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

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.

Download Full-text

The Course of Tardive Dyskinesia in Patients on Long-Term Neuroleptics

The British Journal of Psychiatry ◽

10.1192/bjp.154.4.523 ◽

1989 ◽

Vol 154 (4) ◽

pp. 523-528 ◽

Cited By ~ 43

Author(s):

J. A. Bergen ◽

E. A. Eyland ◽

J. A. Campbell ◽

P. Jenkings ◽

K. Kellehear ◽

...

Keyword(s):

Tardive Dyskinesia ◽

Psychiatric Patients ◽

Involuntary Movement ◽

Neuroleptic Treatment ◽

Community Based ◽

Abnormal Involuntary Movement Scale ◽

History Of ◽

Significant Change ◽

Chronic Psychiatric Patients

Results are presented of five consecutive annual examinations using the Abnormal Involuntary Movement Scale for 101 community-based chronic psychiatric patients. These 101 patients had a history of longer and more consistent neuroleptic treatment than the 231 patients who initially entered the study, so no conclusions about prevalence of TD can be drawn. At each examination two-thirds of this group showed signs of TD; however, only 45% were TD positive at most examinations and 24% were best described as having fluctuating TD status. Of those patients who were consistently TD positive, 82% showed no overall significant change in summed AIMS scores, 11% improved and 7% became worse.

Download Full-text

The Expression of Schizophrenia, Affective Disorder and Vulnerability to Tardive Dyskinesia in an Extensive Pedigree

The British Journal of Psychiatry ◽

10.1192/bjp.153.3.376 ◽

1988 ◽

Vol 153 (3) ◽

pp. 376-381 ◽

Cited By ~ 27

Author(s):

John L. Waddington ◽

Hanafy A. Youssef

Keyword(s):

Family History ◽

Tardive Dyskinesia ◽

Movement Disorder ◽

Affective Disorder ◽

Psychiatric Illness ◽

Late Onset ◽

Psychiatric Morbidity ◽

Neuroleptic Treatment ◽

History Of

The demography, psychiatric morbidity, and motor consequences of long-term neuroleptic treatment in the 14 children born to a father with a family history of chronic psychiatric illness and a mother with a late-onset affective disorder resulting in suicide are documented. Twelve siblings lived to adulthood, nine of whom were admitted to a psychiatric hospital in their second or third decade, and required continuous in-patient care; five remaining in hospital, with long-term exposure to neuroleptics, had chroniC., deteriorating, schizophrenic illness and emergence of movement disorder. Two siblings showed no evidence of psychosis but developed a late-onset affective disorder. The implications for the issues of homotypia, vulnerability to involuntary movements, and interaction with affective disorder are discussed.

Download Full-text

Benefit of Clomipramine-quetiapine Combination in Obsessive-compulsive Disorder with Non Response to Serotonin Selective Reuptake Inhibitors. Case Report

European Psychiatry ◽

10.1016/s0924-9338(09)71267-2 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

G. Marian ◽

B. Ionescu ◽

D. Ghinea ◽

N. Alina

Keyword(s):

Obsessive Compulsive Disorder ◽

Rating Scale ◽

Case Series ◽

Antidepressant Medication ◽

Tricyclic Antidepressant ◽

Psychotic Symptoms ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Work Related ◽

Affective Symptoms

Background:Patients who suffer of obsessive-compulsive disorder (OCD) experience obsessive thoughts and/or urges to engage in compulsive behaviours. the condition causes severe discomfort and, in many cases, leads to serious impairment in social and work-related functioning.Although antipsychotic monotherapy has been associated with ineffectiveness and even increase of psychotic symptoms (especially in psychotic patients), antipsychotics as adjuvant to antidepressant medication have proven to be effective in several case series and pilot clinical trials.The objective of this case was to evaluate the effectiveness of clomipramine-quetiapine combination in OCD refractory to serotonin selective reuptake inhibitors treatment patient.Method:23 years unemployed male was diagnosed with OCD after 1 year from onset and received 3 trials with serotonin selective reuptake inhibitors at therapeutical doses, without any improvement and even more with worsening of affective associated symptoms. We managed this case by using a tricyclic antidepressant (clomipramine up to 100 mg/day) with an atypical antipsychotic (quetiapine up to 200 mg/day). We employed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive-Compulsive Checklist (OCC) and Hamilton Depression rating Scale (HDRS) at baseline, weekly for the first 2 months and monthly after (follow up 2 years).Results:Patient achieved a very fast and sustained improvement both in obsessive-compulsive and affective symptoms, which provided a very good social and work rehabilitation.Conclusion:Clomipramine-quetiapine combination may be a benefit for OCD refractory to serotonin selective reuptake inhibitors and a safe strategy.

Download Full-text

A rare instance of tardive dyskinesia with SSRI use: A case study

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1424 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S759-S759

Author(s):

D. Roy

Keyword(s):

Tardive Dyskinesia ◽

Involuntary Movement ◽

Depressive Illness ◽

Cognitive Testing ◽

Gradual Improvement ◽

Dyskinetic Movement ◽

History Of ◽

Significant Attenuation ◽

Good Improvement ◽

Competing Interest

IntroductionCase presentation of a middle aged lady Mrs. C.K., who developed tardive dyskinesia (TD) after a trial of an SSRI.Case reportA 49-year-old Australian aboriginal lady, presented with involuntary movement of her face (bucco-linguo masticatory), movements after a 3 months trial of sertraline (maximum dose of 100 mg daily) for her depressive illness. There was no history of trials with anti-psychotics or any other medications, which may have caused the oral dyskinesias. Routine examinations including cognitive testing, EEG and MRI revealed no pathological findings. Her sertraline was ceased and she was commenced on mirtazapine 15 mg at night, which was hiked to 30 mg after 1 week and continued on this dose over the next 3 months. She exhibited good improvement in her depressive symptoms and a significant attenuation of her TD's. Involuntary movement scale rating: she was rated on the abnormal involuntary movement scale (AIMS) and showed gradual improvement in the severity of her orofacial dyskinetic movement. Her scores were–initial presentation (scored 22/36); at 4 weeks (9/36); 8 weeks (6/36) and at 16 weeks (4/36).DiscussionAlthough TD's are seen in approximately 1 to 5% of mental health patients treated with anti-psychotics (and some other medications like Levodopa, Metochlorpromide, etc.), research studies on SSRI's causing TD's are rare and few (Leo et al., 1996; Gerber et al., 1998).ConclusionsTo alert and educate clinicians about a relatively rare adverse-effect of SSRI producing an involuntary movement disorder.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Download Full-text

141 The Effects of Valbenazine on Tardive Dyskinesia: Subgroup Analyses of 3 Randomized, Double-Blind, Placebo-Controlled Trials

CNS Spectrums ◽

10.1017/s1092852918000366 ◽

2018 ◽

Vol 23 (1) ◽

pp. 88-88

Author(s):

Jonathan Meyer ◽

Gary Remington ◽

Ali Norbash ◽

Joshua Burke ◽

Scott Siegert ◽

...

Keyword(s):

Tardive Dyskinesia ◽

Involuntary Movement ◽

Controlled Trials ◽

Cyp2d6 Genotype ◽

Double Blind ◽

Double Blind Placebo ◽

Score Improvement ◽

Subgroup Analyses ◽

History Of ◽

Intent To Treat

AbstractStudy ObjectivesThe approval of valbenazine (INGREZZA; VBZ) for the treatment of tardive dyskinesia (TD) in adults was based on results from double-blind, placebo (PBO)-controlled trials. These studies demonstrated the efficacy of once-daily VBZ based on intent-to-treat analyses. However, because many different types ofpatients can develop TD, subgroup analyses describing treatment outcomes by various patient factors were also conducted.MethodsData were pooled from three 6-week trials: KINECT (NCT01688037), KINECT 2 (NCT01733121), KINECT 3 (NCT02274558), with outcomes analyzed by VBZ dose (80 mg, 40 mg) and PBO. Descriptive analyses conducted using the Abnormal Involuntary Movement Scale (AIMS) total score included: mean change from baseline to Week 6; and AIMS response, defined as 50% improvement from baseline to Week 6. Subgroups were defined as follows: age (<55 years, ≥55 years), sex (male, female), psychiatric diagnosis (schizophrenia/schizoaffective disorder, mood disorder), CYP2D6 genotype (poor metabolizer [PM], non-PM), body mass index (BMI) (<18.5, 18.5 to <25, 25 to <30, ≥30 kg/m2), concomitant antipsychotic (yes, no); type of antipsychotic (atypical, typical/both); lifetime history of suicidality (yes, no); concomitant anticholinergic (yes, no); TD duration (<7 years, ≥7 years).ResultsThe pooled population included 373 participants (VBZ 80 mg, n=101; VBZ 40 mg, n=114; PBO, n=158). Mean improvements from baseline to Week 6 in AIMS total score were greater overall with VBZ compared to PBO. Within subgroup categories, AIMS score improvement with VBZ 80 mg (recommended dose) was greater in CYP2D6 PMs (n=17; 80 mg, -6.8; 40 mg, 2.4; PBO, 0.5), participants taking no concomitant antipsychotics (n=64; 80 mg, -4.9; 40 mg, -3.0; PBO, 0.0), and overweight participants (BMI 25 to <30 kg/m2, n=115; 80 mg, -4.2; 40 mg, 2.7; PBO, -0.7). Overweight participants also had the highest AIMS response rates at Week 6 (80 mg, 57.7%; 40 mg, 31.6%; PBO, 11.8%), followed by participants taking typical/both antipsychotics (n=67; 80 mg, 57.1%; 40 mg, 20.0%; PBO, 25.0%), and those taking anticholinergics (n=126; 80 mg, 52.9%; 40 mg, 22.7%; PBO, 6.3%).ConclusionThese preliminary analyses indicate that TD improvements were generally greater with VBZ than PBO across most subgroups. However, the small sizes of some subgroups may need to be considered when interpreting results. Additional analyses within subgroup categories are ongoing and will be presented at the meeting.Funding AcknowledgementsThis study was funded by Neurocrine Biosciences, Inc.

Download Full-text

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.

Download Full-text

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?

Download Full-text

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.

Download Full-text