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.

Drugs associated with DIP

Drug-induced parkinsonism (DIP) is one of the most frequent extrapyramidal disorders that develops against the background of prescribing a large number of medications. Initially, DIP was described as an adverse drug reactions (ADRs) against the background of the use of antipsychotic drugs, but later recognized as ADRs of a number of other drugs, including prokinetics, antidepressants, calcium channel blockers and antiepileptic drugs. The relative risk of developing LIP on the background of taking typical antipsychotics increased by 2.92 times compared to patients who do not take these drugs. The risk of developing DIP in patients receiving flunarizine is increased by 2.75-4.07 times. The risk of DIP with the use of antidepressants is increased by 2.14 times, among the drugs of this group with an increased risk of DIP, the use of selective serotonin reuptake inhibitors is most often associated with DIP (relative risk 1.24). Among other antidepressants, there is evidence of the development of DIP against the background of the use of duloxetine, mirtazapine, amitriptyll clomipramine, venlafaxine, trazodone. Among anticonvulsants, DIP can rarely develop against the background of the appointment of valproic acid, gabapentin, pregabalin, carbamazepine, oxcarbazepine. The risk of DIP in patients receiving metoclopramide is extremely low (0.06%), but it is 2.16 times higher compared to people who do not take this drug. Among drugs from other groups, DIP can occur against the background of the use of lithium carbonate, tacrolimus, cyclosporine, amiodarone, captopril, amphotericin B. If DIP develops, it is necessary, if possible, to reduce the dose or cancel the inducer drug, or replace it with another drug with minimal risk of DIP. Symptoms of DIP most often regress within a few weeks or months after dose reduction or withdrawal of the drug inducer. If the symptoms persist longer, it is necessary to exclude the presence of Parkinson’s disease or dementia with with Lewy bodies.

Multimodality Anatomic and Molecular Imaging of Parkinson Disease and Atypical Parkinson Syndromes with MRI, Iodine 123 N-ω-Fluoropropyl-2β-Carbomethoxy-3β-(4-Iodophenyl) Nortropane SPECT (Dopamine Transporter SPECT), Iodine 123 Metaiodobenzylguanidine Cardiac Scintigraphy, and [18F] FDG-PET

Advances in molecular imaging techniques and the increasing availability of functional imaging are expanding the role of nuclear medicine in neuroradiology. Molecular imaging has a well-established role in the evaluation of extrapyramidal disorders. In this setting, functional assessment can be combined with structural imaging to make a more accurate diagnosis. This is particularly useful in a number of more clinically challenging pathologies. This review discusses the role and context of imaging in extrapyramidal disorders. Structural imaging with MR imaging in combination with iodine 123 N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane SPECT (dopamine transporter SPECT), iodine 123 metaiodobenzylguanidine cardiac scintigraphy, and [18F]FDG-PET can be used to differentiate various underlying disease processes including Parkinson disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, and corticobasal degeneration.Learning Objective: To assess dopamine transporter studies qualitatively and semiquantitatively and categorize them as having normal, abnormal, or indeterminate findings and to understand the role of MR imaging, iodine 123 metaiodobenzylguanidine cardiac scintigraphy, and [18F] FDG-PET in advancing the differential diagnoses of patients with Parkinson disease and atypical parkinsonian syndrome

Scale of the severity of extrapyramidal tone

It is known that the progression of neurodegenerative diseases significantly limits the daily household and professional activities of patients, greatly affecting the functions associated with movement, self-care and cognitive control. Despite the significant scientific breakthroughs in the field of neuroimaging and pathogenetic therapy, the diagnosis and treatment of this category of patients remains a difficult and sometimes a challenging task. Оne of the basic principles in identifying nervous system diseases is implemented through the use of specialized indices, tests and scales. These diagnostic markers are widely used by neurologists, physical medicine and rehabilitation physician, orthopedists, occupational therapists, physical therapists, hel-ping experts to determine not only the presence of pathology, but also, most importantly in rehabilitation, the evolution of certain signs of the disease with the possibility of further timely dynamic control. Among patients with movement disorders, individuals with extrapyramidal disorders make up a separate group in need of rehabilitation care. Unfortunately, the issues of lapidary diagnosis of extrapyramidal disorders remain relevant today. In the avai-lable specialized scientific and practical literature, we failed to find a convenient scale for measuring the severity of extrapyramidal tone in order to assess the effectiveness of drug and comprehensive non-drug rehabilitation treatment. The scale of the severity of extrapyramidal tone developed by us and recommended for practical use will allow neurologists to master a simple, but at the same time effective tool that facilitates early identification and determination of the stage of development of degenerative diseases of the nervous system accompanied by a specific change in muscle tone, which indicates the accuracy of the chosen ways of rehabilitation treatment.

Mirror Movements in Acquired Neurological Disorders: A Mini-Review

Mirror movements (MMs) are specifically defined as involuntary movements occurring on one side of homologous muscles when performing unilateral movements with the contralateral limb. MMs have been considered a kind of soft neurological signs, and the persistence or reappearance of MMs in adults is usually pathologic. In addition to some congenital syndrome, MMs have been also described in age-related neurological diseases including pyramidal system diseases (e.g., stroke, amyotrophic lateral sclerosis) and extrapyramidal disorders (e.g., Parkinson's disease, essential tremor). With the advances in instrumentation and detection means, subtle or subclinical MMs have been deeply studied. Furthermore, the underlying mechanism is also being further elucidated. In this mini-review, we firstly discuss the MM examination means, and then review the literature regarding MMs in individuals with acquired neurological disorders, in order to further understand the pathogenesis of MMs.

NEUROPSYCHOLOGICAL PRINCIPLES OF COGNITIVE AND COMMUNICATIVE ACTIVITIES DIAGNOSIS IN ADULTS WITH EXTRAPYRAMIDAL SYSTEM DISORDERS

The aim is to determine the neuropsychological peculiarities of cognitive and communicative activities in adults with the extrapyramidal system disorders. Materials and methods: The research was conducted during 2018-2021, during which a retrospective analysis of medical treatment records of the patients with extrapyramidal disorders of various etiologies was performed. The research involved 137 adult patients with extrapyramidal disorders: 93 persons with Parkinson’s disease, 36 people with manganese encephalopathy, 5 persons with progressive supranuclear palsy and 3 people with Wilson-Konovalov disease. Results: A significant difference between the indicators of preservation of cognitive and communicative activities and the communicative and semantic component in the group of patients with Parkinson’s disease without speech disorders and Parkinson’s disease and between the groups of patients with Parkinson’s disease without speech disorders and progressive supranuclear palsy indicates the need for experimental correctional and rehabilitation work to restore cognitive and communicative activities of the patients with extrapyramidal disorders. Conclusions: The most preserved communicative and speech function was found in the patients who had initial and mild stages of the disease, in particular in the patients with Parkinson’s disease without speech disorders. It should be emphasized that the diagnosis of cognitive and communicative activities and the communicative and semantic component in adults with extrapyramidal disorders is a necessary prerequisite for the organization of the process of comprehensive rehabilitation treatment.

THE INFLUENCE OF THE PHYSICAL THERAPY PROGRAM ON THE UPPER LIMB FUNCTIONING INDICATORS IN ELDERLY ADULTS WITH SARCOPENIA AND EXTRAPYRAMIDAL DISORDERS IN THE POST-IMMOBILIZATION PERIOD AFTER THE DISTAL RADIUS METAPHYSEAL FRACTURE

Aim: to evaluate the impact of a comprehensive program of physical therapy on the functioning of the upper extremity in the elderly adults with sarcopenia and extrapyramidal disorders (due to Parkinson's disease) in the postimmobilization period after fracture of the distal metaphysis of the radial bone. Material and methods. Twenty seven elderly people with sarcopenia and extrapyramidal disorders in the early post-immobilization period after fracture of the distal metaphysis of the radial bone were examined. They were divided into two groups: 1 (practiced according to the principles of outpatient rehabilitation with a predominance of preformed physical factors) and 2 (engaged in the developed physical therapy program, which was created in terms of patient-centered model of rehabilitation taking into account the specifics of each polymorbid condition with functional training, massage, kinesio taping, nutrition correction). The effectiveness of the program was evaluated by comparing the condition of healthy and injured hands according to the results of goniometry, wrist dynamometry, standard tests and questionnaires Nine-hole peg test, Action Research Arm Test, French Arm Test, ABILIHAND, DASH. Results. Subjects found significant dysfunction of the upper extremity in all domains of the International Classification of Functioning, as determined by goniometry of the radial-carpal joint, wrist dynamometry, functional tests Nine-hole peg test, Action Research Arm Test, French Research Arm Test, questionnaires and DASH. The developed pathogenetically substantiated complex program of physical therapy showed a statistically significantly better effect on the indicators of functional capabilities of the forearm and wrist compared to the general outpatient rehabilitation program for all studied indicators (p <0.05). Conclusion. Elderly patients with complex pathology need to compile pathogenetically substantiated physical therapy programs taking into account and correcting the specifics of each disease, which increases the overall effectiveness of rehabilitation.

Diagnostic capabilities of posturological methods in extrapyramidal disorders

The posture is the position of the body in space, the ultimate goal of which is to maintain balance in static and dynamic conditions. The balance of the body is due to a complex system of regulation. The field of knowledge that studies balance maintenance processes is posturology. For over 20 years, stabilometry as a method of diagnosing postural balance has been widely used in clinical practice. This method has found its application in patients with pathologies of central and peripheral nervous systems. In this review we present modern concepts of postural balance formation and mechanisms of postural balance maintenance, as well as diagnostic capabilities of stabilometry in patients with diseases of extrapyramidal system.