The fundamentals of psychiatry
Ben Green in 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.
Prescribing for a first episode of schizophrenia-like psychosis
Kathy J Aitchison, Karena Meehan, Robin M Murray in First Episode Psychosis, 2021
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)
Antipsychotics: Predicting Response/Maximizing Efficacy
Mark S. Gold, R. Bruce Lydiard, John S. Carman in Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Practicing clinicians are painfully aware that long-term administration of antipsychotics can cause tardive dyskinesia (TD). It is believed to be a result of DA receptor supersensitivity produced by prolonged receptor blockade by antipsychotics.7 The syndrome consists of abnormal, involuntary movements of the tongue, mouth, jaw, and face. In severe cases, postural muscles are also affected. The movements can range in severity from barely discernible tongue or lip movements to dramatic and incapacitating choreoathetoid movements. More unusual cases can involve involuntary muscle controlling respiration and occasionally result in respiratory alkalosis.204 Chewing and swallowing difficulties may increase the risk of aspiration for some patients.
A comprehensive review of swallowing difficulties and dysphagia associated with antipsychotics in adults
Published in Expert Review of Clinical Pharmacology, 2019
Giuseppe Cicala, Maria Antonietta Barbieri, Edoardo Spina, Jose de Leon
The most common presentation of tardive dyskinesia is bucco-lingual-masticatory syndrome, which consists of involuntary movements affecting the face, jaw and tongue but can also affect extremities. Tardive dyskinesia occurs frequently with FGAPs but also can happen with SGAPs; it is still uncertain that SGAPs have less risk. A recent meta-analysis [59] described lower rates with current SGAP treatment (21%; 95% confidence interval, CI = 17%-25%) versus current FGAP treatment (30%; CI = 26–34). Other risk factors are: 1) higher age, world region (lower in Asia), longer illness duration, and frequency of parkinsonism (according to the meta-analysis [63]) and 2) female sex, ID and brain damage, negative symptoms in schizophrenia, mood disorders, cognitive symptoms in mood disorders, some gene polymorphisms, diabetes, smoking, alcohol and substance abuse and anticholinergic co-treatment (according to another review [64]).
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.
Prevalence and pattern of antipsychotic induced movement disorders in a tertiary care teaching hospital in India – a cross-sectional study
Published in International Journal of Psychiatry in Clinical Practice, 2018
Nimisha Desai, Parvati B. Patel, Sandip Shah, Tejas K. Patel, Saurabh N. Shah, Ela Vatsala
Our study also observed the low prevalence of tardive dyskinesia as compared to earlier studies (11.8–43%) (Bakker et al., 2013; Gebhardt et al., 2006; Halliday et al., 2002; Janno et al., 2004). The risk factors for high occurrence of tardive dyskinesia are advanced age, duration of treatment with antipsychotics, and treatment with a conventional antipsychotic (Halliday et al., 2002; Miller et al., 2005). The possible reasons could be study population of chronic schizophrenia and schizoaffective patients (Gebhardt et al., 2006; Janno et al., 2004), longer study duration (Bakker et al., 2013; Halliday et al., 2002), high percentage of patients on conventional antipsychotics (Janno et al., 2004), use of relatively high doses of conventional antipsychotics (Janno et al., 2004) in earlier studies. In our study, elderly accounted for less than 10% of study population.
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