Tardive Dyskinesia: Legal and Preventive Aspects

Shriqui, Christian L.; Bradwejn, Jacques; Jones, Barry D.

doi:10.1177/070674379003500702

Cited by 10 publications

(7 citation statements)

References 31 publications

(30 reference statements)

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“…Instead, existing tocopherol tri-chotic to address it could constitute malpracals involve patients who already have tardive dys-tice. [10,11] Accordingly, any patient treated with kinesia at baseline. However, a recent meta-analysis antipsychotic medications should be monitored on a of these studies did find that tocopherol-treated pa-regular basis for tardive dyskinesia, bearing in mind that it may begin insidiously and require careful the vitamin at a dosage of 1200-1600 mg/day with examination to detect.…”

Section: Treatments For Acute Epsmentioning

confidence: 99%

“…as well as psychiatric malpractice lawsuits. [10,11] A dystonia is a sustained posture produced by While atypical antipsychotics are thought to be assocontinuous muscular contraction. Acute dystonias ciated with a significantly reduced EPS risk, this risk are typically focal, affecting the muscles of the neck, is not zero and recent evidence calls into question to jaw, back, extremities, eyes, throat and tongue.…”

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confidence: 99%

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Extrapyramidal Symptoms with Atypical Antipsychotics

2005

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The treatment of schizophrenia changed drastically with the discovery of antipsychotic medications in the 1950s, the release of clozapine in the US in 1989 and the subsequent development of the atypical or novel antipsychotics. These newer medications differ from their conventional counterparts, primarily based on their reduced risk of extrapyramidal symptoms (EPS). EPS can be categorised as acute (dystonia, akathisia and parkinsonism) and tardive (tardive dyskinesia and tardive dystonia) syndromes. They are thought to have a significant impact on subjective tolerability and adherence with antipsychotic therapy in addition to impacting function. Unlike conventional antipsychotic medications, atypical antipsychotics have a significantly diminished risk of inducing acute EPS at recommended dose ranges. These drugs may also have a reduced risk of causing tardive dyskinesia and in some cases may have the ability to suppress pre-existing tardive dyskinesia. This paper reviews the available evidence regarding the incidence of acute EPS and tardive syndromes with atypical antipsychotic therapy. Estimates of incidence are subject to several confounds, including differing methods for detection and diagnosis of EPS, pretreatment effects and issues surrounding the administration of antipsychotic medications. The treatment of acute EPS and tardive dyskinesia now includes atypical antipsychotic therapy itself, although other adjunctive strategies such as antioxidants have also shown promise in preliminary trials. The use of atypical antipsychotics as first line therapy for the treatment of schizophrenia is based largely on their reduced risk of EPS compared with conventional antipsychotics. Nevertheless, EPS with these drugs can occur, particularly when prescribed at high doses. The EPS advantages offered by the atypical antipsychotics must be balanced against other important adverse effects, such as weight gain and diabetes mellitus, now known to be associated with these drugs.

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Section: Treatments For Acute Epsmentioning

confidence: 99%

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confidence: 99%

Extrapyramidal Symptoms with Atypical Antipsychotics

2005

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“…All 21 included studies were placebo-controlled RCTs (Table 1). However, 15 studies were published in English (Lohr et al , 1987; Lohr et al , 1988; Elkashef et al , 1990; Egan et al , 1992; Shriqui et al , 1992; Adler et al ., 1993; Akhtar et al , 1993; Dabiri et al , 1994; Lam et al , 1994; Lohr and Caligiuri, 1996; Dorevitch et al , 1997; Sajjad 1998; Adler et al , 1998; Adler et al , 1999; Zhang et al , 2004) and six in Chinese (Sun et al , 1995; Sun and Hu 1996; Feng et al , 1997; Chen et al , 1998; Xu et al , 1998; Li et al , 2015). We assessed the risk of bias with the Cochrane risk of bias assessment tool (Supplementary Table 1, Supplemental digital content 2, http://links.lww.com/ICP/A92).…”

Section: Resultsmentioning

confidence: 99%

Vitamin E in the treatment of tardive dyskinesia: a meta-analysis

Qin

Chen

et al. 2022

International Clinical Psychopharmacology

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Long-term use of antipsychotic drugs is associated with tardive dyskinesia. At present, there is no satisfactory treatment for tardive dyskinesia. Some randomized trials suggested that vitamin E can improve tardive dyskinesia. This study was undertaken to evaluate the effects of vitamin E treatment for tardive dyskinesia. We searched internet databases for randomized controlled trials . A total of 21 studies including 854 patients with tardive dyskinesia were included in this meta-analysis. Eighteen studies reported the Abnormal Involuntary Movements Scale (AIMS) as the primary outcome. After vitamin E treatment, a decrease of 2.36 (95% CI = −3.27 to −1.45; P < 0.00001) in the AIMS was observed in the treatment group, compared with the control group. Vitamin E may offer a new avenue treatment for tardive dyskinesia.

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“…We are living in a time when increasing attention is being paid to the legal ramifications of medical practice. The subsequent article, Tardive Dyskinesia: Legal and Preventive Aspects by Shriqui et al (1) in this issue, draws attention to five recent legal judgements in the United States that related to the syndrome of tardive dyskinesia (TD). Medical shortcomings cited by the court include the following: failure to obtain informed consent for neuroleptic treatment, lack of a clearly documented indication for maintenance neuroleptic therapy, inappropriate continuation of neuroleptics after the appearance of dyskinetic movements, and the use of excessive doses of neuroleptic medication.…”

Section: Tardive Dyskinesia and The Lawmentioning

confidence: 99%