Clinical audit investigating the recognition of tardive dyskinesia in an acute inpatient setting

AimsTardive dyskinesia (TD) is a disabling extra-pyramidal side effect (EPSE) associated with long-term antipsychotic medication, with an incidence rate of 5% per year of typical antipsychotic exposure. The Abnormal Involuntary Movement Scale (AIMS) is a validated tool for screening for TD and its use is recommended every 3–6 months in those taking antipsychotics. Atypical antipsychotics present a lower risk and have contributed to complacency in monitoring and treatment. The primary aim of this audit was to establish whether AIMS was completed for all patients taking regular antipsychotic medication for three months or more. Secondary aims were to investigate whether patients were informed about EPSEs on initiation, titration and change of antipsychotics, and whether they were assessed for the emergence of side effects during subsequent clinical reviews.MethodThis single-site audit examined the care of inpatients on Ward 4 of the Becklin Centre, a male working-age acute psychiatric ward, between 1st November 2020 and 31st January 2021. Patients aged 18–65 years who were prescribed regular antipsychotics were eligible for inclusion. Exclusion criteria included the presence of other neurological movement disorders. 50 patients were included. Data collection took place between 8th February and 6th March 2021; this involved reviewing patient records throughout their inpatient stay on Care Director, an electronic patient record system. Results were compiled using a pre-determined data collection tool and analysed using Microsoft Excel.ResultFor 14 (28.0%) patients there was documented evidence of the provision of verbal information surrounding EPSEs during initiation or change of antipsychotics, and 12 (24.0%) received written or verbal information about wider side effects. For 19 (38.0%) there was a documented assessment of side effects during clinical review following the initiation or change of antipsychotic medication. Of the 33 patients who took antipsychotics for over three months, 3 (9.1%) received an AIMS assessment.ConclusionAn inadequate proportion of inpatients prescribed long-term antipsychotics were assessed for TD, likely due to a lack of awareness of the relevant guidance. A substantial number of patients were not informed about side effects, suggesting an element of medical paternalism. This study provides opportunity to improve practice by educating the medical workforce and raising awareness of TD symptoms amongst the wider team. Valbenazine is a new FDA-approved treatment for adults with tardive dyskinesia, representing a further avenue for management. Greater focus on patient involvement, and communication surrounding anticipated side effects, is likely to benefit compliance with treatment and improve the doctor-patient relationship.

Download Full-text

Tardive Dyskinesia: A Concern for the Pediatrician

PEDIATRICS ◽

10.1542/peds.77.4.553 ◽

1986 ◽

Vol 77 (4) ◽

pp. 553-556

Author(s):

HARVEY S. SINGER

Keyword(s):

Side Effects ◽

Tardive Dyskinesia ◽

Children And Adolescents ◽

Behavior Disorders ◽

Antipsychotic Drugs ◽

Extrapyramidal Side Effects ◽

Body Movements ◽

Neuroleptic Therapy

Antipsychotic drugs, such as the phenothiazines (chlorpromazine, fluphenazine, thioridazine), butyrophenones (haloperiodol), and diphenylbutylpiperidines (pimozide) are used in children and adolescents to treat a variety of clinical entities including psychoses, tics, behavior disorders, and movement problems. Because virtually all of these drugs have a potential to affect body movements and posture, they have also been termed neuroleptics.1 Most physicians are aware of the more common acute extrapyramidal side effects of these drugs, such as oculogyria, pseudoparkinsonism, dystonia, and restlessness (akathisia). Despite the widespread use of neuroleptics, however, little is known about the long-term neurologic consequences of such treatment. Of particular concern, based originally on data in adults, is the risk of severe and persistent tardive dyskinesia developing in persons receiving neuroleptic therapy.

Download Full-text

EP20 Long term safety and efficacy of denosumab and zoledronate

Rheumatology ◽

10.1093/rheumatology/keaa109.019 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Ziad Alkutobi ◽

Deena Laila ◽

Mohammad Tariq

Keyword(s):

Side Effects ◽

Neck Of Femur ◽

Dxa Scan ◽

Safety And Efficacy ◽

Oral Bisphosphonate ◽

Retrospective Audit ◽

Number Of Patients ◽

Gastrointestinal Side Effects ◽

To Receive

Abstract Background Denosumab and zoledronate are increasingly prescribed for primary and secondary osteoporosis long-term management. Methods A retrospective audit was conducted at Basildon Hospital during 2012-2019 using the NICE guidelines standards to evaluate the long term safety and efficacy of denosumab and zoledronate. Number of patients was 84, diagnosed with osteoporosis or osteopenia, 34 of them received 10 or more denosumab injections and 50 patients planned to receive 5 zoledronate infusions (9 patients received 5 and 38 patients received 4). Results Forty percent of the patients were at their 8th decade followed by 28.57% and 21.42 % at their 9th and 7th decades respectively. More than 90% were Caucasian females. Primary prevention was in 39.28% and secondary prevention in 60.71%. The commonest sites of fracture were the wrist and vertebrae at 34.37% for each; followed by the neck of femur and humerous at 12.5% for each. Denosumab was the 1st, 2nd, 3rd or 4th line of treatment in 9.52%, 13.09%, 16.66% and 1.19% respectively; whereas zoledronate was the 1st, 2nd or 3rd line of treatment in 13.09%, 40.47% and 5.95% respectively. The commonest reason for choosing denosumab as the first line was chronic kidney disease, whereas the reason for choosing it as the 2nd or 3rd line was inefficacy of bisphosphonate in 69% or gastrointestinal side effects in 14%. Zoledronate was chosen in all cases because of intolerability to oral bisphosphonate or gastrointestinal side effects. Repeat DXA scan was performed after the 5th, 10th denosumab injections and the 3rd zoledronate infusions. After the 5th Denosumab, DXA scan showed improvement or stability in 100% and 85.29% at the spine and hip respectively whilst deterioration was seen in 14.7% at the hip. After the 10th denosumab, the rate of improvement or stability at the spine was reduced to 88.23% and decline was seen in 2.94%. At the hip area, 73.52% continued to show improvement or stability, whilst 17.66 % showed deterioration. After the 3rd zoledronate, 98% and 88% showed improvement or stability at the spine and hip respectively whilst deterioration seen in 2% and 12% at the spine and hip respectively. One patient on zoledronate experienced dental issues after the 4th injection and stopped treatment. There were no jaw osteonecrosis, no new fractures and no significant side effects with either denosumab or zoledronate. Ninety percent of patients who completed 10 denosumab injections were planned to continue for another 5 injections. Conclusion After the period of 3-5 years, denosumab and zoledronate were well tolerated and BMD was either stable or improved at both spinal and hip sites. There were few cases of deterioration mainly at the hip area with both zoledronate and denosumab. Future researches are needed to stratify guidelines on discontinuation of denosumab. Disclosures Z. Alkutobi None. D. Laila None. M. Tariq None. A. Nandagudi None.

Download Full-text

The role of medication

10.1093/med/9780198754237.003.0007 ◽

2017 ◽

Author(s):

Tom Burns ◽

Mike Firn

Keyword(s):

Side Effects ◽

Antipsychotic Medication ◽

Mood Stabilizers ◽

Clozapine Therapy

This chapter focuses mainly on the importance of maintenance antipsychotic medication and mood stabilizers. It examines procedures to support persistence with these drugs and maintain engagement. The techniques for initiating and monitoring clozapine therapy in the community for patients with resistant schizophrenia are outlined. The practical processes for ensuring and conducting regular structured reviews of long-term medication, both to assess progress and to identify side effects, are described in detail. In addition, the judicious use of antidepressants and benzodiazepines is outlined.

Download Full-text

Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy

Strahlentherapie und Onkologie ◽

10.1007/s00066-020-01670-4 ◽

2020 ◽

Vol 196 (12) ◽

pp. 1103-1115

Author(s):

Maria-Elena A. Salfelder ◽

Kerstin A. Kessel ◽

Uwe Thiel ◽

Stefan Burdach ◽

Severin Kampfer ◽

...

Keyword(s):

Survival Rate ◽

Side Effects ◽

Survival Rates ◽

Young Patients ◽

Intensity Modulated Radiotherapy ◽

High Survival ◽

Single Target ◽

Number Of Patients ◽

Grade 3

Abstract Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6–19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0–6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5–66.0 Gy) and a single dose of 2 Gy (1.80–2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3–48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5‑year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation.

Download Full-text

Prevalence of Extrapyramidal Side Effects in Patients Receiving Depot Antipsychotic Medication

European Psychiatry ◽

10.1016/s0924-9338(09)71244-1 ◽

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.

Download Full-text

Kezdeti tapasztalataink spinalis muscularis atrophiában szenvedő gyermekek intravénás génterápiájával

Orvosi Hetilap ◽

10.1556/650.2020.31890 ◽

2020 ◽

Vol 161 (42) ◽

pp. 1806-1816

Author(s):

Borbála Mikos ◽

Anita Gergely ◽

Réka Balázsfi ◽

Edina Bányász ◽

Beáta Gyömörei ◽

...

Keyword(s):

Side Effects ◽

Troponin I ◽

Muscular Atrophy ◽

Safety Data ◽

Clinical Results ◽

Genetic Diagnostics ◽

Number Of Patients ◽

Movement Performance ◽

Term Basis

Összefoglaló. A veleszületett gerincvelői izomsorvadás ritka, progresszív neurodegeneratív betegség, a gyermekkori halál egyik legjelentősebb genetikai oka. Az orvostudomány lehetőségei a XXI. század előtt a progresszió megfékezésére, a szövődmények késleltetésére és ellátására korlátozódtak. A legsúlyosabb génhibában szenvedő gyermekeket általában kétéves kor előtt elveszítettük. A genetikai diagnosztika fejlődése lehetővé teszi a korai diagnózist, a súlyosság és a progresszió előrejelzését. A 2018-ban hazánkban engedélyezett intrathecalis nuszinerszennel a nagy betegszámon alapuló klinikai eredmények meggyőzőek. A 2019-től elérhető új, intravénás génpótló terápiával (onaszemnogén abeparvovek) kapcsolatos tapasztalatok még kisebb betegszámon alapulnak. Hazánkban öt betegnél került sor az alkalmazására a Bethesda Gyermekkórházban, szigorú szakmai kritériumok és előkészületek alapján. Közülük annak a három gyermeknek a kezeléséről számolunk be dolgozatunkban, akiknél már rendelkezünk utánkövetési tapasztalatokkal. Vizsgálatunk szerint a készítmény elősegíti a mozgásteljesítmény javulását. A mellékhatások elsősorban reverzibilis májenzim-emelkedésben, thrombocytopeniában, granulocytopeniában és a szívizom-nekroenzim emelkedésében nyilvánultak meg. Ezért fontosnak tartjuk a betegek szoros és tartós követését, a mellékhatások korai észlelése és elhárítása érdekében. Orv Hetil. 2020; 161(42): 1806–1816. Summary. Congenital spinal muscular atrophy is a rare, progressive neurodegenerative disease, one of the major genetic causes of childhood death. The possibilities of medicine to curb its progression and to delay and treat the disease’s complications were limited before the 21st century. Therefore, children with the most severe genetic defects were usually lost before their second birthday. Advances in genetic diagnostics allow for early diagnosis, prediction of severity and expected progression. Using intrathecal nusinersen (available in Hungary since 2018), clinical results based on a large number of patients are convincing. Experience with the new intravenous gene therapy (onasemnogene abeparvovec) available from 2019 is still based on a less number of patients. It was used in Hungary in Bethesda Hospital in five children based on strict professional criteria and preparations. Our paper summarizes the most important efficacy and safety data of the first three consecutive patients. According to our experiences, the product helps to improve movement performance. Side effects are mainly reversible elevations of liver enzymes and serum troponin-I levels, thrombocytopenia and granulocytopenia. Therefore, we found that it is important to monitor patients closely on a long-term basis in order to detect and eliminate side effects early. Orv Hetil. 2020; 161(42): 1806–1816.

Download Full-text

Positive and Negative Effects of Antipsychotic Medication: An International Online Survey of 832 Recipients

Current Drug Safety ◽

10.2174/1574886314666190301152734 ◽

2019 ◽

Vol 14 (3) ◽

pp. 173-181 ◽

Cited By ~ 10

Author(s):

John Read ◽

James Williams

Keyword(s):

Side Effects ◽

Adverse Effects ◽

Antipsychotic Medication ◽

Online Survey ◽

Negative Effects ◽

Duration Of Treatment ◽

Direct To Consumer ◽

Poor Outcomes

Background: Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients. Objective: To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects. Methods: An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date. Results: Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects. Conclusion: Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

Download Full-text

A Ten-Year Assessment of Methicillin-Associated Side Effects

PEDIATRICS ◽

10.1542/peds.58.3.329 ◽

1976 ◽

Vol 58 (3) ◽

pp. 329-334

Author(s):

Martha D. Yow ◽

Larry H. Taber ◽

Fred F. Barrett ◽

A. Aaron Mintz ◽

G. Richard Blankinship ◽

...

Keyword(s):

Side Effects ◽

Great Majority ◽

Incidence Rates ◽

Term Therapy ◽

Average Dose ◽

True Incidence ◽

Number Of Patients ◽

Chemical Irritation ◽

Long Term Therapy

The exact incidence and importance of side effects associated with methicillin therapy in children is unknown. During the ten-year period from 1964 to 1974 approximately 3,000 Houston children who received methicillin were observed for side effects. The great majority of these patients received the drug for less than ten days; however, side effects were more common in patients receiving long-term therapy. In order to assess these side effects, experiences with 124 children who received methicillin for ten days or longer were reviewed in depth. The average dose of methicillin was 200 mg/kg/day and the average duration was 22 days. In this highly selected group there were no adverse side effects in 54.8% and only eosinophilia in an additional 13%. Leukopenia occurred in 16%, microscopic hematuria in 8%, gross hematuria in 4%, skin rash in 6%, and "drug fever" in 6%. In many instances several of these side effects occurred within a single patient so that the total number of patients with definite side effects was 39 of 124 (31.5%). The true incidence figure of overall side effects is much lower than 31.5%. Corrected incidence rates based on a conservative figure of 3,000 methicillin-treated children are less than 1.5% for all side effects. In some patients the mechanism producing the adverse reactions seemed to be chemical irritation or toxicity and in others hypersensitivity. In nine of the 39 patients follow-up studies were not optimal. In the other 30 patients all side effects were reversible.

Download Full-text

A Brief Review on Breast cancer treatment and current challenges

World Journal of Current Medical and Pharmaceutical Research ◽

10.37022/wjcmpr.vi.170 ◽

2021 ◽

pp. 27-31

Author(s):

Isha Shah ◽

Nensi Raytthatha

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Cancer Treatment ◽

Effective Treatment ◽

Breast Cancer Survivors ◽

Early Stage ◽

Breast Cancer Treatment ◽

Good News ◽

Number Of Patients

Cancer is a global disease, so rational and effective treatment is needed. Breast cancer is one of the most common cancers in a woman and now the number of patients is increasing day by day. Therefore, development and research are underway for the effective treatment of breast cancer. Breast cancer treatment depends on the stage of cancer and the risk, based on this medical agents should be employed on patients to prevent breast cancer. In addition, breast cancer survival rates are rising which is good news for science but on the other hand the side effects of treatment present new challenges. An early-stage cancer diagnosis can save a patient's active or healthy life due to long-term and varied treatments that can be used for cancer otherwise breast cancer is a life-threatening disease. Breast cancer survivors not only have negative side effects of cancer treatment but also, have many other issues of previous treatment so it is a challenge for researchers. As a result, this review article deals with the effective treatment of breast cancer and its side effects. This review will help researchers better understand the long-term medical implications for breast cancer.

Download Full-text