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Prescribing for a first episode of schizophrenia-like psychosis
Published in Kathy J Aitchison, Karena Meehan, Robin M Murray, First Episode Psychosis, 2021
Kathy J Aitchison, Karena Meehan, Robin M Murray
Tardive dyskinesia is an abnormal involuntary movement disorder caused by sustained exposure to antipsychotics which can affect any part of the body, but most commonly affects the orofacial area. This appears as a protrusion or twisting of the tongue, repetitive pursing or sucking movements of the lips, chewing and lateral movements of the jaw or puffing of the cheeks. Involuntary limb movements appear choreiform or choreo-athetoid, including athetosis of the extremities and purposeless, stereotyped movements. Risk factors include:200,201long duration of antipsychotic usehigh potency antipsychoticsubtle movement disorder prior to treatmentcognitive impairmenthistory of alcohol abuseolder ageconcurrent medical condition (eg diabetes)
Pharmacology
Published in Bhaskar Punukollu, Michael Phelan, Anish Unadkat, MRCPsych Part 1 In a Box, 2019
Bhaskar Punukollu, Michael Phelan, Anish Unadkat
Tardive dyskinesia: Abnormal movements most commonly affecting the face, mouth or trunk. Lip smacking or chewing, tongue protrusion, choreiform hand movements, pelvic thrusting. Orofacial movements leading to difficulty speaking or eating food. Movements are exacerbated by stress. Tardive dyskinesia becomes more likely with longer duration of antipsychotic treatment.
The fundamentals of psychiatry
Published in Ben Green, Problem-based Psychiatry, 2018
Akathisia, tardive dyskinesia and Parkinsonism are often seen in patients taking psychiatric medications (see Chapter 13, ‘Physical treatments’). Akathisia is a drug-induced restlessness which may be described by the patient or observed as agitated fidgeting in a chair or restless pacing about the room. Tardive dyskinesia is a basal ganglia movement disorder manifesting as a combination of involuntary rhythmic movements of any of the following: lips, tongue, face, arms, hands, legs, feet or trunk. Sometimes it may be observed as choreoathetoid movements. Tardive dyskinesia is thought to be a late side-effect of some antipsychotic drugs. Parkinsonism may be an early side-effect of such drugs (extra-pyramidal side-effects) and may manifest with classical Parkinsonian features such as mask-like features, pill-rolling tremor and bradykinesia.
The incidence and economic burden of extrapyramidal symptoms in patients with schizophrenia treated with second generation antipsychotics in a Medicaid population
Published in Journal of Medical Economics, 2022
Aditi Kadakia, Brenna L. Brady, Carole Dembek, G. Rhys Williams, Justine M. Kent
Antipsychotic medications are the mainstay for acute and chronic pharmacologic treatment of patients with schizophrenia6,7. Antipsychotics are mainly dopamine D2 and serotonin 5-HT2A antagonists and are associated with varying levels of side-effects, often relating to their D2 antagonistic effect, such as extrapyramidal symptoms (EPS) including acute dystonia, akathisia, and parkinsonism6,8. Medications such as benztropine, trihexyphenidyl, amantadine, and biperiden have been used to treat EPS6. While not common, following sustained exposure to antipsychotic medications, the abnormal involuntary movement disorders can become persistent, a condition called tardive dyskinesia6. Medications such as deutetrabenazine, valbenazine, and tetrabenazine are used to treat tardive dyskinesia6.
Can ketamine be a safe option for treatment-resistant bipolar depression?
Published in Expert Opinion on Drug Safety, 2022
Balwinder Singh, Jennifer L. Vande Voort, Mark A. Frye, Simon Kung
Bipolar disorder (BD) is a recurrent condition with fluctuating mood swings from energetic mania/hypomania to severe depression, leading to significant disability and a high risk of mortality. Patients with BD spend most of their time in depressive episodes compared with manic or hypomanic episodes. Despite advances in psychopharmacology, only five FDA-approved treatment options for bipolar depression are available, four of which are atypical antipsychotics (quetiapine, lurasidone, cariprazine, and lumateperone), and the fifth is a combination atypical antipsychotic (olanzapine) and antidepressant (fluoxetine). These medications often work slowly and carry a significant side-effect burden, including the risk of irreversible tardive dyskinesia. Despite adequate trials, a significant proportion of patients remain treatment-resistant. There is a lack of faster-acting antidepressants, causing significant distress and poor quality of life for patients with treatment-resistant bipolar depression (TRBD). Thus, identifying novel molecules that have a rapid onset of antidepressant effects is a major priority.
Extrapyramidal reactions following treatment with antidepressants: Results of the AMSP multinational drug surveillance programme
Published in The World Journal of Biological Psychiatry, 2020
Sabrina Mörkl, Daniel Seltenreich, Martin Letmaier, Susanne Bengesser, Walter Wurm, Renate Grohmann, Stefan Bleich, Sermin Toto, Susanne Stübner, Mary I. Butler, Siegfried Kasper
EPS can present in a variety of ways, and five different syndromes have been described: akathisia, acute dystonia, malignant neuroleptic syndrome (MNS), parkinsonism and tardive dyskinesia (Fahn et al. 2011). Akathisia is the subjective perception of restlessness. It is extremely distressing for patients, who are often unable to sit still and describe the need for continuous movement. It usually occurs shortly after commencement or dose increase of antipsychotic medication. Tardive dyskinesia, conversely, is a condition which results from long-term (typically several years, at least several months) antipsychotic treatment. It is characterised by stereotypical, involuntary movements usually affecting the oropharyngeal region (tongue and throat) and facial muscles. The symptoms of acute dystonia involve a contraction of a muscle group to the maximal limit. Often, the sternocleidomastoid muscle (torticollis) and the tongue are involved, but the contractions can also be widespread (i.e., opisthotonus) (Semple and Smyth 2013). MNS is a potentially life-threatening complication of psychotropic medication usually involving antipsychotic drugs but also, less commonly, antidepressants (Lu et al. 2006; Tanii et al. 2006; Uguz and Sonmez 2013). When fully developed, symptoms include confusion, rigidity, hyperthermia, hyperhidrosis, tremor, autonomic dysregulation, and increased creatinine kinase (Fahn et al. 2011). Antipsychotic medications can also quite commonly cause parkinsonism, a clinical syndrome of bradykinesia, rigidity and tremor and postural instability.