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Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII.
J Clin Psychiatry. 2017 Mar; 78(3):e279-e285.JC

Abstract

OBJECTIVE

To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI).

METHODS

We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D₂) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models.

RESULTS

There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D₂ affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D₂ affinity switch model), while starting a high D₂ affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D₂ affinity switch model).

CONCLUSIONS

The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D₂ affinity antipsychotic may reduce the severity of TD.

Authors+Show Affiliations

Innova, GGz Centraal, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands. c.l.mentzel@gmail.com. Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom.Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.Psychiatric Centre GGz Curaçao, Groot Kwartier, Curaçao.Parnassia Psychiatric Institute, The Hague, The Netherlands. Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Department of Epidemiology, Columbia University, New York, New York, USA.Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands. Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28199071

Citation

Mentzel, Charlotte L., et al. "Effect of Antipsychotic Type and Dose Changes On Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: the Curaçao Extrapyramidal Syndromes Study XII." The Journal of Clinical Psychiatry, vol. 78, no. 3, 2017, pp. e279-e285.
Mentzel CL, Bakker PR, van Os J, et al. Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII. J Clin Psychiatry. 2017;78(3):e279-e285.
Mentzel, C. L., Bakker, P. R., van Os, J., Drukker, M., Matroos, G. E., Hoek, H. W., Tijssen, M. A., & van Harten, P. N. (2017). Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII. The Journal of Clinical Psychiatry, 78(3), e279-e285. https://doi.org/10.4088/JCP.16m11049
Mentzel CL, et al. Effect of Antipsychotic Type and Dose Changes On Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: the Curaçao Extrapyramidal Syndromes Study XII. J Clin Psychiatry. 2017;78(3):e279-e285. PubMed PMID: 28199071.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII. AU - Mentzel,Charlotte L, AU - Bakker,P Roberto, AU - van Os,Jim, AU - Drukker,Marjan, AU - Matroos,Glenn E, AU - Hoek,Hans W, AU - Tijssen,Marina A J, AU - van Harten,Peter N, PY - 2016/07/01/received PY - 2017/01/03/accepted PY - 2017/2/16/pubmed PY - 2017/6/13/medline PY - 2017/2/16/entrez SP - e279 EP - e285 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 78 IS - 3 N2 - OBJECTIVE: To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). METHODS: We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D₂) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. RESULTS: There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D₂ affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D₂ affinity switch model), while starting a high D₂ affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D₂ affinity switch model). CONCLUSIONS: The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D₂ affinity antipsychotic may reduce the severity of TD. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/28199071/Effect_of_Antipsychotic_Type_and_Dose_Changes_on_Tardive_Dyskinesia_and_Parkinsonism_Severity_in_Patients_With_a_Serious_Mental_Illness:_The_Curaçao_Extrapyramidal_Syndromes_Study_XII_ L2 - http://www.psychiatrist.com/JCP/article/Pages/2017/v78n03/v78n0307.aspx DB - PRIME DP - Unbound Medicine ER -