Neuroleptic Side Effects: Acute Extrapyramidal Syndromes and Tardive Dyskinesia

  • D. E. Casey
  • G. A. Keepers
Conference paper
Part of the Psychopharmacology Series book series (PSYCHOPHARM, volume 5)

Abstract

The neuroleptic-induced motor system side effects of acute extrapyramidal syndromes (EPS) and tardive dyskinesia (TD) are the major limitations of these drugs. Effective strategies for managing these problems are based on the clinical presentations, pathophysiological processes, and a complex interaction of patient and treatment variables. New concepts about the causes and long- term outcome of acute EPS and TD are emerging to challenge some of the commonly held views about these syndromes. The primary method of preventing undue side effects is to use the lowest effective dose of both neuroleptic and anti-EPS drugs. The pressing need is for novel compounds which treat schizophrenia and are free of the undesirable motor system effects (a nonneuroleptic neuroleptic).

Keywords

Dementia Morphine Propranolol Prolactin Haloperidol 

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References

  1. Ayd FJ (1961) A survey of drug-induced extrapyramidal reactions. JAMA 175: 1054–1060PubMedCrossRefGoogle Scholar
  2. Baker LA, Cheng LY, Amara IB (1983) The withdrawal of benztropine mesylate in chronic schizophrenic patients. Br J Psychiatry 143: 584–590PubMedCrossRefGoogle Scholar
  3. Baldessarini RJ, Cole JO, Davis JM, Gardos G, Preskorn SH, Simpson GM, Tarsy D (1980) Tardive dyskinesia: a task force report. American Psychiatric Press, Washington DCGoogle Scholar
  4. Bamrah JS, Kumar V, Krska J, Soni SD (1986) Interactions between procyclidine and neuroleptic drugs. Br J Psychiatry 149: 726–733PubMedCrossRefGoogle Scholar
  5. Barnes TRE, Braude WM (1985) Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry 42: 874–878PubMedCrossRefGoogle Scholar
  6. Barnes TRE, Kidger T, Gore SM (1983) Tardive dyskinesia: a 3-year follow-up study. Psychol Med 13: 71–81PubMedCrossRefGoogle Scholar
  7. Bleuler E (1950) Dementia praecox or the group of schizophrenias. International Universities Press, New York, p 191Google Scholar
  8. Boyer WF, Bakalar NH, Lake CR (1987) Anticholinergic prophylaxis of acute haloperidol-induced dystonic reactions. J Clin Psychopharmacol 7:164–166PubMedGoogle Scholar
  9. Burke RE, Fahn S, Jankovic J, Marsden CD, Lang AE, Gollomp S, Ilson J (1982) Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology 32: 1335–1346PubMedGoogle Scholar
  10. Casey DE (1981) The differential diagnosis of tardive dyskinesia. Acta Psychiat Scand 63 [Suppl 291): 71–87CrossRefGoogle Scholar
  11. Casey DE ( 1984 a) Tardive dyskinesia and affective disorders. In: Gardos G, Casey DE (eds) Tardive dyskinesia and affective disorders. American Psychiatric Press, Washington DC, pp 1–20Google Scholar
  12. Casey DE (1984b) Tardive dyskinesia — animal models. Psychopharmacol Bull 20: 376–379PubMedGoogle Scholar
  13. Casey DE ( 1985 a) Behavioral effects of long-term neuroleptic treatment in cebus monkeys. In: Casey DE, Chase T, Gerlach AV, Gerlach J (eds) Dyskinesia: research and treatment. Springer, Berlin Heidelberg New York, pp 211–216CrossRefGoogle Scholar
  14. Casey DE (1985 b) Spontaneous and tardive dyskinesia: clinical and laboratory studies. J Clin Psychiatry 46(4): 42–47Google Scholar
  15. Casey DE ( 1985 c) Tardive dyskinesia: reversible and irreversible. In: Casey DE, Chase T, Christensen AV, Gerlach J (eds) Dyskinesia: research and treatment. Springer, Berlin Heidelberg New York, pp 88–97CrossRefGoogle Scholar
  16. Casey DE ( 1985 d) Tardive dyskinesia: nondopaminergic treatment approaches. In: Casey DE, Chase T, Christensen AV, Gerlach J (eds) Dyskinesia: research and treatment. Springer, Berlin Heidelberg New York, pp 137–144CrossRefGoogle Scholar
  17. Casey DE ( 1987 a) Tardive dyskinesia. In: Meltzer H (ed) Psychopharmacology: The third generation of progress. Raven, New York, pp 1411–1419Google Scholar
  18. Casey DE ( 1987 b) Neuroleptic-induced parkinsonism increases with repeated treatment in monkeys. In: Dahl SG, Gram LF, Paul SM, Potter WZ (eds) Clinical pharmacology in psychiatry IV. Selectivity in psychotropic drug action — promise or problems. Springer, Berlin Heidelberg New York, pp 243–247Google Scholar
  19. Casey DE, Denney D (1977) Pharmacological characterization of tardive dyskinesia. Psychopharmacology (Berlin) 54: 1–8CrossRefGoogle Scholar
  20. Casey DE, Gerlach J (1984) Tardive dyskinesia. In: Stancer HC, Garfinkel PE, Rakoff VM (eds) Guidelines for the use of psychotropic drugs: a clinical handbook. Spectrum, Jamaica, NY, pp 183–203Google Scholar
  21. Casey DE, Hansen TE (1984) Spontaneous dyskinesias. In: Jeste DV, Wyatt RJ (eds) Neuropsychiatry movement disorders. American Psychiatric Press, Washington DC, pp 68–95Google Scholar
  22. Casey DE, Gerlach J, Christensson E (1980) Dopamine, acetylcholine, and GABA effects in acute dystonia in primates. Psychopharmacology (Berlin) 70: 83–87CrossRefGoogle Scholar
  23. Casey DE, Povlsen UJ, Meidahl B, Gerlach J (1986) Neuroleptic-induced tardive dyskinesia and parkinsonism: changes during several years of continuing treatment. Psychopharmacol Bull 22: 250–253PubMedGoogle Scholar
  24. Christensen AV, Fjalland B, Moller Nielsen I (1976) On the supersensitivity of dopamine receptors induced by neuroleptics. Psychopharmacology (Berlin) 48: 1–6CrossRefGoogle Scholar
  25. Clow A, Jenner P, Marsden CD (1979) Changes in dopamine-mediated behavior during one year’s neuroleptic administration. Eur J Pharmacol 57: 365–375PubMedCrossRefGoogle Scholar
  26. Crane GE, Smeets RA (1974) Tardive dyskinesia and drug therapy in geriatric patients. Arch Gen Psychiatry 30: 341–343PubMedCrossRefGoogle Scholar
  27. Crow TJ, Cross AJ, Johnstone EC, Owen F, Owens DG, Waddington JL (1982) Abnormal involuntary movements in schizophrenia: are they related to the disease process or its treatment? Are they associated with changes in dopamine receptors? J Clin Psychopharmacol 2: 336–340PubMedCrossRefGoogle Scholar
  28. Faurbye A, Rasch PJ, Bender Peterson P, Brandenborg G, Pakkenberg H (1964) Neurologic symptoms in the pharmacotherapy of psychoses. Acta Psychiatr Scand 40: 10–26PubMedCrossRefGoogle Scholar
  29. Garver DL, Davis JM, Dekirmenjian H, Ericksen S, Gosengeld L, Haraszti J (1976) Dystonic reactions following neuroleptics: time course and proposed mechanisms. Psychopharmacology (Berlin) 47: 199–201CrossRefGoogle Scholar
  30. Gerlach J (1985) Pathophysiological mechanisms underlying tardive dyskinesia. In: Casey DE, Chase T, Christensen AV, Gerlach J (eds) Dyskinesia: research and treatment. Springer, Berlin Heidelberg New York, pp 98–103CrossRefGoogle Scholar
  31. Gerlach J, Reisby N, Randrup A (1974) Dopaminergic hypersensitivity and cholinergic hypo- function in the pathophysiology of tardive dyskinesia. Psychopharmacologia (Berlin) 34: 21–35CrossRefGoogle Scholar
  32. Gerlach J, Casey DE, Korsgaard S (1986) Tardive dyskinesia: epidemiology, pathophysiology, and pharmacology. In: Shah NS, Donald AG (eds) Movement disorders. Plenum, New York, pp 119–147Google Scholar
  33. Glassman RB, Glassman HN (1980) Oral dyskinesia in brain-damaged rats withdrawn from a neuroleptic: implication for models of tardive dyskinesia. Psychopharmacology (Berlin) 69: 19–25CrossRefGoogle Scholar
  34. Gunne LM, Barany S (1976) Haloperidol-induced tardive dyskinesia in monkeys. Psychopharmacology (Berlin) 50: 237–240CrossRefGoogle Scholar
  35. Gunne LM, Häggström JE (1985) Pathophysiology of tardive dyskinesia. In: Casey DE, Chase T, Christensen AV, Gerlach J (eds) Dyskinesia: research and treatment. Springer, Berlin Heidelberg New York, pp 191–193CrossRefGoogle Scholar
  36. Hansen LB, Larsen NE, Vestergard P (1981) Plasma levels of perphenazine ( Trilafon) related to development of extrapyramidal side effects. Psychopharmacology (Berlin) 74: 306–309CrossRefGoogle Scholar
  37. Hansen TE, Casey DE, Vollmer W (1986) Is there an epidemic of tardive dyskinesia? In: Casey DE, Gardos G (eds) Tardive dyskinesia and neuroleptics: from dogma to reason. American Psychiatric Press, Washington DC, pp 2–14Google Scholar
  38. Jellinek T, Gardos G, Cole JO (1981) Adverse effects of antiparkinson drug withdrawal. Am J Psychiatry 138: 1567–1571PubMedGoogle Scholar
  39. Jeste DV, Wyatt RJ (1982) Therapeutic strategies against tardive dyskinesia. Arch Gen Psychiatry 39: 803–816PubMedCrossRefGoogle Scholar
  40. Jeste DV, Potkin SG, Sinha S, Feder S, Wyatt RJ (1979) Tardive dyskinesia — reversible and irreversible. Arch Gen Psychiatry 36: 585–590PubMedCrossRefGoogle Scholar
  41. Jeste DV, Lohr JB, Kaufmann CA, Wyatt RJ (1986) Pathophysiology of tardive dyskinesia: evaluation of supersensitivity theory and alternative hypotheses. In: Casey DE, Gardos G (eds) Tardive dyskinesia and neuroleptics: from dogma to reason. American Psychiatric Press, Washington DC, pp 15–32Google Scholar
  42. Kane JM, Smith JM (1982) Tardive dyskinesia: prevalence and risk factors, 1959 to 1979. Arch Gen Psychiatry 39: 473–481PubMedCrossRefGoogle Scholar
  43. Kane JM, Woerner M, Weinhold P, Wegner J, Kinon B, Borenstein M (1984 a) Incidence of tardive dyskinesia: five-year data from a prospective study. Psychopharmacol Bull 20: 387–389Google Scholar
  44. Kane JM, Woerner M, Weinhold P, Kinon B, Lieberman J, Borenstein M ( 1984 b) Incidence and severity of tardive dyskinesia in affective illness. In: Gardos G, Casey DE (eds) Tardive dyskinesia and affective illness. American Psychiatric Press, Washington DC, pp 22–28Google Scholar
  45. Kane JM, Woerner M, Sarantakos S, Kinon B, Lieberman J (1986) Do low-dose neuroleptics prevent or ameliorate tardive dyskinesia? In: Casey DE, Gardos G (eds) Tardive dyskinesia and neuroleptics: from dogma to reason. American Psychiatric Press, Washington DC, pp 99–108Google Scholar
  46. Keepers GA, Casey DE (1986) Clinical management of acute neuroleptic-induced extrapyramidal syndromes. In: Masserman JH (ed) Current psychiatric therapies. Grune and Stratton, New York, pp 139–157Google Scholar
  47. Keepers GA, Clappison VJ, Casey DE (1983) Initial anticholinergic prophylaxis for neuroleptic- induced extrapyramidal syndromes. Arch Gen Psychiatry 40: 1113–1117PubMedCrossRefGoogle Scholar
  48. Keepers GA, Hansen TE, Casey DE (1986) Prospective prediction of vulnerability to neuroleptic-induced extrapyramidal syndromes. Proc Soc Biol Psychiatry 170: 222Google Scholar
  49. Klawans HL, Rubovits R (1972) An experimental model of tardive dyskinesia. J Neural Transm 33: 235–246PubMedCrossRefGoogle Scholar
  50. Kraepelin E (1907) Clinical psychiatry. MacMillan, New York, p 229Google Scholar
  51. Lipinski JF, Zubenko GS, Cohen BM, Barreira PJ (1984) Propranolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 141: 412–415PubMedGoogle Scholar
  52. Manos N, Gkiouzepas J, Tzotzoras T, Tzanetoglou A (1981) Gradual withdrawal of antiparkinson medication in chronic schizophrenics: any better than the abrupt? J Nerv Ment Dis 169: 659–661PubMedCrossRefGoogle Scholar
  53. Manos N, Lavrentiadis G, Gkiouzepas J (1986) Evaluation of the need for prophylactic antiparkinsonian medication in psychotic patients treated with neuroleptics. J Clin Psychiatry 47: 114–116PubMedGoogle Scholar
  54. McEvoy JP (1983) The clinical use of anticholinergic drugs as treatment for extrapyramidal side effects of neuroleptic disorders. J Clin Psychopharmacol 3: 288–302PubMedCrossRefGoogle Scholar
  55. Mclnnis M, Petursson H (1985) Withdrawal of trihexyphenidyl. Acta Psychiatr Scand 71: 297–303CrossRefGoogle Scholar
  56. Moleman P, Schmitz PJM, Ladee GA (1982) Extrapyramidal side effects and oral haloperidol: an analysis of explanatory patient and treatment characteristics. J Clin Psychiatry 43: 492–496PubMedGoogle Scholar
  57. Orlov P, Kasparian G, DiMascio A, Cole JO (1971) Withdrawal of antipsychotic drugs. Arch Gen Psychiatry 25: 410–412PubMedCrossRefGoogle Scholar
  58. Owens DGC, Johnstone EC, Frith CD (1982) Spontaneous involuntary disorders of movement. Arch Gen Psychiatry 39: 452–461PubMedCrossRefGoogle Scholar
  59. Quitkin F, Rifkin A, Gochfeld L, Klein DF (1977) Tardive dyskinesia: are first signs reversible? Am J Psychiatry 134: 84–87PubMedGoogle Scholar
  60. Rupniak NMJ, Jenner P, Marsden CD (1983) Cholinergic manipulation of perioral behavior induced by chronic neuroleptic administration to rats. Psychopharmacology (Berlin) 79: 226–230CrossRefGoogle Scholar
  61. Rupniak NMJ, Jenner P, Marsden CD (1986) Acute dystonia induced by neuroleptic drugs. Psychopharmacology (Berlin) 88: 403–419CrossRefGoogle Scholar
  62. Sayers AC, Burki HR, Ruch W, Asper H (1976) Anticholinergic properties of antipsychotic drugs and their relation to extrapyramidal side effects. Psychopharmacology (Berlin) 51: 15–22CrossRefGoogle Scholar
  63. Schelkunov EL (1967) Adrenergic effect of chronic administration of neuroleptics. Nature 214: 1210–1212PubMedCrossRefGoogle Scholar
  64. Schönecker M (1957) Ein eigentümliches Syndrom im oralen Bereich bei Megaphen-Applikation. Nervenarzt 28: 35–36Google Scholar
  65. Sigwald J, Bouttier D, Raymondeaud C (1959) Quatre cas de dyskinesie facio-bucco-linguo-ma- sticatrice à l’évolution prolongée secondaire à un traitement par les neuroleptiques. Rev Neurol (Paris) 100: 751–755Google Scholar
  66. Snyder S, Greenberg D, Yamamura H (1974) Antischizophrenic drugs and brain cholinergic receptors. Arch Gen Psychiatry 31: 58–61PubMedCrossRefGoogle Scholar
  67. Sovner R, DiMascio (1978) Extrapyramidal syndromes and other neurological side effects of psychotropic drugs. In: Lipton MA, DiMascio A, Killam DK (eds) Psychopharmacology: a generation of progress. Raven, New York, pp 1021–1032Google Scholar
  68. Sramek JJ, Simpson GM, Morrison RL, Heiser JF (1986) Anticholinergic agents for prophylaxis of neuroleptic-induced dystonic reactions: a prospective study. J Clin Psychiatry 47: 305–309PubMedGoogle Scholar
  69. Tarsy D, Baldessarini RJ (1973) Pharmacologically induced behavioral supersensitivity to apomorphine. Nature 245: 262–263Google Scholar
  70. Toenniessen LM, Casey DE, McFarland BH (1985) Tardive dyskinesia in the aged. Arch Gen Psychiatry 42: 278–284PubMedCrossRefGoogle Scholar
  71. Tune L, Coyle JT (1981) Acute extrapyramidal side effects: serum levels of neuroleptics. Psychopharmacology (Berlin) 75: 9–15CrossRefGoogle Scholar
  72. Uhrbrand L, Faurbye A (1960) Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine, and electroconvulsive therapy. Psychopharmacologia (Berlin) 1: 408–418CrossRefGoogle Scholar
  73. Ungerstedt U (1971) Post-synaptic supersensitivity after 6-hydroxydopamine-induced degeneration of the nigrostriatal dopamine system. Acta Physiol Scand 82 [Suppl] 367: 69–93Google Scholar
  74. Van Putten T, Mutalipassi LR, Malkin MD (1974) Phenothiazine-induced decompensation. Arch Gen Psychiatry 30: 102–105PubMedCrossRefGoogle Scholar
  75. Villeneuve A (1972) The rabbit syndrome: a peculiar extrapyramidal reaction. Can Psychiatr Assoc J 17: 69–72Google Scholar
  76. Waddington JL, Cross AJ, Gamble SJ, Bourne RC (1983) Spontaneous orofacial dyskinesia and dopaminergic function in rats after 6 months of neuroleptic treatment. Science 220: 530–532PubMedCrossRefGoogle Scholar
  77. Winslow RS, Stillner V, Coons DJ, Robinson MW (1986) Prevention of acute dystonic reactions in patients beginning high-potency neuroleptics. Am J Psychiatry 143: 706–710PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • D. E. Casey
    • 1
    • 2
    • 3
    • 4
  • G. A. Keepers
    • 1
    • 5
  1. 1.Psychiatry ServiceVA Medical CenterUSA
  2. 2.Department of PsychiatryOregon Health Sciences UniversityPortlandUSA
  3. 3.Department of NeurologyOregon Health Sciences UniversityPortlandUSA
  4. 4.Department of Animal BehaviorOregon Regional Primate Research CenterBeavertonUSA
  5. 5.Department of PsychiatryOregon Health Sciences UniversityPortlandUSA

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