Extrapyramidal side-effects of antipsychotics in a randomised
                        trial

Miller, Del D.; Caroff, Stanley N.; Davis, Sonia M.; Rosenheck, Robert A.; McEvoy, Joseph P.; Saltz, Bruce L.; Riggio, Silvana; Chakos, Miranda; Swartz, Marvin S.; Keefe, Richard S.E.; Stroup, T. Scott; Lieberman, Jeffrey A.

doi:10.1192/bjp.bp.108.050088

Cited by 231 publications

(168 citation statements)

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“…Similar to our study, from a population that consisted a large proportion of previously used first generation antipsychotics, Woods (29) reported classical and atypical antipsychotics, contrary to popular belief, were not different in terms of TD risk.…”

Section: Discussionsupporting

confidence: 72%

Tardive dyskinesia in long term hospitalized patients with schizophrenia

Nalbant¹,

Can²,

Burhan³

et al. 2016

Dusunen Adam

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Tardive dyskinesia in long term hospitalized patients with schizophreniaObjective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders caused by dopamine receptor-blocking agents. TD prevalence is estimated as 20-50% of all patients treated with neuroleptics. This study aimed to investigate the prevalence rate of TD in long-term hospitalized patients with schizophrenia. Method:We recorded age, gender, duration and type (first/second generation or mixed) of medication both at the time of interview and over preceding years. Dyskinesia was assessed by using the Abnormal Involuntary Movements Scale (AIMS). We also used the Simpson-Angus Scale for tardive parkinsonism.Akathisia was measured using the Barnes Akathisia Rating Scale (BARS).Results: Mean duration of the longest used antipsychotic was 206.63 months. Probable TD was found in 18 (22.5%) of patients. None of the patients had tardive akathisia. Relation between type of the longest used treatment and prevalence of TD was not statistically significant. Relationship between type of ongoing treatment and prevalence of TD was not determined statistically significant either. There was a statistically significant relationship between the mean age and TD.Discussion: Despite very long duration of antipsychotic use, 22.5% rate of prevalence is still lower than expected. This can be explained that these patients are under direct and close follow-up of healthcare providers and in hospital conditions, so that risky conditions can be intervened rapidly. Another noteworthy finding of our study is that there is no statistically significant difference betwen first and second generation antipsychotic use and TD prevalence. Sonuç: Uzun süreli ilaç kullanımı olan bir grupta %22.5 oranı, yine de, beklenenden düşüktür. Hastaların hastane ortamında ve sağlık çalışanları gözetiminde doğrudan ve yakın izlemde olmaları ve risk oluşturabilecek durumlara erken müdahale edilmesi bu durum için bir açıklama olabilir. 1. ve 2. kuşak antipsikotik kullanımıyla ile TD yaygınlığı arasında çalışmamızda istatistik olarak anlamlı fark bulunmamısı da bir diğer önemli bulgudur.

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Section: Discussionsupporting

confidence: 72%

Tardive dyskinesia in long term hospitalized patients with schizophrenia

Nalbant¹,

Can²,

Burhan³

et al. 2016

Dusunen Adam

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“…In a recent review of 12 trials published between 2004 and 2008, the annual incidence of TD was found to be 3.9 % for SGAs and 5.5 % for first-generation drugs [36]. Several other studies have found no change in the incidence at all [38][39][40].…”

Section: Is Td Disappearing?mentioning

confidence: 99%

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

2014

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Tardive dyskinesia (TD) is a serious, often disabling, movement disorder that is caused by medications that block dopamine receptors (i.e., neuroleptics, anti-emetics). There is currently no standard treatment approach for physicians confronted with such patients. This may be the result of notions that TD is disappearing because of the switch to secondgeneration antipsychotic agents and that it is largely reversible.In this article we demonstrate that second-generation antipsychotics do, indeed, cause TD and, in fact, the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years. In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn. Furthermore, neuroleptic agents are often utilized to treat TD, despite prolonged exposure being a risk factor for irreversibility. The outcome of these trends is a growing population afflicted with TD. We review non-neuroleptic agents that have shown positive results in small, early-phase, blinded trials, including tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba. Other options, such as botulinum toxin and deep brain stimulation, will also be discussed, and a suggested treatment algorithm is provided. While these agents are reasonable treatment options at this time there is a need, with a concerted effort between neurology and psychiatry, for full-scale drug development, including multicenter, randomized, blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones.

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“…Moreover, results in favor of SGAs have not been uniform, with at least two adult studies failing to find an advantage for SGAs (de Leon, 2007;Miller et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…However, the actual evidence for a low TD risk of SGAs is still limited, and, recently, advantages of SGAs vs firstgeneration antipsychotics (FGAs) regarding TD prevalence (de Leon, 2007) and incidence rates (Miller et al, 2008;Lee et al, 2005) have been questioned. Two recent systematic reviews pooled data on prevalence (Davidson et al, 2000) and incidence rates (Correll and Schenk, 2008;Correll et al, 2004) of TD or dyskinesia from studies using SGAs and FGAs that lasted at least 1 year.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

Woerner

Correll

Alvir

et al. 2011

Neuropsychopharmacol

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Tardive dyskinesia (TD) rates with second-generation antipsychotics (SGAs) are considered to be low relative to first-generation antipsychotics (FGAs), even in the particularly vulnerable elderly population. However, risk estimates are unavailable for patients naïve to FGAs. Therefore, we aimed to determine the TD incidence in particularly vulnerable, antipsychotic-naïve elderly patients treated with the SGA risperidone or olanzapine. The present work describes a prospective inception cohort study of antipsychotic-naïve elderly patients aged X55 years identified at New York Metropolitan area in-patient and out-patient geriatric psychiatry facilities and nursing homes at the time of risperidone or olanzapine initiation. At baseline, 4 weeks, and at quarterly periods, patients underwent assessments of medical and medication history, abnormal involuntary movements, and extra-pyramidal signs. TD was classified using Schooler-Kane criteria. Included in the analyses were 207 subjects (age: 79.8 years, 70.0% female, 86.5% White), predominantly diagnosed with dementia (58.9%) or a major mood disorder (30.9%), although the principal treatment target was psychosis (78.7%), with (59.4%) or without (19.3%) agitation. With risperidone (n ¼ 159) the cumulative TD rate was 5.3% (95% confidence interval (CI): 0.7, 9.9%) after 1 year (mean dose: 1.0±0.76 mg/day) and 7.2% (CI: 1.4, 12.9%) after 2 years. With olanzapine (n ¼ 48) the cumulative TD rate was 6.7% (CI: 0, 15.6%) after 1 year (mean dose: 4.3±1.9 mg/day) and 11.1% (CI: 0, 23.1%) after 2 years. TD risk was higher in females, African Americans, and patients without past antidepressant treatment or with FGA co-treatment. The TD rates for geriatric patients treated with risperidone and olanzapine were comparable and substantially lower than previously reported for similar patients in direct observation studies using FGAs. This information is relevant for all patients receiving antipsychotics, not just the especially sensitive elderly.

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Extrapyramidal side-effects of antipsychotics in a randomised trial

Abstract: The incidence of treatment-emergent EPS and change in EPS ratings indicated that there are no significant differences between second-generation antipsychotics and perphenazine or between second-generation antipsychotics in people with schizophrenia.

Cited by 231 publications

References 50 publications

Tardive dyskinesia in long term hospitalized patients with schizophrenia

Tardive dyskinesia in long term hospitalized patients with schizophrenia

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

Incidence of Tardive Dyskinesia with Risperidone or Olanzapine in the Elderly: Results from a 2-Year, Prospective Study in Antipsychotic-Naïve Patients

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