chart reviews, and prospective cohort studies analyzed, 25 were deemed appropriate for purposes of this review. Common antimicrobial-induced cognitive side effects for all antimicrobial classes included confusion, delirium, encephalopathy, and impaired concentration or attention. Recurring risk factors included, but were not limited to, older age and renal impairment. Mechanisms of cognitive impairment were relatively specific to each antimicrobial class. Discussion: Awareness of the potential for antimicrobial-induced cognitive side effects, including the general time frame of symptom onset and symptom presentation, is critical in challenging patient cases. This review article aims to summarize the risk factors, clinical symptoms, mechanisms, and management of antimicrobial-induced cognitive side effects. Pharmacists can play a key role in prevention through adjustment of medications for renal or hepatic dysfunction, avoidance of polypharmacy, and knowledge of critical drug interactions that may precipitate cognitive decline.

Prevalence of Extrapyramidal Side Effects in Patients Receiving Depot Antipsychotic Medication

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
B. Luft ◽  
E. Berent
Keyword(s):  
Side Effects ◽  
Tardive Dyskinesia ◽  
Antipsychotic Medication ◽  
Rating Scales ◽  
Involuntary Movement ◽  
Extrapyramidal Side Effects ◽  
Drug Induced ◽  
Adherence To Medication ◽  
Depot Antipsychotic ◽  
Long Acting

Introduction:Long-acting depot antipsychotic medication is associated with extrapyramidal side effects (EPS). This may reduce adherence to medication, and precipitate relapse (1). Clearly, EPS is a major drawback and early detection is essential. However, in an earlier review of patients’ medical notes, we identified only one patient with an examination that recorded the presence of EPS. Despite the fact that a number of rating scales are available. We proposed that the application of these rating scales, would allow us to improve the assessment of EPS.Method:All patients prescribed a depot antipsychotic or long-acting risperidone injection, were identified. the Barnes Akathisia Scale (2) was chosen to rate akathisia, a modified Simpson-Angus scale (3) was chosen to rate parkinsonism and the Abnormal Involuntary Movement Scale (4) was chosen to rate tardive dyskinesia.Results:A total of 43 patients were evaluated. 23 (53%) patients showed drug induced EPS. the total number of positive cases of akathisia was 12 (28%), and 10 (23%) patients were found to have tardive dyskinesia. 13 (30%) patients were found to have drug induced parkinsonism.Conclusions:Our screening programme has identified high rates of previously undiscovered drug induced EPS.

Extrapyramidal side effects and functional remission in schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S195-S196
Author(s):  
B. Ghajati ◽  
C. Leila ◽  
L. Raja ◽  
C. Majda
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Spectrum Disorder ◽  
Extrapyramidal Side Effects ◽  
Schizophrenia Spectrum Disorder ◽  
Cross Sectional ◽  
Schizophrenia Spectrum ◽  
The Social ◽  
Competing Interest ◽  
Social Autonomy

Treating patients with schizophrenia has evolved towards including, as an effective goal, their functional remission. Beyond the discrepancies in this concept definition, a plethora of studies has been conducted trying to identify predictors of functioning in schizophrenia. Among which antipsychotic prescription and related side effects.AimExplore extrapyramidal side effects link with functional prognosis of patients with schizophrenia spectrum disorder.MethodsWe conducted a cross-sectional, retrospective and descriptive study in the psychiatry department “C”, in Razi hospital (Tunis), between October 2014 and March 2015. Sixty patients suffering from schizophrenia spectrum disorder (DSM IV-R) were included. Functional status was explored with the Global Assessment of Functioning Scale (GAF), the Social and Occupational Functioning Assessment Scale (SOFAS) and the Social Autonomy Scale (EAS). Extrapyramidal side effects (EPS) were evaluated using the Simpson and Angus Rating Scale (SAS).ResultsFunctional remission was achieved according to GAF, SOFAS and EAS in respectively: 63,30%, 48,30% and 51,70% of the patients. SAS mean score was 0.898 ± 0.29 (0.4–2). Although SAS showed no significant association with GAF, SOFAS and EAS global scores, patient with less EPS had better autonomy in EAS’ dimension “Relationship with the outside” (P = 0.048).ConclusionEPS may influence functional remission at several levels starting from the neurobiological to the social stigmatization and the treatment adherence levels. Further research in this matter is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Efficacy of atypical v. typical antipsychotics in the treatment of early psychosis: meta-analysis

2010 ◽  
Vol 196 (6) ◽  
pp. 434-439 ◽  
Author(s):  
Nicolas A. Crossley ◽  
Miguel Constante ◽  
Philip McGuire ◽  
Paddy Power
Keyword(s):  
Side Effects ◽  
Randomised Controlled Trials ◽  
Atypical Antipsychotics ◽  
Meta Analysis ◽  
Evidence Base ◽  
First Episode ◽  
Controlled Trials ◽  
Extrapyramidal Side Effects ◽  
Randomised Controlled ◽  
Typical Antipsychotics

BackgroundThere is an ongoing debate about the use of atypical antipsychotics as a first-line treatment for first-episode psychosis.AimsTo examine the evidence base for this recommendation.MethodMeta-analyses of randomised controlled trials in the early phase of psychosis, looking at long-term discontinuation rates, short-term symptom changes, weight gain and extrapyramidal side-effects. Trials were identified using a combination of electronic (Cochrane Central, EMBASE, MEDLINE and PsycINFO) and manual searches.ResultsFifteen randomised controlled trials with a total of 2522 participants were included. No significant differences between atypical and typical drugs were found for discontinuation rates (odds ratio (OR) = 0.7, 95% CI 0.4 to 1.2) or effect on symptoms (standardised mean difference (SMD) = –0.1, 95% CI –0.2 to 0.02). Participants on atypical antipsychotics gained 2.1 kg (95% CI 0.1 to 4.1) more weight than those on typicals, whereas those on typicals experienced more extrapyramidal side-effects (SMD = –0.4, 95% CI –0.5 to –0.2).ConclusionsThere was no evidence for differences in efficacy between atypical and typical antipsychotics, but there was a clear difference in the side-effect profile.

Cross-sectional examination of extrapyramidal side effects in a specialist palliative care inpatient unit

2018 ◽  
Vol 9 (3) ◽  
pp. 271-273
Author(s):  
Hannah O'Brien ◽  
Fiona Kiely ◽  
Aileen Barry ◽  
Sarah Meaney
Keyword(s):  
Palliative Care ◽  
Side Effects ◽  
Rating Scale ◽  
Demographic Data ◽  
Previous History ◽  
Inpatient Unit ◽  
Screening Tools ◽  
Screening Tests ◽  
Extrapyramidal Side Effects ◽  
Inclusion Criteria

ObjectivesExtrapyramidal side effects (EPSEs) are serious potentially reversible side effects of antipsychotic and other medications that can cause distress for patients. A core principle of palliative care involves optimising quality of life. If side effects of medications are burdensome, it is imperative that we address this issue. The aim of the study was to determine and describe the burden of EPSEs in a specialist inpatient unit.MethodsConsenting patients who met inclusion criteria were assessed for EPSE with two validated screening tests, the Modified Simpson-Angus Scale (MSAS) and Barnes Akathisia Rating Scale (BARS). Additional demographic data were collected including medications associated with EPSE, previous history of EPSE and known risk factors that may predispose a patient to EPSE.Results43% inpatients met inclusion criteria. At least 66% of patients were taking regular medications associated with EPSE. Of those, 25% were taking ≥2 medications associated with EPSE. The MSAS revealed 50% scored <3, 44% scored 3–5% and 6% scored 6–11. Seven patients had at least one ‘not rateable score’. In the BARS (sitting±standing), 94% scored 0/5 and 6% scored 1/5. 12.5% of participants were able to stand for 2 min to complete the BARS.Conclusions50% screened positive for EPSE. The complete BARS was unsuitable for most participants. The MSAS, while allowing a not rateable score, may underestimate EPSE. The frailty of an inpatient unit population impacts on applicability of screening tools and may therefore underestimate the burden of the problem in this population. Development of a population-specific screening tool warrants further investigation.

Aspects of dysphoria and symptoms of schizophrenia

1998 ◽  
Vol 28 (6) ◽  
pp. 1433-1441 ◽  
Author(s):  
R. M. G. NORMAN ◽  
A. K. MALLA ◽  
L. CORTESE ◽  
F. DIAZ
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Self Report ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Extrapyramidal Side Effects ◽  
Psychomotor Slowing ◽  
Drug Induced ◽  
Observer Ratings ◽  
Reality Distortion

Background. In the past it has been postulated that dysphoric emotions may be related to positive and/or negative symptoms in schizophrenia. The results of several recent studies have suggested that composite dysphoria indices are more strongly related to positive than negative symptoms. In the current study we use part correlation techniques to examine the possible unique contributions of two aspects of dysphoria – depression and anxiety – to three syndromes of symptoms (reality distortion, disorganization and psychomotor poverty) within schizophrenia.Methods. Data were obtained from 60 patients with a DSM-III-R diagnosis of schizophrenia. Symptoms of schizophrenia were assessed using the SAPS and SANS and dysphoria was assessed using both self-report (BDI and BAI) and observer ratings (HRSD and HARS). Assessment of schizophrenia symptoms and ratings of depression and anxiety were completed by different observers. In addition, drug induced extrapyramidal side effects were rated.Results. Part correlations showed that unique aspects of anxiety (particularly physiological arousal) were correlated with reality distortion while unique aspects of depression (including psychomotor slowing and loss of social interest) were related to psychomotor poverty. At least part of the latter relationship may be due to extrapyramidal side effects of neuroleptic medication.Conclusions. Although there is considerable overlap between anxiety and depression, it appears that the unique arousing or activating aspects of anxiety are related to the experience of reality distortion symptoms in schizophrenia and the unique slowing and withdrawal aspects of depression are particularly related to psychomotor poverty. Possible reasons for these relationships are discussed.

Effect of integrated yoga on anti-psychotic induced side effects and cognitive functions in patients suffering from schizophrenia

2018 ◽  
Vol 16 (1) ◽  
Author(s):  
Meghnath Verma ◽  
Hemant Bhargav ◽  
Shivarama Varambally ◽  
Nagarathna Raghuram ◽  
Gangadhar BN
Keyword(s):  
Side Effects ◽  
Cognitive Functions ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Clinical Symptoms ◽  
Stable State ◽  
Preliminary Evidence ◽  
Relaxation Techniques ◽  
Anti Psychotic ◽  
Drug Induced

Abstract Background Twenty one (12 females) subjects, diagnosed with schizophrenia by a psychiatrist using ICD-10, in the ages 52.87 + 9.5 years and suffering since 24.0 ± 3.05 years were recruited into the study from a schizophrenia rehabilitation center in Bengaluru. Methods All subjects were taking anti-psychotic medications and were in stable state for more than a month. Psychiatric medications were kept constant during the study period. Assessments were done at three points of time: (1) baseline, (2) after one month of usual routine (pre) and (3) after five months of validated Integrated Yoga (IY) intervention (post). Validated 1 h Yoga module (consisting of asanas, pranayama, relaxation techniques and chantings) was practiced for 5 months, five sessions per week. Antipsychotic-induced side effects were assessed using Simpson Angus Scale (SAS) and Udvalg for Kliniske Undersogelser (UKU) side effect rating scale. Cognitive functions (using Trail making Test A and B), clinical symptoms and anthropometry were assessed as secondary variables. Comparisons between “pre” and “post” data was done using paired samples t-tests after subtracting baseline scores from them respectively. Results At the end of five months, significant reduction in drug-induced Parkinsonian symptoms (SAS score; p=0.001) and 38 items of UKU scale was observed along with significant improvement in processing speed, executive functions and negative symptoms of schizophrenia patients. No side effects of Yoga were reported. Conclusions The present study provides preliminary evidence for usefulness of Integrated Yoga intervention in managing anti-psychotic-induced side effects.

Sign in / Sign up

Export Citation Format

Share Document