Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Psychiatry AND Tardive dyskinesia [keywords]
- Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder. [JOURNAL ARTICLE]
- Neurotherapeutics 2013 Oct 10.
Tardive dyskinesia (TD) is a serious, often disabling, movement disorder that is caused by medications that block dopamine receptors (i.e., neuroleptics, anti-emetics). There is currently no standard treatment approach for physicians confronted with such patients. This may be the result of notions that TD is disappearing because of the switch to second-generation antipsychotic agents and that it is largely reversible. In this article we demonstrate that second-generation antipsychotics do, indeed, cause TD and, in fact, the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years. In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn. Furthermore, neuroleptic agents are often utilized to treat TD, despite prolonged exposure being a risk factor for irreversibility. The outcome of these trends is a growing population afflicted with TD. We review non-neuroleptic agents that have shown positive results in small, early-phase, blinded trials, including tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba. Other options, such as botulinum toxin and deep brain stimulation, will also be discussed, and a suggested treatment algorithm is provided. While these agents are reasonable treatment options at this time there is a need, with a concerted effort between neurology and psychiatry, for full-scale drug development, including multicenter, randomized, blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones.
- Clozapine and tardive movement disorders: A review. [Journal Article]
- Asian J Psychiatr 2013 Dec; 6(6):439-51.
Tardive syndromes (TS) arise from long term exposure to dopamine receptor blocking agents. Clozapine has been considered to have low risk of causing new onset TS and is considered as a treatment option in patients with TS.This review evaluates the usefulness of clozapine in patients with TS and occasional reports of clozapine causing TS.Electronic searches were carried out using the search engines of PUBMED, Science direct and Google Scholar databases. All reports describing use of clozapine in management of TS, monitoring of TS while on clozapine and onset of TS after initiation of clozapine were identified.Fifteen trials and 28 case series/case reports describe the use of clozapine in TS. Most of these reports show that clozapine is useful in patients with TS, in the dose range of 200-300mg/day and the beneficial effect is seen within 4-12 weeks of initiation. One case series and two case reports described clozapine withdrawal emergent dyskinesias suggesting a masking role of clozapine. One trial, three case series and two case reports describe beneficial effects of clozapine on long standing neurological syndromes. There is relatively less literature (2 trials and 15 case series/reports) describing the emergence of TS with clozapine.Evidence of beneficial effects of clozapine in TS is greater than its role in causation/worsening of TS. Hence, clozapine should be considered in symptomatic patients who develop TS while receiving other antipsychotics. Further research on mechanism of TS and clozapine effect on TS is required.
- A Case of Paranoid Schizophrenia and Severe Antipsychotic-Induced Parkinson's Disorder Treated with a Combination of Olanzapine and Lurasidone. [JOURNAL ARTICLE]
- Innov Clin Neurosci 2013 9; 10(9-10):10-11.
- Deep brain stimulation for tremor resulting from acquired brain injury. [JOURNAL ARTICLE]
- J Neurol Neurosurg Psychiatry 2013 Dec 4.
To evaluate the efficacy of deep brain stimulation (DBS) in the treatment of tremor resulting from acquired brain injury (ABI).A series of eight consecutive patients with post-ABI tremor were treated with DBS of the ventro-oralis posterior (VOP)/zona incerta (ZI) region, and subsequently underwent blinded assessments using Bain's tremor severity scale.VOP/ZI DBS produced a mean reduction in tremor severity of 80.75% based on Bain's tremor severity scale, with significant reductions in all five component tremor subscores: rest, postural, kinetic, proximal and distal. No adverse neurological complications were reported, although one patient experienced exacerbation of pre-existing gait ataxia.VOP/ZI stimulation is demonstrated here to be an effective and safe approach for the treatment of post-ABI tremor in the largest series published at the time of writing.
- Factors Associated with Duration Before Receiving Definitive Diagnosis of Narcolepsy among Japanese Patients Affected with the Disorder. [JOURNAL ARTICLE]
- Int J Behav Med 2013 Dec 3.
Narcolepsy (NA) is a sleep disorder characterized by excessive daytime sleepiness and an increased propensity of rapid eye movement sleep. If left untreated, NA can lead to academic underachievement or job loss because of dozing off or mistakes caused by inattentiveness due to sleepiness.Although untreated narcolepsy patients may suffer from many social disadvantages due to excessive daytime sleepiness, mostly it takes a long time to receive a definitive diagnosis of the disorder. This retrospective study investigated factors related to the period until definitive diagnosis among patients with narcolepsy in Japan.We enrolled 181 consecutive patients (108 men, 73 women; mean age 37.6 ± 16.6 years old; narcolepsy with cataplexy/narcolepsy without cataplexy = 131:50). Multivariate logistic regression analysis was performed with period until definitive diagnosis as the dependent variable and descriptive clinical variables as the independent variables.The mean period until receiving the diagnosis among the participants was 9.9 ± 10.1 years. More than half of the patients first learned about the disorder from information provided by the media. Multivariate logistic analysis indicated that adult onset (p < 0.01), onset in 1995 or later (p < 0.001), and first learning about the disorder from a sleep disorder specialist physician or a general practitioner (p < 0.001) were associated with a time taken for receiving a definitive diagnosis less than or equal to the median value (7 years).Improving access to information about the concept of the disorder and the medical institutions specialized in sleep disorders, especially via the Internet, would be necessary to promote early diagnosis of the disorder.
- Movement disorders: Tourette syndrome-beyond swearing and sex? [JOURNAL ARTICLE]
- Nat Rev Neurol 2013 Dec 3.
- A naturalistic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular haloperidol in agitated elderly patients with schizophrenia. [JOURNAL ARTICLE]
- Ther Adv Psychopharmacol 2013 Dec; 3(6):314-321.
This study was a comparative investigation of the clinical efficacy and safety of intramuscular (IM) olanzapine and IM haloperidol in agitated elderly patients with schizophrenia at 2 hours postdose.The subjects were 23 inpatients who had been diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Their clinical symptoms were assessed using Positive and Negative Syndrome Scale Excited Component (PANSS-EC), PANSS and Agitation Calmness Evaluation Scale (ACES), and their safety were assessed using the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) and laboratory tests.The mean reduction from baseline on the PANSS-EC total score, the PANSS total score and the ACES score were significantly greater in the IM olanzapine injection group than in the IM haloperidol injection group. The mean changes from baseline on the AIMS score, the BARS score and the DIEPSS total score were significantly better in the IM olanzapine injection group than in the IM haloperidol injection group. No serious adverse events such as paralytic ileus, diabetic ketoacidosis, neuroleptic malignant syndrome or tardive dyskinesia occurred between the two groups.The results of this study suggest the possibility that agitated elderly patients may result in superior efficacy and safety after IM olanzapine without serious adverse events in comparison with IM haloperidol.
- Resting state functional connectivity of the ventral attention network in children with a history of depression or anxiety. [Journal Article]
- J Am Acad Child Adolesc Psychiatry 2013 Dec; 52(12):1326-1336.e5.
We examined whether depression and anxiety disorders in early childhood were associated with changes in resting state functional connectivity (RSFC) of the ventral attention network (VAN), and whether RSFC in the VAN was associated with alterations in attention specific to these disorders. Important clinical features of these illnesses, including changes in attention toward novel stimuli and changes in attention to stimuli of negative valence (threat/sad bias), indirectly implicate the VAN.We collected resting state functional magnetic resonance imaging data in children aged 8 to 12 years. Data were volume censored to reduce artifact from submillimeter movement, resulting in analyzable data from 30 children with a history of depression and/or anxiety and 42 children with no psychiatric history. We compared pairwise RSFC among the following VAN regions: right ventro-lateral prefrontal cortex (VLPFC), right posterior superior temporal gyrus (pSTG), and right ventral supramarginal gyrus (vSMG). We also collected measures of threat bias and current clinical symptoms.Children with a history of depression and/or anxiety had reduced RSFC among the regions of the VAN compared to children with no psychiatric history. The magnitude of VAN RSFC was correlated with measures of attention bias toward threat but not with current depressive, internalizing, or externalizing symptoms. No RSFC changes were detected between groups among homotopic left hemisphere regions.Disruption in the VAN may be an early feature of depression and anxiety disorders. VAN changes were associated with attention bias and clinical history but not with current symptoms of depression and anxiety.
- Report on the 2nd International Consortium on Hallucination Research: Evolving Directions and Top-10 "hot spots" in Hallucination Research. [JOURNAL ARTICLE]
- Schizophr Bull 2013 Nov 26.
This article presents a report on the 2nd meeting of the International Consortium on Hallucination Research, held on September 12th and 13th 2013 at Durham University, UK. Twelve working groups involving specialists in each area presented their findings and sought to summarize the available knowledge, inconsistencies in the field, and ways to progress. The 12 working groups reported on the following domains of investigation: cortical organisation of hallucinations, nonclinical hallucinations, interdisciplinary approaches to phenomenology, culture and hallucinations, subtypes of auditory verbal hallucinations, a Psychotic Symptoms Rating Scale multisite study, visual hallucinations in the psychosis spectrum, hallucinations in children and adolescents, Research Domain Criteria behavioral constructs and hallucinations, new methods of assessment, psychological therapies, and the Hearing Voices Movement approach to understanding and working with voices. This report presents a summary of this meeting and outlines 10 hot spots for hallucination research, which include the in-depth examination of (1) the social determinants of hallucinations, (2) translation of basic neuroscience into targeted therapies, (3) different modalities of hallucination, (4) domain convergence in cross-diagnostic studies, (5) improved methods for assessing hallucinations in nonclinical samples, (6) using humanities and social science methodologies to recontextualize hallucinatory experiences, (7) developmental approaches to better understand hallucinations, (8) changing the memory or meaning of past trauma to help recovery, (9) hallucinations in the context of sleep and sleep disorders, and (10) subtypes of hallucinations in a therapeutic context.
- [Sleep disorders in older adults]. [English Abstract, Journal Article]
- Nihon Rinsho 2013 Oct; 71(10):1763-74.
Sleep is an essential physiological process with restorative functions. It is reported that the prevalence of chronic sleep-related complaints in older adults is over 50%, which is higher than that in younger adults. The etiology of sleep disorders in older adults is considered to be multifactorial, consisting of normal age-related changes(e.g., sleep fragmentation, earlier awakening, and decreased slow wave sleep), medical or psychiatric diseases (e.g., lifestyle-related diseases, dementia, delirium, and depression), primary age-related sleep disorders(e.g., sleep-related breathing disorders and periodic limb movement disorders), or a combination of these factors. Because sleep disorders in older adults may have implications for quality of life, it is crucial to distinguish normal age-related sleep changes from those originating from pathological processes. This mini-review discusses crucial points in the diagnosis and management of sleep disorders in older adults.