Exploring the Relationship Between Movement Disorders and Physical Activity in Patients With Schizophrenia: An Actigraphy Study

Low physical activity (PA) and sedentary behavior (SB) are major contributors to mental health burden and increased somatic comorbidity and mortality in people with schizophrenia and related psychoses. Movement disorders are highly prevalent in schizophrenia populations and are related to impaired functioning and poor clinical outcome. However, the relationship between movement disorders and PA and SB has remained largely unexplored. Therefore, we aimed to examine the relationship between movement disorders (akathisia, dyskinesia, dystonia, and parkinsonism) and PA and SB in 216 patients with schizophrenia and related psychoses. Actigraphy, the St. Hans Rating Scale for extrapyramidal syndromes, and psychopathological ratings (PANSS-r) were applied. Data were analyzed using multiple linear regression, adjusting for sex, age, negative symptoms, and defined daily dose of prescribed antipsychotics. Parkinsonism was significantly associated with decreased PA (β = −0.21, P < .01) and increased SB (β = 0.26, P < .001). For dystonia, only the relationship with SB was significant (β = 0.15, P < .05). Akathisia was associated with more PA (β = 0.14, P < .05) and less SB (β = −0.15, P < .05). For dyskinesia, the relationships were non-significant. In a prediction model, akathisia, dystonia, parkinsonism and age significantly predicted PA (F(5,209) = 16.6, P < .001, R2Adjusted = 0.27) and SB (F(4,210) = 13.4, P < .001, R2Adjusted = 0.19). These findings suggest that movement disorders, in particular parkinsonism, are associated with reduced PA and increased SB in patients with psychotic disorders. Future studies should take movement disorders into account when examining PA and SB, to establish the clinical value of movement disorders in activating people with psychotic disorders to improve their mental and somatic health.

Karakteristik Pasien Dengan Ektrapiramidal Sindrom Di Bangsal Jiwa RSUD Banyumas

The provision of antipsychotics can cause poot response and side effects such symptoms of extrapyramidal metabolic syndrome. Extrampyramidal side effects are one of the causes of patients become frequent relapses and treatment will be even longer and can last a lifetime. Objective know the description of the characteristics on the patients with extrapyramidal syndrome. This research uses non-experimental research and descriptive research type. The sample is 30 patients with total sampling. The instrument with questionnaire sheets. Univariate analysis with descriptive frequencies was used to analyze the data obtained. Result the most respondents, 13 respondents (43,3%), had extrapyramidal syndromes, 13 respondents (43,3%) were aged 17-25 years old, 21 respondents (70,0%) were male, 10 respondents (33,3%) were graduates from junior high school. Most patients 11 respondents (36,7%), received the therapy for chlorpromazine + tribexyphenidyl + haloperidol, 13 respondents (43,3%) received the therapy for schizoaffective medical diagnoses, 17 respondents (56,7%) had a history of irregular therapy, 26 respondents (86,7%) did not have history of comorbidities and 12 respondents (40,0%) had a history of early mental illness for the first time. Most EPS patients got chlorpromazine, had a history of irregular therapy, had no history of comorbidities and had a history of early mental disorder for first time. Keywords: extrapyramidal syndrome

Prevalence of syphilis reactivity in patients with stroke, cognitive impairment and extrapyramidal syndromes: a retrospective study.

In the last two decades, there has been a resurgence of syphilis worldwide. However, epidemiological data on neurosyphilis are inconsistent for the lack of reporting data and diagnostic gold standard tests. The aim of the present study was to estimate the prevalence of syphilis reactivity in a cohort of patients with neurological diseases of our hospital. We retrospectively analyzed the medical records of the patients hospitalized at the Stroke Unit of the Neurology Clinic and those suffering from cognitive impairment hospitalized at the acute ward of the Geriatrics Clinic between January 2017 and December 2019. Also the patients who attended the Movement disorder outpatient clinic during the same study period were examined. To detect syphilis reactivity a qualitative specific treponemal test on patient’s serum was performed: the Treponema pallidum haemagglutination assay (TPHA). A total of 652 patients were admitted and 315 of them (52%) were submitted to a routine screening for syphilis: 307 (97%) were negative while 8 (3%) had a positive syphilis serology. The TPHA-positive patients (4 males, 4 females) were 2 patients with stroke, 5 with cognitive impairment and 1 with Parkinsonism with a mean age of 83 years, suffering from multiple comorbidities. Although the patients we have retrospectively studied have not undergone lumbar puncture to confirm the diagnosis of neurosyphilis, the not negligible syphilis reactivity rate found in our series suggests that serological screening for syphilis should be reviewed as a routine screening test in neurology and geriatrics departments, especially if the clinical presentation of the neurological diseases is atypical.

Rabbit syndrome induced by the use of Risperidone: a case report

Context: Risperidone is a selective monoaminergic antagonist, its main action as an antipsychotic is attributed to its affinity to dopamine D2 receptors. However, intervention in dopaminergic transmission by this medication can affect the motor control performed by the striatum, generating the so-called extrapyramidal syndromes. Among these syndromes, we have the rabbit syndrome (SC), which is manifested by the chronic use of antipsychotics and causes involuntary movements of the muscles of the jaw and tongue. Case report: E. B. L., a 89- year-old woman undergoing neurological follow-up due to dementia. He started using risperidone 1mg at night to treat behavioral changes and aggressions. However, 4 months after the start of the medication, he started to have a tremor of the chin and stiffness in the upper limbs. These symptoms improved after switching from risperidone to olanzapine 5mg at night. Conclusions: The present study emphasizes the importance of recognizing Rabbit Syndrome and the clinical repercussions of symptomatic variants, such as tardive dyskinesia, nocturnal bruxism and altered tongue motricity, in the differential diagnosis of drug-induced movement disorders. In this sense, neurological assessment includes an elucidating clinical history and targeted physical examination.

Ascorbic acid improves extrapyramidal syndromes and corpus striatal degeneration induced by dopamine-2 receptor inhibition in Wistar rats

ObjectivesThe prolonged uses of fourth-generation antipsychotics have been implicated in inducing extrapyramidal syndromes characterized by the motor deficit. This was attributed to the loss of dopamine-2 receptor (D2R) signaling. However, ascorbic acid (SVCT2R stimulation) in the brain is proposed to modulate D2R activity. We, therefore, investigated the beneficial roles of ascorbic acid in improving the extrapyramidal symptoms seen in D2R loss.MethodsTwenty adult male Wistar rats of average weight 200 g were distributed randomly into four groups. The control (NS) received normal saline for 28 days, Untreated D2R inhibition group (−D2R) received normal saline for seven days and then subsequently received chlorpromazine for 21 days, D2R inhibition group treated with ascorbic acid (−D2R+SVCT2R) received chlorpromazine for 21 days and was subsequently treated with ascorbate for seven days while the withdrawal group (WG) received chlorpromazine for 21 days and subsequently received normal saline for seven days. Motor deficits were assessed using a rotarod and cylinder test. The corpus striatum was harvested, processed, and stained using H&E and Nissl stains. Cellular density was analyzed using Image J software 1.8.0.ResultsMotor deficit was observed in −D2R animals administered chlorpromazine with less improvement in WG compared to control (p<0.05) in both rotarod and cylinder test. Ascorbic acid (SVCT2R stimulation) significantly (p<0.001) improved the latency of fall and climbing attempts observed in −D2R animals. The density of basophilic trigoid bodies was significantly (p<0.001) restored in −D2R+SVCT2R group, suggesting recovery of neural activity in the corpus striatum. Moreover, the hallmarks of neuronal degeneration were less expressed in the ascorbic acid treatment groups.ConclusionsAscorbic acid putatively ameliorates extrapyramidal symptoms observed in D2R blockage by chlorpromazine in Wistar rats.