Extrapyramidal symptoms and cocaine abuse

Sl, Satel; Ac, Swann

doi:10.1176/ajp.150.2.347a

Cited by 13 publications

(1 citation statement)

References 2 publications

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“…Furthermore, long-term cocaine use is associated with a significant reduction in DA receptor D 2 availability in the dorsal striatum that may last for months after withdrawal, similar to the striatal dopaminergic deficit observed in PD [27][28][29]. Nonpsychotic individuals with cocaine use disorder (CoUD) showed EPSs, including rigidity and parkinsonian resting tremor, up to 12 weeks after having discontinued use of the substance [23,25,[30][31][32]. In patients with a diagnosis of SZ, cocaine use is a major risk factor for dystonia, parkinsonism, dyskinesia, and akathisia [23,33,34].…”

Section: Introductionmentioning

confidence: 99%

Psychomotor Symptoms in Chronic Cocaine Users: An Interpretative Model

Cenci

Carbone

Callegari

et al. 2022

IJERPH

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According to the latest estimates, there are around 24.6 million cocaine users worldwide, and it is estimated that around a quarter of the population worldwide has used cocaine at some point in their lifetime. It follows that such widespread consumption represents a major risk for public health. Long-term use of cocaine, in addition to being related to many cerebral and cardiovascular diseases, is increasingly associated with a higher incidence of psychomotor symptoms and neurodegenerative disorders. In recent years, numerous studies have shown an increased risk of antipsychotic-induced extrapyramidal symptoms (EPSs) in patients with psychotic spectrum disorders comorbid with psychostimulant misuse, particularly of cocaine. In the present paper, we describe the case of a young patient on his first entry into a psychiatric setting with previous cocaine misuse who rapidly presented psychomotor symptoms and was poorly responsive to symptomatic therapy consisting of benzodiazepines and anticholinergics, in relation to the introduction of various antipsychotics (first, second, and third generation). Furthermore, we propose neurobiological mechanisms underlying the hypothesized increased vulnerability to psychomotor symptoms in chronic cocaine abusers. Specifically, we supposed that the chronic administration of cocaine produces important neurobiological changes, causing a complex dysregulation of various neurotransmitter systems, mainly affecting subcortical structures and the dopaminergic and glutamatergic pathways. We believe that a better understanding of these neurochemical and neurobiological processes could have useful clinical and therapeutic implications by providing important indications to increase the risk–benefit ratio in pharmacological choice in patients with psychotic spectrum disorders comorbid with a substance use disorder.

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Section: Introductionmentioning

confidence: 99%

Psychomotor Symptoms in Chronic Cocaine Users: An Interpretative Model

Cenci

Carbone

Callegari

et al. 2022

IJERPH

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Striatal dopamine, dopamine transporter, and vesicular monoamine transporter in chronic cocaine users

Wilson

Levey

Bergeron

et al. 1996

Annals of Neurology

160

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Depletion of striatal dopamine (DA) has been hypothesized to explain some of the neurological and psychiatric complications of chronic use of cocaine, including increased risk for neuroleptic-precipitated movement disorders. We measured levels of DA, as well as two DA nerve terminal indices, namely, the DA transporter (DAT) and the vesicular monoamine transporter (VMAT2) in autopsied brain of 12 chronic cocaine users. Mean DA levels were normal in the putamen, the motor component of the striatum; however 4 of the 12 subjects had DA values below the lower limit of the control range. DA concentrations were significantly reduced in the caudate head (head, -33%; tail, -39%) with a trend for reduction in nucleus accumbens (-27%). Striatal DAT protein (-25 to -46%) and VMAT2 (-17 to -22%) were reduced, whereas DAT determined by [3H]WIN 35,428 binding was normal. In conclusion, our data suggest that chronic cocaine use is associated with modestly reduced levels of striatal DA and the DA transporter in some subjects and that these changes might contribute to the neurological and psychiatric effects of the drug.

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Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia

et al. 2010

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Extrapyramidal symptoms (EPS) such as parkinsonism, dystonia, dyskinesia, and akathisia are conditions of impaired motor function, which are associated with chronic antipsychotic treatment in schizophrenia. In addition, EPS is often exacerbated by psychoactive substance (PAS) abuse, which is frequently observed in this population. Few studies, however, have investigated the contribution of PAS abuse on EPS in PAS-abusers without comorbid psychosis. This study compared the occurrence of EPS in outpatient schizophrenia patients with (DD group; n= 36) and without PAS abuse (SCZ group; n = 41) as well as in nonschizophrenia PAS abusers undergoing detoxification [substance use disorder (SUD) group; n = 38]. Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for schizophrenia. Extrapyramidal symptoms were evaluated with the Extrapyramidal Symptoms Rating Scale and the Barnes Akathisia Scale. SUD diagnoses were complemented with urine drug screenings. We found that DD patients exhibited significantly more parkinsonism than SCZ patients. Our subanalyses revealed that cocaine and alcohol abuse/dependence was responsible for the increase in parkinsonism in DD patients. Additionally, we found that SUD individuals exhibited significantly more akathisia than SCZ patients. In these latter individuals, subanalyses revealed that alcohol and cannabis abuse/dependence was responsible for the increase in akathisia. Our results suggest that PAS abuse is a contributor to EPS in individuals with and without schizophrenia.

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Extrapyramidal symptoms and cocaine abuse

Cited by 13 publications

References 2 publications

Psychomotor Symptoms in Chronic Cocaine Users: An Interpretative Model

Psychomotor Symptoms in Chronic Cocaine Users: An Interpretative Model

Striatal dopamine, dopamine transporter, and vesicular monoamine transporter in chronic cocaine users

Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia

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