scholarly journals Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 2: Incidence and Management Strategies in Patients with Schizophrenia

2005 ◽  
Vol 50 (11) ◽  
pp. 703-714 ◽  
Author(s):  
Howard C Margolese ◽  
Guy Chouinard ◽  
Theodore T Kolivakis ◽  
Linda Beauclair ◽  
Robert Miller ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Tardive Dyskinesia ◽  
Atypical Antipsychotics ◽  
De Novo ◽  
Management Strategies ◽  
Antipsychotic Agents ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Conventional Antipsychotic

Objective: Tardive dyskinesia (TD), the principal adverse effect of long-term conventional antipsychotic treatment, can be debilitating and, in many cases, persistent. We sought to explore the incidence and management of TD in the era of atypical antipsychotics because it remains an important iatrogenic adverse effect. Methods: We conducted a review of TD incidence and management literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, management, therapy, neuroleptics, antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. Additional articles were obtained by searching the bibliographies of relevant references. We considered articles that contributed to the current understanding of both the incidence of TD with atypical antipsychotics and management strategies for TD. Results: The incidence of TD is significantly lower with atypical, compared with typical, antipsychotics, but cases of de novo TD have been identified. Evidence suggests that atypical antipsychotic therapy ameliorates long-standing TD. This paper outlines management strategies for TD in patients with schizophrenia. Conclusion: The literature supports the recommendation that atypical antipsychotics should be the first antipsychotics used in patients who have experienced TD as a result of treatment with conventional antipsychotic agents. The other management strategies discussed may prove useful in certain patients.

scholarly journals Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 1: Pathophysiology and Mechanisms of Induction

2005 ◽  
Vol 50 (9) ◽  
pp. 541-547 ◽  
Author(s):  
Howard C Margolese ◽  
Guy Chouinard ◽  
Theodore T Kolivakis ◽  
Linda Beauclair ◽  
Robert Miller
Keyword(s):  
Tardive Dyskinesia ◽  
Lower Incidence ◽  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
Term Treatment ◽  
Functional Reserve ◽  
Cholinergic Interneurons ◽  
Long Term Treatment ◽  
Typical And Atypical Antipsychotics

Objective: Tardive dyskinesia (TD) is the principal adverse effect of long-term treatment with conventional antipsychotic agents. Several mechanisms may exist for this phenomenon. Mechanisms for the lower incidence of TD with atypical antipsychotics also remain to be fully understood. We undertook to explore and better understand these mechanisms. Methods: We conducted a comprehensive review of TD pathophysiology literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, neuroleptics, antipsychotics, pathophysiology, and mechanisms. Additional articles were obtained by searching the bibliographies of relevant references. Articles were considered if they contributed to the current understanding of the pathophysiology of TD. Results: Current TD vulnerability models include genetic vulnerability, disease-related vulnerability, and decreased functional reserve. Mechanisms of TD induction include prolonged blockade of postsynaptic dopamine receptors, postsynaptic dopamine hypersensitivity, damage to striatal GABA interneurons, and damage of striatal cholinergic interneurons. Atypical antipsychotics may cause less TD because they have less impact on the basal ganglia and are less likely to cause postsynaptic dopamine hypersensitivity. Conclusion: Although the ultimate model for TD is not yet understood, it is plausible that several of these vulnerabilities and mechanisms act together to produce TD. The lower incidence of TD with atypical antipsychotics has helped to elucidate the mechanisms of TD.

scholarly journals Supersensitivity Psychosis and Its Response to Asenapine in a Patient with Delusional Disorder

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Ravi Philip Rajkumar
Keyword(s):  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
Delusional Disorder ◽  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Typical Antipsychotic ◽  
Persecutory Delusions ◽  
Established Treatment

Supersensitivity psychosis is a recognized complication of long-term antipsychotic treatment, in which patients develop new or reemergent psychotic symptoms, generally accompanied by dyskinetic movements, due to prolonged dopamine receptor blockade and resultant supersensitivity. Though it is most closely associated with schizophrenia and the use of typical antipsychotic agents, it has also been documented in patients with other diagnoses, and in those receiving atypical antipsychotics. There is no established treatment for this condition. In this paper, we describe a patient with persistent delusional disorder, jealous type, who developed a supersensitivity psychosis characterized by persecutory delusions, auditory hallucinations, and thought insertion in association with mild tardive dyskinesia. These symptoms resolved completely following six weeks of treatment with the second-generation antipsychotic asenapine, 20 mg/day. The mechanisms and implications of the patient’s symptomatology and response are discussed.

Antipsychotic-induced tardive dyskinesia: The role of glutamatergic system

2016 ◽  
Vol 33 (S1) ◽  
pp. S97-S97
Author(s):  
A. Boiko ◽  
S. Ivanova ◽  
A. Semke
Keyword(s):  
Tardive Dyskinesia ◽  
Glutamate Transporter ◽  
Antipsychotic Treatment ◽  
Nucleotide Polymorphisms ◽  
Antipsychotic Therapy ◽  
Drug Induced ◽  
Schizophrenic Patients ◽  
Competing Interest

Tardive dyskinesia (TD) occurs in 20–25% of patients with long-term antipsychotic therapy. Abnormalities in glutamatergic transmission are considered one of the key components of the pathogenesis of drug-induced side effects. Glutamate acts as excitotoxin under certain conditions and in excessive concentrations.Aim is to study the concentration of glutamate and analysis of single nucleotide polymorphisms (SNP) in genes coding the glutamate transporter and NMDA-receptors in schizophrenic patients with TD and without it.The study group included 156 patients with schizophrenia receiving long-term antipsychotic treatment. Patients were divided into two groups: 63 patients with TD and 93 patients without it. Glutamate was determined in serum by spectrophotometric method. Determination of allelic variants of gene SLC1A2 (rs4354668) and GRIN2A (rs2650427, rs1969060) was performed by polymerase chain reaction in real-time.We found a significant (P < 0.05) increase of the concentration of glutamate in patients with TD. Significant (P < 0.05) reduction in frequency of genotype GG of GRIN2A (rs1969060) and TT of SLC1A2 (rs4354668) were found in patients with TD in comparison to group without TD. In the study of glutamate concentration depending on the genotype GRIN2A (rs1969060) and genotype SLC1A2 (rs4354668) we observed a statistically significant change: elevated levels of glutamic acid identified with the heterozygous genotype in patients.It is possible to suggest that reduction in frequency of these genotypes increases the risk of movement disorders due to the protective effect of these genotypes.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Antipsychotic-induced supersensitivity – A reappraisal

2021 ◽  
pp. 000486742110256
Author(s):  
William Lugg
Keyword(s):  
Tardive Dyskinesia ◽  
Significant Proportion ◽  
Underlying Mechanism ◽  
Antipsychotic Treatment ◽  
Physiological Changes ◽  
Antipsychotic Therapy ◽  
Neurotransmitter Systems ◽  
Potential Benefits ◽  
Treatment Refractory ◽  
Brain Pathways

Objectives: Tardive dyskinesia, psychotic relapse and treatment-refractory psychosis have long been associated. A common underlying mechanism involving antipsychotic-induced ‘supersensitivity’, albeit in different brain pathways, was proposed as early as 1978. This piece seeks to reappraise the concept and potential implications of antipsychotic-induced supersensitivity. Conclusions: Evidence increasingly suggests that chronic antipsychotic exposure induces neuroadaptive physiological changes in dopaminergic, and other, neurotransmitter systems that may render some individuals more vulnerable to psychotic relapse - including those receiving continuous antipsychotic treatment. It is possible that in treating every episode of psychosis with prolonged or indefinite antipsychotic therapy, we paradoxically increase the risk of psychotic relapse in a significant proportion of people. A greater appreciation of supersensitivity may allow us to optimise any potential benefits of antipsychotics while minimising the risk of inadvertent iatrogenic harms. More research is needed to improve our understanding of the underlying neurophysiology of supersensitivity and to better identify which individuals are most vulnerable to its development. It is time we paid more attention to the concept, emerging evidence and potential implications of antipsychotic-induced supersensitivity and, where appropriate, adjusted our practice accordingly.

scholarly journals Antipsychotic Effects on Cortical Morphology in Schizophrenia and Bipolar Disorders

2020 ◽  
Vol 14 ◽  
Author(s):  
Ruiqi Feng ◽  
Fay Y. Womer ◽  
E. Kale Edmiston ◽  
Yifan Chen ◽  
Yinshan Wang ◽  
...  
Keyword(s):  
Atypical Antipsychotic ◽  
Cortical Thickness ◽  
Atypical Antipsychotics ◽  
Structural Changes ◽  
Middle Temporal Gyrus ◽  
Antipsychotic Treatment ◽  
Illness Duration ◽  
Cortical Thinning ◽  
Age Related

Background: Previous studies of atypical antipsychotic effects on cortical structures in schizophrenia (SZ) and bipolar disorder (BD) have findings that vary between the short and long term. In particular, there has not been a study exploring the effects of atypical antipsychotics on age-related cortical structural changes in SZ and BD. This study aimed to determine whether mid- to long-term atypical antipsychotic treatment (mean duration = 20 months) is associated with cortical structural changes and whether age-related cortical structural changes are affected by atypical antipsychotics.Methods: Structural magnetic resonance imaging images were obtained from 445 participants consisting of 88 medicated patients (67 with SZ, 21 with BD), 84 unmedicated patients (50 with SZ, 34 with BD), and 273 healthy controls (HC). Surface-based analyses were employed to detect differences in thickness and area among the three groups. We examined the age-related effects of atypical antipsychotics after excluding the potential effects of illness duration.Results: Significant differences in cortical thickness were observed in the frontal, temporal, parietal, and insular areas and the isthmus of the cingulate gyrus. The medicated group showed greater cortical thinning in these regions than the unmediated group and HC; furthermore, there were age-related differences in the effects of atypical antipsychotics, and these effects did not relate to illness duration. Moreover, cortical thinning was significantly correlated with lower symptom scores and Wisconsin Card Sorting Test (WCST) deficits in patients. After false discovery rate correction, cortical thinning in the right middle temporal gyrus in patients was significantly positively correlated with lower HAMD scores. The unmedicated group showed only greater frontotemporal thickness than the HC group.Conclusion: Mid- to long-term atypical antipsychotic use may adversely affect cortical thickness over the course of treatment and ageing and may also result in worsening cognitive function.

scholarly journals Effectiveness analysis of antipsychotics in schizophrenia using psychometric scales: an observational study

2020 ◽  
Vol 9 (2) ◽  
pp. 305
Author(s):  
Ratna Agrawal ◽  
Bhabagrahi Rath ◽  
Rajni Kant Shukla ◽  
Sabita Mohapatra
Keyword(s):  
Clinical Global Impression ◽  
Atypical Antipsychotics ◽  
First Generation ◽  
Treatment Options ◽  
Age Group ◽  
Antipsychotic Therapy ◽  
Psychometric Scales ◽  
Effectiveness Analysis ◽  
Clinical Global Impression Improvement

Background: Schizophrenia is a commonest and one of the well known psychiatric disorders. Life expectancy of a patient with schizophrenia may be 20 to 30 years shorter than the general population. Long term antipsychotic therapy is usually required for the management of schizophrenia. It is not currently possible to predict which antipsychotic may be optimal for a given patient because there are still many debates about effectiveness and efficacy of atypical drugs over first generation antipsychotics. So, our aim is to assess the effectiveness of various antipsychotics by using various psychometric scales, which will be helpful to bring out better treatment options for schizophrenia patients.Methods: This was an observational questionnaire based study, conducted on patients of inpatient and outpatient Department of Psychiatry and Department of Pharmacology at VIMSAR, Burla, for a period of 24 months (September 2015 to August 2017). Patients of schizophrenia aged 18 years or above were subjected to clinical global impression – severity scale (CGI-S) and clinical global impression – improvement scale (CGI-I) questionnaire after taking informed consent. Then scores were calculated using non parametric test with Graph pad Prism version 6.0.Results: Out of the 90 cases, majority (60) of patients belonged to the middle (25 to 45 yrs) age group followed by 20 younger (<25 yrs) age group and rest 10 were elderly (>45 yrs) patients. Both scales showed significant improvement with atypical antipsychotics as compared to first generation antipsychotics.Conclusions: Based on these findings, we can conclude that atypical antipsychotics are more effective than first generation antipsychotics. But further studies are needed to assist clinicians in making optimum treatment decisions.

Metabolic Syndrome in German Patients with Schizophrenia - Baseline-data from Treatment-naive Patients and Patients Previously Treated with Antipsychotics

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S. Kraemer ◽  
A. Minarzyk ◽  
C. Beal ◽  
H.P. Hundemer ◽  
T. Forst ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Atypical Antipsychotics ◽  
American Heart ◽  
Previous Treatment ◽  
Antipsychotic Treatment ◽  
Lower Prevalence ◽  
Antipsychotic Therapy ◽  
Treatment Naïve ◽  
Previously Treated Patients ◽  
Previously Treated

Introduction:Several studies have already reported increased prevalence of metabolic and cardiovascular risk factors in patients on antipsychotics. This observational aimed to assess the prevalence of metabolic syndrome (MetS) in differently treated patients with schizophrenia.Methods:Patients with schizophrenia (age >=18 years) from 162 psychiatric practices throughout Germany were enrolled if they were either treatment-naive and initiated on antipsychotic therapy, or had received previous antipsychotic treatment and were switched to a new medication. Baseline physical and laboratory parameters were evaluated to assess the prevalence of MetS (American Heart Association's definition). Clopper-Pearson 95%CIs were calculated. Patients were assigned to evaluation cohorts by previous treatment: olanzapine (Olz, N=62), risperidone (Risp, N=67), quetiapine (Quet, N=49), other atypical monotherapy (Atyp, N=103), typical therapy (Typ, N=90), atypical combination (Comb, N=109), treatment-naive (TN, N=162).Results:The sample included 642 patients, mean age 45.2 ±13.3 years, 325 (50.6%) women. Characteristics for the TN-cohort were: mean BMI 25.3 ±4.5, mean blood triglycerides 157.3 ±122.4 mg/DL, rates of concomitant diseases (28.4%), and prevalence of MetS (24.7%, CI18.3;32.1). in comparison, previously treated patients had a mean BMI: 27.0 ±4.9 (Quet) to 29.3 ±5.4 (Comb), mean triglycerides: 182.4 ±116.9mg/DL (Risp) to 232.3 ±164.3mg/DL (Comb), concomitant diseases: 29.9% (Risp) to 41.7% (Comb), MetS: 42.4% (Risp, CI30.3-55.2) to 57.0% (Comb, CI47.1-66.5).Conclusion:TN-patients (see above) had a significantly lower prevalence of MetS than the overall sample (42.8 CI 38.9;46.7). Comb-patients showed the highest prevalence of MetS. Typ-patients had a similar prevalence of MetS (43.3, CI32.9;54.2) than patients treated with atypical antipsychotics.

scholarly journals Assessment of drug-related movement disorders in schizophrenia

2000 ◽  
Vol 6 (5) ◽  
pp. 332-341 ◽  
Author(s):  
Maurice Gervin ◽  
Thomas R.E. Barnes
Keyword(s):  
Side Effects ◽  
Movement Disorders ◽  
Relapse Prevention ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
Significant Proportion ◽  
Antipsychotic Agents ◽  
New Drugs ◽  
Conventional Antipsychotic

Conventional antipsychotic drugs remain one of the mainstays of treatment of schizophrenia and related psychotic disorders. The therapeutic efficacy of these drugs is well established, both for treatment of acute symptoms and in relapse prevention. Unfortunately, they are associated with a broad range of side-effects, the most prominent of which is the development of a variety of movement disorders (see Box 1). Compared with the conventional antipsychotic agents, the newer, atypical antipsychotics have a lower liability for the acute extrapyramidal side-effects (EPS) and, for a few of the new drugs, there is some evidence of a lower risk of tardive dyskinesia (Barnes & McPhillips, 1999). Nevertheless, even with these newer agents, movement disorders are seen in a significant proportion of patients.

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