The effect of antipsychotic-induced extrapyramidal disorders on patient’s compliance with schizophrenia (a clinical case)

Extrapyramidal disorders are common adverse events in antipsychotic therapy. However, their diagnosis is difficult due to broad differential diagnosis, and often their specific clinical variant is not recognized, and timely intervention is not performed, which leads to severe patient suffering. This affects the quality of life of patients with schizophrenia and leads to their refusal to receive therapy, which aggravates the course of the disease. The article presents a clinical case of a 33-year-old patient at a psychiatric hospital with schizophrenia combined with such rare severe extrapyramidal disorders as antipsychotic-induced tardive dyskinesia and tardive dystonia.The diagnosis was carried out in accordance with the criteria of the International Classification of Diseases, Tenth Revision (ICD-10). The intensity of clinical manifestations was assessed using the Positive and Negative Syndrome Scale (PANSS), the Abnormal Involuntary Movement Scale (AIMS), and the Barnes Akathisia Rating Scale (BARS). Compliance was assessed using the Method for Measuring Medication Adherence in Psychiatry. Detailed differential diagnosis of tardive dyskinesia and tardive dystonia with akathisia and Huntington’s disease was presented. Substantiated treatment strategy and positive clinical dynamics with increased compliance were described.

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Assessment of Tardive Dyskinesia in Psychiatric Outpatients Using a Standardized Rating Scale

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048678109159407 ◽

1981 ◽

Vol 15 (1) ◽

pp. 33-37 ◽

Cited By ~ 10

Author(s):

J. M. Rey ◽

G. E. Hunt ◽

G. F. S. Johnson

Keyword(s):

Tardive Dyskinesia ◽

Neurological Disorders ◽

Rating Scale ◽

Involuntary Movement ◽

Antidepressant Medication ◽

Tricyclic Antidepressant ◽

Neuroleptic Treatment ◽

Psychiatric Outpatients ◽

History Of ◽

Australian Sample

Psychiatric outpatients were assessed for dyskinetic movements using the abnormal involuntary movement scale (AIMS). The prevalance of tardive dyskinesia in an Australian sample of 66 patients was 44% which is similar to reported prevalence in other countries. Although the prevalence was significantly higher in patients over 45 years of age and with more than a 5 year history of neuroleptic medication, there were no significant correlations between presence of dyskinesias and age, sex or duration of neuroleptic treatment. Organic factors such as neurological disorders, ECT or alcoholism were not related to dyskinetic movements, nor was the use of anticholinergic or tricyclic antidepressant medication. The AIMS is a reliable rating scale for dyskinetic movements and could be used more widely as a screening instrument for early detection of tardive dyskinesia.

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Clinical case of differential diagnosis of retrocervical endometriosis

V F Snegirev Archives of Obstetrics and Gynecology ◽

10.17816/2313-8726-2021-8-2-109-115 ◽

2021 ◽

Vol 8 (2) ◽

Author(s):

Sergey A. Levakov ◽

Ainur E. Mamedova ◽

Gyullar Y. Azadova ◽

Sergey V. Paukov

Keyword(s):

Differential Diagnosis ◽

Histological Examination ◽

Clinical Case ◽

Progressive Disease ◽

Abdominal Cavity ◽

Clinical Manifestations ◽

Fallopian Tubes

Endometriosis is a chronic hormone-dependent progressive disease characterized by the presence of ectopic endometrioid tissue. Most often, endometriosis affects the ovaries, fallopian tubes and the abdominal cavity, but endometrioid foci are also found in the intestines, heart, lungs, skin and other atypical localizations. This article presents a clinical case of retrocervical endometriosis diagnosed based on the results of pathological and histological examination. It is important to note the complexity of the differential diagnosis of this form of endometriosis due to secondary changes in the area of the colon and the absence of characteristic clinical manifestations.

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MESENCHYMAL TUMORS OF THE COLON AND RECTUM: DIAGNOSIS, TREATMENT, PROGNOSIS (case report and review)

Koloproktologia ◽

10.33878/2073-7556-2020-19-3-97-112 ◽

2020 ◽

Vol 19 (3) ◽

pp. 97-112

Author(s):

O. A. Mainovskaya ◽

M. A. Tarasov ◽

E. M. Romanova ◽

S. V. Chernyshov

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Clinical Case ◽

Clinical Manifestations ◽

Mesenchymal Tumor ◽

Mesenchymal Tumors ◽

Different Types ◽

Colon And Rectum ◽

Treatment Prognosis ◽

Derivatives Of

Mesenchymal tumors of the colon and rectum are extremely rare and do not have specific clinical manifestations, their diagnosis and staging cause certain difficulties.Different types of mesenchymal tumors differ in prognosis and choice of the treatment. It explains the importance of differential diagnosis of these neoplasms among themselves and tumors-derivatives of other embryonic structures.The article describes the clinical case of a rare mesenchymal tumor and management of the patient.

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Challenges of the differential diagnosis between the subtypes of the junctional epidermolysis bullosa: presentation of two clinical cases

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2019-47-009 ◽

2019 ◽

Vol 47 (1) ◽

pp. 83-93

Author(s):

Yu. Yu. Kotalevskaya ◽

N. M. Marycheva

Keyword(s):

Differential Diagnosis ◽

Epidermolysis Bullosa ◽

Skin Disease ◽

Clinical Case ◽

Molecular Genetic ◽

Clinical Signs ◽

Clinical Manifestations ◽

Junctional Epidermolysis Bullosa ◽

Reliable Determination ◽

Clinical Cases

Background: Epidermolysis bullosa (EB) is a rare hereditary skin disease. It is subdivided into EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and Kindler syndrome. JEB is diagnosed in 2 per 1,000,000 of the population. There are few descriptions of clinical JEB cases in the literature. Clinical diagnosis of JEB and its subtypes is a challenge, especially in the early age. The paper presents 2 clinical cases of JEB in patients of the West Slavonic origin. Clinical case No. 1 was a girl of Ukrainian ethnicity, with confirmed definitive diagnosis of severe generalized JEB. Molecular genetic tests identified mutations of the LAMA3 gene that had not been described previously. The patient died at the age of 24 months from acute respiratory failure. When the patient was alive, her EB type and subtype was not possible to identify, because she had a combination of clinical manifestations typical for various JEB subtypes. Despite such symptoms as hoarse voice, stenoses, granulation tissue of typical location, laryngeal granulations, the girl was steadily gaining weight, with some periods of relative stabilization of the skin disease; she also had longer life longevity than was common for patients with severe generalized JEB. All this made a precise diagnosis difficult. Clinical case No. 2: an ethnic Russian boy with non-classified JEB. Molecular genetic testing helped to identify a homozygote mutation in the LAMA3 gene that had not been previously described; reliable determination of the subtype was not possible. The patient had mixed clinical manifestation similar both to generalized severe JEB and to laryngo-onycho-cutaneous (LOC) syndrome. During his lifetime, the patient was clinically diagnosed with Hallopeau acrodermatitis and LOC syndrome. The differential diagnostic problems were associated with the presence of signs not typical for each of the subtypes. Significant life longevity of the proband is not characteristic for severe generalized JEB (at the time of the publication the patient is 13 years old), whereas for LOC syndrome the absence of eye involvement is not typical, as well as severe laryngeal involvement at adolescence.Conclusion: Detailed descriptions of phenotype of JEB subtypes including rare and minimal clinical signs can be useful to study the clinical manifestations and natural course of the disease, including its differential diagnosis.

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CLINICAL CASE: MICROSCOPIC POLYANGIITIS AS ONE OF THE MAIN VARIANTS OF PULMONARY-RENAL SYNDROME

Vestnik ◽

10.53065/kaznmu.2021.18.58.066 ◽

2021 ◽

pp. 345-349

Author(s):

М.А. Жанузаков ◽

М.К. Бапаева ◽

А.Ж. Шурина ◽

Э.М. Утежанов

Keyword(s):

Differential Diagnosis ◽

Early Diagnosis ◽

Research Methods ◽

Clinical Case ◽

Microscopic Polyangiitis ◽

Clinical Manifestations ◽

Additional Research ◽

Treatment Goal ◽

Adequate Treatment ◽

Pulmonary Renal Syndrome

Клинические проявления микроскопического полиангиита многообразны, что затрудняет своевременную диагностику и соответственно адекватное лечение. Цель: привлечь внимание терапевтов, пульмонологов, нефрологов к своевременному выявлению легочно-почечного синдрома и установлению его нозологической основы, в частности микроскопического полиангиита на примере клинического случая. Материалы и методы: проведены обследование пациента с микроскопическим полиангиитом и дифференциальная диагностика в рамках легочно-почечного синдрома. Результаты: на основании анамнеза заболевания, результатов клинического и дополнительных методов исследования пациента, установлен диагноз микроскопического полиангиита. Выводы: для ранней диагностики микроскопического полиангиита необходима настороженность при возникновении легочно-почечного синдрома в виде сочетания гломерулонефрита и геморрагического альвеолита на фоне сосудистой пурпуры. Clinical manifestations of microscopic polyangiitis are diverse, which complicates timely diagnosis and, accordingly, adequate treatment. Goal: to draw the attention of therapists, pulmonologists, nephrologists to the timely detection of pulmonary-renal syndrome and the establishment of its nosological basis, in particular microscopic polyangiitis by the example of a clinical case. Materials and methods: an examination of a patient with microscopic polyangiitis and differential diagnosis within the framework of pulmonary-renal syndrome were carried out. Results: based on the anamnesis of the disease, the results of clinical and additional research methods of the patient, the diagnosis of microscopic polyangiitis was established. Conclusions: for early diagnosis of microscopic polyangiitis, alertness is necessary in the event of pulmonary-renal syndrome in the form of a combination of glomerulonephritis and hemorrhagic alveolitis against the background of vascular purpura.

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77 Long-term Valbenazine Treatment in Patients with Schizophrenia/Schizoaffective Disorder or Mood Disorder and Tardive Dyskinesia

CNS Spectrums ◽

10.1017/s1092852919000579 ◽

2019 ◽

Vol 24 (1) ◽

pp. 214-215 ◽

Cited By ~ 1

Author(s):

Jean-Pierre Lindenmayer ◽

Stephen R. Marder ◽

Carlos Singer ◽

Cynthia Comella ◽

Khody Farahmand ◽

...

Keyword(s):

Adverse Events ◽

Tardive Dyskinesia ◽

Mood Disorder ◽

Schizoaffective Disorder ◽

Psychiatric Diagnosis ◽

Rating Scale ◽

Involuntary Movement ◽

Depression Scale ◽

Psychiatric Status

AbstractBackgroundPatients treated with antipsychotics, regardless of psychiatric diagnosis, are at risk for developing tardive dyskinesia (TD), a potentially debilitating drug-induced movement disorder. Valbenazine (INGREZZA; VBZ) is a novel vesicular monoamine transporter 2 (VMAT2) inhibitor approved to treat TD in adults. Data from KINECT 4 (NCT02405091) were analyzed to evaluate the long-term effects of VBZ in adults with schizophrenia/schizoaffective disorder (SZD) or mood disorder (MD) and moderate or severe TD.MethodsKINECT 4 included open-label treatment (48weeks) followed by washout (4weeks). Entry requirements included: moderate or severe TD, qualitatively assessed at screening by a blinded, external reviewer; DSM diagnosis of SZD or MD; psychiatric stability (Brief Psychiatric Rating Scale score <50). Stable concomitant psychiatric medications were allowed. Dosing was initiated at 40mg, with escalation to 80mg at Wk4 if participants had a Clinical Global Impression of Change-TD score of ≥3 (minimally improved to very much worse) and tolerated 40mg. A reduction to 40mg was allowed if 80mg was not tolerated (80/40mg); participants unable to tolerate 40mg were discontinued. Safety was the primary focus, but the Abnormal Involuntary Movement Scale (AIMS) total score (sum of items 1–7) was used to evaluate changes in TD. Mean changes from baseline (BL) in AIMS total score (rated by on-site investigators) were analyzed descriptively. Safety assessments included treatment-emergent adverse events (TEAEs) and psychiatric scales (Positive and Negative Syndrome Scale [PANSS], Calgary Depression Scale for Schizophrenia [CDSS], Montgomery-Åsberg Depression Rating Scale [MADRS], Young Mania Rating Scale [YMRS], and Columbia-Suicide Severity Rating Scale [C SSRS]).ResultsOf 163 participants in the analyses, 103 completed the study. Adverse events (n=26) was the most common reason for discontinuation. Analyses included 119 participants with SZD (40mg=37; 80mg=76; 80/40mg=6) and 44 with MD (40mg=8; 80mg=31; 80/40mg=5). At Wk48, mean improvements from BL in AIMS total score were: SZD (40mg, –10.1; 80mg,–10.7); MD (40mg, 10.2; 80mg: –11.6). AIMS total scores at Wk52 (end of washout) indicated a return toward BL levels. Compared to SZD, the MD subgroup had a higher incidence of any TEAE (84% vs 61% [all doses]) but fewer TEAEs leading to discontinuation (7% vs 18%). Urinary tract infection was the most common TEAE in the MD subgroup (18%); somnolence and headache were most common in the SZD subgroup (7% each). Psychiatric status remained stable from BL to Wk48: SZD (PANSS positive, –0.7, PANSS negative, –0.6; CDSS, –0.7); MD (MADRS, –0.3; YMRS, –0.3). Most participants (95%) had no change in C-SSRS score during the study.ConclusionSustained and clinically meaningful TD improvements were observed with VBZ, regardless of primary psychiatric diagnosis. VBZ was generally well tolerated and no notable changes in psychiatric status were observed.Funding Acknowledgements: Supported by Neurocrine Biosciences, Inc.

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A Case Report of Bullous Emphysema in an Adolescent: Congenital Malformation or Outcome of Bronchopulmonary Dysplasia?

Journal of Rare Diseases and Orphan Drugs ◽

10.36013/jrdod.v2i.36 ◽

2020 ◽

Vol 2 ◽

pp. 2-6

Author(s):

Svitlana Ilchenko ◽

Anastasiia Fialkovska ◽

Oleksii Makoveychuk

Keyword(s):

Differential Diagnosis ◽

Clinical Case ◽

Diagnostic Method ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Detailed Examination ◽

Pathological Process ◽

Pulmonary Diseases ◽

Chronic Obstructive ◽

Chronic Obstructive Pulmonary Diseases

Pulmonary emphysema belongs to the group of chronic obstructive pulmonary diseases, and inpediatric pulmonology is one of the complex diagnoses that require a careful differential diagnosis. Thearticle describes the possible causes of the formation and clinical manifestations of pulmonaryemphysema in children. We present a clinical case of bullous emphysema in a teenager. This case showsthat a detailed examination using such a modern diagnostic method as high-resolution computedtomography played a crucial role in establishing the patient's correct diagnosis. However, establishing thenature of this pathological process in the child was very difficult. Perhaps an earlier diagnosis couldprevent severe irreversible changes in a teenager's lungs would avoid developing the diffusebronchopulmonary process.

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A state hospital survey of movement disorders including intention tremor

BJPsych Open ◽

10.1192/bjo.2021.633 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S236-S237

Author(s):

Nigel Bark ◽

Sung-Ai Kim ◽

George Eapen

Keyword(s):

Tardive Dyskinesia ◽

Movement Disorder ◽

State Hospital ◽

Movement Disorders ◽

Rating Scale ◽

Involuntary Movement ◽

Intention Tremor ◽

State Hospitals ◽

Brain Localization ◽

The Difference

AimsIn a survey of movement disorders in patients in a State Hospital the finger-nose test was included because of increasing interest in the cerebellum in schizophrenia. It was expected that this would reflect the pathobiology of schizophrenia and be unrelated to the type of medication.BackgroundAbnormalities of movement and involuntary movements have gone from being considered part of schizophrenia to side-effects of medication to now demonstrably present in those who have never taken anti-psychotic medication. Soft neurological signs (SNS) are increased in schizophrenia, unrelated to medication, considered not to indicate brain localization, yet often include the finger-nose test which localizes to the cerebellum.MethodAll available patients in a State Hospital were examined for movement disorders. They were rated on the following scales: Abnormal Involuntary Movement Scale (AIMS) for Tardive Dyskinesia (TD), Simpson-Angus Neurological Rating Scale for Parkinsonism (SANRS), Barnes Akathisia Scale (BAS), a Dystonia scale and the finger-nose test.Result250 patients were included, 174 were examined or observed for movement disorder: 120 had no missing data, 54 refused part of the exam. Their mean age was 47, 62% male, 53% black, 26% Hispanic, 17% white.Medication: First Generation Antipsychotic (FGA) 35 (mean CPZ equivalent dose:1177mg), Second Generation Antipsychotic (SGA) 159 (734mg), both FGA and SGA 56 (1907mg), no antipsychotic 3; anticholinergic or amantidine: FGA 57%, SGA 16%, both FGA and SGA: 50%.Tardive Dyskinesia: all 23%, FGA 36%, SGA 25%, both 7%Parkinsonism: all 38%, FGA 43%, SGA 33%, both 34%Akathisia: all 3%, FGA 0%, SGA 4%, both 3%Pseudo-akathisia: FGA 11%, SGA 4%, both13%Dystonia: all 10%, FGA 13%, SGA 11%, both 8%Intention Tremor: all 16%, FGA 0%, SGA 21%, both 16%Half of those with Intention Tremor had Parkinsonism, a third had TD and a half were on anti-Parkinson medication.None of these differences were statistically significant at p = 0.05 though intention tremor did show a trend (p = 0.08). The difference between FGA and SGA only became significant when all movement disorders were added together with those on anticholinergics with no movement disorder.When compared with rates in similar State Hospitals in the 1970s tardive dyskinesia was now half the rate and Parkinsonism about the same.ConclusionOverall rates of movement disorder are not very different between FGA and SGA. The surprise was that intention tremor only occurred with SGAs. Why?

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Diazepam in Tardive Dyskinesia

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808301700705 ◽

1983 ◽

Vol 17 (7-8) ◽

pp. 523-527 ◽

Cited By ~ 12

Author(s):

Stanley S. Weber ◽

Robert L. Dufresne ◽

Robert E. Becker ◽

Peter Mastrati

Keyword(s):

Tardive Dyskinesia ◽

Rating Scale ◽

Case Reports ◽

Involuntary Movement ◽

Similar Degree ◽

Brief Psychiatric Rating Scale ◽

Abnormal Movements ◽

Psychiatric Rating ◽

Motor Movements ◽

Psychiatric Rating Scale

Tardive dyskinesia, a syndrome of involuntary motor movements, can be a permanent consequence of the long-term use of antipsychotic drugs. While there is no well-established drug treatment, case reports and the results of a few clinical studies suggest that drugs that facilitate the GABA-ergic system may decrease the abnormal movements. One such class of drugs is the benzodiazepines. We administered diazepam to 13 subjects in a 24-week, crossover design study. Tardive dyskinesia and psychopathology were assessed by blind raters using the Abnormal Involuntary Movement Scale and the Brief Psychiatric Rating Scale (BPRS). The means of all movement measurements improved from the baseline, with orofacial, subtotal, symptom severity, and total reaching significance. However, we were unable to demonstrate a drug effect; the patients improved to a similar degree whether or not they received diazepam. Their psychiatric disorders did not worsen with diazepam administration and, in fact, improved slightly; the activation factor of the BPRS was significantly improved over baseline. Our results suggest that diazepam is not effective in managing the movements of tardive dyskinesia and that behavior modification strategies be investigated to help patients control symptoms.

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