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Incidence of tardive dyskinesia and tardive dystonia in African Caribbean patients on long-term antipsychotic treatment: the Curaçao extrapyramidal syndromes study V.
J Clin Psychiatry. 2006 Dec; 67(12):1920-7.JC

Abstract

OBJECTIVE

Tardive dyskinesia (TD) and tardive dystonia (TDt) syndromes represent severe side effects of first-generation antipsychotics (FGAs). Although second-generation antipsychotics (SGAs) confer a lower risk for tardive syndromes, many patients continue to use FGAs alone or in combination with SGAs. Some patients remain free of TD or TDt even after many years of antipsychotic treatment with predominantly FGAs. Do these patients remain at risk for TD or TDt and, consequently, should a switch to SGAs be considered? A longitudinal cohort study in patients on long-term antipsychotic treatment may answer this question.

METHOD

A 9-year cohort study (1992-2001) was conducted of the whole, mostly chronic, psychiatric inpatient population on the Caribbean island of Curaçao (N = 194). Almost all patients (95%) were of African Carribean origin. TD and TDt were assessed (1 baseline, 6 follow-ups) with the Abnormal Involuntary Movement Scale and the Fahn-Marsden rating scale, respectively. New cases of TD or TDt were diagnosed if they fulfilled the criteria at 2 successive follow-up visits.

RESULTS

In patients with a mean antipsychotic use of approximately 18 years, the yearly incidence rates of TD and TDt were 10.2% (95% CI = 7.7 to 13.5) and 0.7% (95% CI = 0.4 to 1.5), respectively. The severity of TD was strongly associated with the severity of TDt (beta = 0.08, 95% CI = 0.03 to 0.14) and vice versa (beta = 0.10, 95% CI = 0.03 to 0.16). TD severity was positively associated with age and akathisia but negatively associated with parkinsonism.

CONCLUSIONS

Patients who are free of TD after many years of antipsychotic treatment still have a considerable risk for TD. Switching to an SGA may be warranted. The risk for incident TDt in this group was very low.

Authors+Show Affiliations

Symfora Group Psychiatric Center, Amersfoort, The Netherlands. pn.van.harten@symfora.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17194270

Citation

van Harten, Peter N., et al. "Incidence of Tardive Dyskinesia and Tardive Dystonia in African Caribbean Patients On Long-term Antipsychotic Treatment: the Curaçao Extrapyramidal Syndromes Study V." The Journal of Clinical Psychiatry, vol. 67, no. 12, 2006, pp. 1920-7.
van Harten PN, Hoek HW, Matroos GE, et al. Incidence of tardive dyskinesia and tardive dystonia in African Caribbean patients on long-term antipsychotic treatment: the Curaçao extrapyramidal syndromes study V. J Clin Psychiatry. 2006;67(12):1920-7.
van Harten, P. N., Hoek, H. W., Matroos, G. E., & van Os, J. (2006). Incidence of tardive dyskinesia and tardive dystonia in African Caribbean patients on long-term antipsychotic treatment: the Curaçao extrapyramidal syndromes study V. The Journal of Clinical Psychiatry, 67(12), 1920-7.
van Harten PN, et al. Incidence of Tardive Dyskinesia and Tardive Dystonia in African Caribbean Patients On Long-term Antipsychotic Treatment: the Curaçao Extrapyramidal Syndromes Study V. J Clin Psychiatry. 2006;67(12):1920-7. PubMed PMID: 17194270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of tardive dyskinesia and tardive dystonia in African Caribbean patients on long-term antipsychotic treatment: the Curaçao extrapyramidal syndromes study V. AU - van Harten,Peter N, AU - Hoek,Hans W, AU - Matroos,Glenn E, AU - van Os,Jim, PY - 2006/12/30/pubmed PY - 2007/1/11/medline PY - 2006/12/30/entrez SP - 1920 EP - 7 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 67 IS - 12 N2 - OBJECTIVE: Tardive dyskinesia (TD) and tardive dystonia (TDt) syndromes represent severe side effects of first-generation antipsychotics (FGAs). Although second-generation antipsychotics (SGAs) confer a lower risk for tardive syndromes, many patients continue to use FGAs alone or in combination with SGAs. Some patients remain free of TD or TDt even after many years of antipsychotic treatment with predominantly FGAs. Do these patients remain at risk for TD or TDt and, consequently, should a switch to SGAs be considered? A longitudinal cohort study in patients on long-term antipsychotic treatment may answer this question. METHOD: A 9-year cohort study (1992-2001) was conducted of the whole, mostly chronic, psychiatric inpatient population on the Caribbean island of Curaçao (N = 194). Almost all patients (95%) were of African Carribean origin. TD and TDt were assessed (1 baseline, 6 follow-ups) with the Abnormal Involuntary Movement Scale and the Fahn-Marsden rating scale, respectively. New cases of TD or TDt were diagnosed if they fulfilled the criteria at 2 successive follow-up visits. RESULTS: In patients with a mean antipsychotic use of approximately 18 years, the yearly incidence rates of TD and TDt were 10.2% (95% CI = 7.7 to 13.5) and 0.7% (95% CI = 0.4 to 1.5), respectively. The severity of TD was strongly associated with the severity of TDt (beta = 0.08, 95% CI = 0.03 to 0.14) and vice versa (beta = 0.10, 95% CI = 0.03 to 0.16). TD severity was positively associated with age and akathisia but negatively associated with parkinsonism. CONCLUSIONS: Patients who are free of TD after many years of antipsychotic treatment still have a considerable risk for TD. Switching to an SGA may be warranted. The risk for incident TDt in this group was very low. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/17194270/Incidence_of_tardive_dyskinesia_and_tardive_dystonia_in_African_Caribbean_patients_on_long_term_antipsychotic_treatment:_the_Curaçao_extrapyramidal_syndromes_study_V_ L2 - http://www.psychiatrist.com/jcp/article/pages/2006/v67n12/v67n1212.aspx DB - PRIME DP - Unbound Medicine ER -