Clozapine Withdrawal_Emergent Dystonias and Dyskinesias

Ahmed, Shahida Perveen; Kn, Chengappa; Vr, Naidu; Rw, Baker; Parepally, Haranath; Nr, Schooler

doi:10.4088/jcp.v59n0906

Cited by 94 publications

(55 citation statements)

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“…There are some case reports of relapse of TD symptoms after abrupt clozapine withdrawal, [9][10][11] indicating that clozapine might only suppress the symptoms. In this trial, the long-term exposure to the drug leads us to believe that clozapine, besides actively suppressing TD symptoms initially, might also diminish the supersensitivity of D 2 receptors in the striatum during the course of treatment.…”

Section: Discussionmentioning

confidence: 99%

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Louzã

Bassitt²

2005

Journal of Clinical Psychopharmacology

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\Drug-induced tardive dyskinesia (TD) affects approximately 20% to 30% of schizophrenic patients. Although it is usually mild, from 1% to 8% of patients may develop severe TD. Second-generation antipsychotics have demonstrated a lower risk of inducing TD. However, despite the advances brought by second-generation antipsychotics, the treatment strategies for TD remain problematic, given both the lack of an established therapeutic choice and the need for long-term use of antipsychotics in the treatment of schizophrenia. Clozapine is an atypical antipsychotic with minimal risk of inducing TD. Furthermore, it has been suggested that clozapine might actually improve the symptoms of TD. Accordingly, we evaluated the effects of clozapine on severe TD over 5 years. Seven patients meeting Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for chronic exacerbated schizophrenia (mean age 28.5 +/- 10.2 years) and presenting severe TD, defined as Abnormal Involuntary Movements Scale score above 13, were treated with clozapine and followed up for 5 years. Extrapyramidal Symptoms Rating Scale assessment was performed in all patients at baseline, after 6 months and 3 and 5 years. Mean Extrapyramidal Symptoms Rating Scale scores decreased 83% after 3 years and 87.5% after 5 years. Mean dose for all patients was 428 +/- 269 mg/d after 5 years. Results from this open-label study suggest that clozapine may be a further option for the treatment of TD over long term.

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Section: Discussionmentioning

confidence: 99%

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Louzã

Bassitt²

2005

Journal of Clinical Psychopharmacology

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“…Faheem et al [32] reported one such patient who developed severe respiratory and diaphragmatic dyskinesias. Several patients have developed severe dyskinesias after withdrawal from clozapine [3], so-called "withdrawal-emergent" dyskinesias. These movements usually affect the neck and trunk.…”

Section: Severe Tardive Dyskinesiasmentioning

confidence: 99%

Movement disorder emergencies

Poston

Frucht

2008

J Neurol

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Movement disorder emergencies include any movement disorder which evolves over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. It is crucial that doctors recognize these emergencies with accuracy and speed by obtaining the proper history and by being familiar with the phenomenology of frequently encountered movements. These disorders will be discussed based on the most common associated involuntary movement, either parkinsonism, dystonia, chorea, tics or myoclonus, and, when available, review the workup and treatment options based on the current literature.

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“…Faheem et al [96] reported one such patient who developed severe respiratory and diaphragmatic dyskinesias. Several patients have developed severe dyskinesias after withdrawal from clozapine [97], so-called "withdrawal-emergent" dyskinesias. These movements usually affect the neck and trunk.…”

Section: Severe Tardive Dyskinesiasmentioning

confidence: 99%

Movement disorder emergencies

Frucht

2005

Curr Neurol Neurosci Rep

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For the past 4 years, Dr. Stanley Fahn and I have given a course at the American Academy of Neurology annual meeting on the topic of movement disorder emergencies. The purpose of this review article is to summarize the topic and to present it to readers of this journal. The text of this article has appeared in nearly the same form as the Academy syllabus accompanying our course. It is being presented here so that readers of the journal may review the material.

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Clozapine Withdrawal_Emergent Dystonias and Dyskinesias

Cited by 94 publications

References 0 publications

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Maintenance Treatment of Severe Tardive Dyskinesia With Clozapine

Movement disorder emergencies

Movement disorder emergencies

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