The Nithsdale Schizophrenia Surveys. IX: Akathisia, Parkinsonism, Tardive Dyskinesia and Plasma Neuroleptic Levels

Abstract

Of all known schizophrenics living in Nithsdale, south-west Scotland, 146 (88%) were examined for the presence of the three principal movement disorders secondary to antipsychotic medication, namely akathisia, tardive dyskinesia and Parkinsonism. Of these, 18% had akathisia, 5% pseudoakathisia, 29% tardive dyskinesia, 8% persistent tardive dyskinesia, and 27% Parkinsonism. No movement disorder was seen in 445, 36% had one and 20% had more than one movement disorder. Plasma neuroleptic levels at the time of clinical assessment were measured by the radioreceptor technique. Correlations between dose and plasma level were low; the ratio of mean plasma concentration to mean dose was greatest with fluphenazine decanoate and lowest for sulpiride. The concentration:dose ratio was higher in the elderly. There was no relationship between neuroleptic levels and akathisia, Parkinsonism or tardive dyskinesia. Additional psychotropic medication influenced neuroleptic levels. In 9% of patients receiving oral antipsychotic medication, no drug was detected in plasma.

Low dose typical antipsychotics – a brief evaluation

“…In a Japanese cohort receiving the equivalent of 64 mg/day haloperidol, 34.8% of patients showed signs of tardive dyskinesia and 40.5% had parkinsonism (Binder et al, 1987). Similar findings were reported for a sample of patients in Scotland (McCreadie et al, 1992): 29% had tardive dyskinesia, 27% parkinsonism and 23% akathisia (mean dose approximately equivalent to 10 mg/ day haloperidol). More recently, a large (n=1559) Italian survey found 29.4% of patients suffering EPSE (mostly parkinsonism) and 18.3% with persistent tardive dyskinesia.…”

Non-functional CYP2D6 alleles and risk for neuroleptic-induced movement disorders in schizophrenic patients

“…In particular, the issue of whether a longer duration and higher dosage of antipsychotics may increase the risk for TD has yielded conßicting results (Jeste and Wyatt 1982;Gardos et al 1988;McCreadie et al 1992;Morgerstern and Glazer 1993;Muscettola et al 1993;Chakos et al 1996). This discrepancy could be due to individual variation in drug metabolism and compliance.…”

“…There have been Þve previous assessments of TD in the Nithsdale cohort of schizophrenic patients: 1981), 1982(Barron and McCreadie 1983), 1984(Robinson and McCreadie 1986), 1989(McCreadie et al 1992(McCreadie et al 1995. A majority of the patients in the present study had been assessed on at least three of these previous occasions.…”

Extrapyramidal symptoms and residual psychopathology with low-dose neuroleptics

“…Although these dosages are lower than those usually employed in other clinical settings and experimental studies, we found a 27 . 5 per cent prevalence of akathisia, which is not dierent from other studies conducted on patients in maintenance neuroleptic treatment (Braude et al, 1983;McCreadie et al, 1992;Halstead et al, 1994). Parkinsonism is present in 27 .…”