Prevalence and pattern of antipsychotic induced movement disorders in a tertiary care teaching hospital in India – a cross-sectional study

Desai, Nimisha; Patel, Pooja; Shah, Sandip; Patel, Tejas; Shah, Saurabh; Vatsala, Ela

doi:10.1080/13651501.2017.1381268

Cited by 9 publications

(8 citation statements)

References 31 publications

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“…Contrary to this, another study reported dose as the most common reason for OLDP [36]. The OLDP patterns in our study revealed a higher off-label use of benzodiazepines which is not parallel to other studies [2,37]. This might be due to a difference in morbidity pattern, as in our setting, the patients are commonly presenting with depression and schizophrenia, for which psychiatrists prescribed longer use of benzodiazepines to treat insomnia and decrease aggressive symptoms [38].…”

Section: Discussioncontrasting

confidence: 97%

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Shakeel

Nesar²,

Rehman

et al. 2021

Pharmacy

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Off-label drug prescribing (OLDP) must be based on strong scientific evidence to make sure that patients get the optimum therapeutic outcomes. Adherence to the prerequisites is determined by the physicians’ attitude and knowledge. In this context, the present study was conducted with the goal of investigating psychiatrists’ perceptions of the use of OLDP in their clinical practice. A total of 14 psychiatrists were interviewed using a semi-structured interview guide. Thematic content analysis was performed. Data saturation was achieved at the 12th interview. Six major themes and fifteen subthemes emerged from qualitative interviews. Among the major themes were knowledge and concepts about the off-label drugs, attitude and current practice of prescribing off-label drugs, and rationale of prescribing and suggestions for reducing the use of off-label drugs. Almost all of the respondents interviewed provided detailed comments concerning the OLDP concept, depicted an optimistic approach and deemed that OLDP is quite common in psychiatry. Off-label usage of benzodiazepines such as clonazepam, diazepam and lorazepam in mania, depression, and obsessive–compulsive disorder were commonly reported. It was observed that the majority of the respondents did not inform the patients before prescribing off-label drugs. The present findings revealed that respondents had awareness; however, they depicted diverse attitudes towards prescribing off-label drugs. Further education and sensitization in regions with impoverished knowledge would certainly assist in preventing the risks associated with the use of OLDP.

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Section: Discussioncontrasting

confidence: 97%

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Shakeel

Nesar²,

Rehman

et al. 2021

Pharmacy

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“…Regarding the geographical distribution, the review included six studies from Europe [4,[25][26][27][28][29], five studies from Asia [30][31][32][33][34], two studies from Africa [35,36], one study from South America [37], and one study from North America [38]. Thirteen of these studies had employed cross-sectional design [4,26,[28][29][30][31][33][34][35][36][37] with two of which being a retrospective chart review [25,32] and the remaining two studies had employed cohort design [27,38]. The sample size of individual studies ranged from 28 [29] to 164,417 [38].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The sample size of individual studies ranged from 28 [29] to 164,417 [38]. Thirteen studies were conducted in hospital settings [4,[26][27][28][29][30][31][33][34][35][36][37][38] whereas two studies were conducted at rehabilitation centers [25,32]. Majority of studies were conducted on adult patients with schizophrenic or schizoaffective disorders whereas the rest studies were conducted on non-specific psychotic patients, acute psychotic patients with substance use disorder, and patients with severe mental illness.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Regarding the regimen, seven studies reported mixed use of both typical and atypical antipsychotics [25, 27-30, 33, 38], five PLOS ONE studies reported independent use of either oral or depot (IM) typical antipsychotics (primarily phenothiazines and thioxanthenes) [4,31,32,35,36] and three studies included participants who took atypical agents only [26,34,37]. Regarding the outcome measures, twelve studies reported the overall magnitude of antipsychotic-induced EPSEs [25,26,[28][29][30][31][32][33][34][35][36][37]. Looking at…”

Section: Study Characteristicsmentioning

confidence: 99%

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Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies

et al. 2021

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Background Antipsychotic agents are the basis for the pharmacological management of acute and chronic schizophrenia, bipolar disorders, mood disorders with psychotic feature, and other psychotic disorders. Antipsychotic medication use is frequently associated with unfavorable adverse effects such as extrapyramidal side effects (EPSEs). Hence, this systematic review and meta-analysis was aimed to determine the magnitude of antipsychotic-induced EPSEs. Method A literature search was conducted using legitimate databases, indexing services, and directories including PubMed/MEDLINE (Ovid®), EMBASE (Ovid®), google scholar and WorldCat to retrieve studies. Following screening and eligibility, the relevant data were extracted from the included studies using an Excel sheet and exported to STATA 15.0 software for analyses. The Random effects pooling model was used to analyze outcome measures at a 95% confidence interval. Besides, publication bias analysis was conducted. The protocol has been registered on PROSPERO with ID: CRD42020175168. Result In total, 15 original articles were included for the systematic review and meta-analysis. The pooled prevalence of antipsychotic-induced EPSEs among patient taking antipsychotic medications was 37% (95% CI: 18–55%, before sensitivity) and 31% (95% CI: 19–44%, after sensitivity). The prevalence of antipsychotic-induced parkinsonism, akathisia, and tardive dyskinesia was 20% (95% CI: 11–28%), 11% (95% CI: 6–17%), and 7% (95% CI: 4–9%), respectively. To confirm a small-study effect, Egger’s regression test accompanied by funnel plot asymmetry demonstrated that there was a sort of publication bias in studies reporting akathisia and tardive dyskinesia. Conclusion The prevalence of antipsychotic-induced EPSEs was considerably high. One in five and more than one in ten patients experienced parkinsonism and akathisia, respectively. Appropriate prevention and early management of these effects can enhance the net benefits of antipsychotics.

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“…The most potent molecules that bind to the alpha-adrenergic receptors are clozapine, iloperidone, and risperidone. Clozapine, olanzapine, and quetiapine also bind to muscarinic cholinergic receptors [7,8]. The less common incidence of extrapyramidal side effects made the atypical antipsychotics very popular among psychiatrists [9].…”

Section: Introductionmentioning

confidence: 99%

Clozapine. Pharmacodynamic Mechanisms, Potential Pharmacogenetic Biomarkers, and Risks in Schizophrenia. Particularities in the Context of Covid-19. An Updated Overview

Drăgoi¹,

Rădulescu²,

Pop³

et al. 2020

Preprint

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Background: Clozapine use is precarious due to its side effects - neurological, cardiovascular, and hematological; however, it is the gold standard in the therapy of resistant schizophrenia (TRS) in adults and harshly underused. Objective: Our purpose is to systematically examine the most recent data regarding clozapine in order to update the knowledge in pharmacological mechanisms, therapy benefits versus side effects to optimize its use in the context of a narrow and scarce of resources pathology, with particularities in the COVID-19 pandemic. (2) Data sources: We performed an accurate search in the primary sources of Databases (PubMed, BMC Public Health, Global Health, Cross Ref, Scopus, Web of Science, and Google Scholar) with specific keywords: “clozapine” and “schizophrenia,” “risks” agranulocytosis” “TRS” “bipolar affective disorder” “pregnancy” “early-onset schizophrenia” “resistance”. Study eligibility criteria: we extracted information regarding drug treatment, side effects profile, and efficacy for each trial; (3) Results: Of all the searched data we selected RCT’s, C.T.’s, reviews, systematic reviews, and meta-analyses; Data were converted and analyzed in a random-effects model. We included 45 studies, centered on six main topics in the search area: (a) treatment-resistant schizophrenia, (b) use in bipolar disorder, (c) side effects during the clozapine therapy - agranulocytosis, metabolic side effects, pharmacogenetic severity markers, dysmetabolic side effects, pulmonary embolism, seizure risk – (d) safety of clozapine in pregnancy, (e) clozapine resistance and ECT augmentation, (f) clozapine therapy and COVID-19 infection. Limitations: _______(4) Conclusions and implications of key findings: (a) The genetic vulnerability postulates predictors of severity so clozapine doses should be personalises for each patient based on pharmacogenetic testing; patients with a lower genetic risk may benefit from a more relaxed hematological monitoring schedule; (b) Pulmonary embolism associated with clozapine has a mortality rate of 36.36%, prophylactic measures for venous thromboembolism for six months after initiating therapy is mandatory; (c) Convulsive episodes are not an indication for stopping the treatment, side effect (s.e.) incidence increases with the dose, the plasma concentration of clozapine (1300 ng/ml) it is a better s. e. predictor than the dosage; (d) clozapine refractory improves up to 69% early-onset schizophrenia, assesed by the Brief Psychiatric Rating Scale (BPRS) (e) more pharmacogenetic studies of the Romanian schizophrenic patients are needed in relation with the clozapine therapy in order to define more precise safety margins; (f) COVID-19 infection may enhance clozapine toxicity generating an increased risk of pneumonia therapy must be continued with proper monitoring of the white blood count and with the decrease of the clozapine dose by half until three days after the subside of the fever; psychiatrists and healthcare providers must act togheder. As in the past four decades, research has failed to generate effective novel psycho-pharmaceuticals, there is an urgent need to enhance the access to clozapine for people with TRS at the worldwide level. The progress of pharmacogenetic researches, endocrinology, genetic testing - offer the psychiatrists nowadays the chance to use this drug at its highest potential in a personalized manner for every patient - minimizing the adverse side-effects.

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Prevalence and pattern of antipsychotic induced movement disorders in a tertiary care teaching hospital in India – a cross-sectional study

Abstract: The higher use of atypical antipsychotics had reduced the occurrence of movement disorders in our setup.

Cited by 9 publications

References 31 publications

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies

Clozapine. Pharmacodynamic Mechanisms, Potential Pharmacogenetic Biomarkers, and Risks in Schizophrenia. Particularities in the Context of Covid-19. An Updated Overview

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