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Neuroleptic Side Effects: Acute Extrapyramidal Syndromes and Tardive Dyskinesia

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Psychopharmacology: Current Trends

Part of the book series: Psychopharmacology 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).

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References

  • Ayd FJ (1961) A survey of drug-induced extrapyramidal reactions. JAMA 175: 1054–1060

    Article  PubMed  CAS  Google Scholar 

  • Baker LA, Cheng LY, Amara IB (1983) The withdrawal of benztropine mesylate in chronic schizophrenic patients. Br J Psychiatry 143: 584–590

    Article  PubMed  CAS  Google Scholar 

  • 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 DC

    Google Scholar 

  • Bamrah JS, Kumar V, Krska J, Soni SD (1986) Interactions between procyclidine and neuroleptic drugs. Br J Psychiatry 149: 726–733

    Article  PubMed  CAS  Google Scholar 

  • Barnes TRE, Braude WM (1985) Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry 42: 874–878

    Article  PubMed  CAS  Google Scholar 

  • Barnes TRE, Kidger T, Gore SM (1983) Tardive dyskinesia: a 3-year follow-up study. Psychol Med 13: 71–81

    Article  PubMed  CAS  Google Scholar 

  • Bleuler E (1950) Dementia praecox or the group of schizophrenias. International Universities Press, New York, p 191

    Google Scholar 

  • Boyer WF, Bakalar NH, Lake CR (1987) Anticholinergic prophylaxis of acute haloperidol-induced dystonic reactions. J Clin Psychopharmacol 7:164–166

    PubMed  CAS  Google Scholar 

  • 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: 1335–1346

    PubMed  CAS  Google Scholar 

  • Casey DE (1981) The differential diagnosis of tardive dyskinesia. Acta Psychiat Scand 63 [Suppl 291): 71–87

    Article  Google Scholar 

  • 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 1–20

    Google Scholar 

  • Casey DE (1984b) Tardive dyskinesia — animal models. Psychopharmacol Bull 20: 376–379

    PubMed  CAS  Google Scholar 

  • 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 211–216

    Chapter  Google Scholar 

  • Casey DE (1985 b) Spontaneous and tardive dyskinesia: clinical and laboratory studies. J Clin Psychiatry 46(4): 42–47

    Google Scholar 

  • 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 88–97

    Chapter  Google Scholar 

  • 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 137–144

    Chapter  Google Scholar 

  • Casey DE ( 1987 a) Tardive dyskinesia. In: Meltzer H (ed) Psychopharmacology: The third generation of progress. Raven, New York, pp 1411–1419

    Google Scholar 

  • 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 243–247

    Google Scholar 

  • Casey DE, Denney D (1977) Pharmacological characterization of tardive dyskinesia. Psychopharmacology (Berlin) 54: 1–8

    Article  CAS  Google Scholar 

  • 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 183–203

    Google Scholar 

  • Casey DE, Hansen TE (1984) Spontaneous dyskinesias. In: Jeste DV, Wyatt RJ (eds) Neuropsychiatry movement disorders. American Psychiatric Press, Washington DC, pp 68–95

    Google Scholar 

  • Casey DE, Gerlach J, Christensson E (1980) Dopamine, acetylcholine, and GABA effects in acute dystonia in primates. Psychopharmacology (Berlin) 70: 83–87

    Article  CAS  Google Scholar 

  • 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: 250–253

    PubMed  CAS  Google Scholar 

  • Christensen AV, Fjalland B, Moller Nielsen I (1976) On the supersensitivity of dopamine receptors induced by neuroleptics. Psychopharmacology (Berlin) 48: 1–6

    Article  CAS  Google Scholar 

  • Clow A, Jenner P, Marsden CD (1979) Changes in dopamine-mediated behavior during one year’s neuroleptic administration. Eur J Pharmacol 57: 365–375

    Article  PubMed  CAS  Google Scholar 

  • Crane GE, Smeets RA (1974) Tardive dyskinesia and drug therapy in geriatric patients. Arch Gen Psychiatry 30: 341–343

    Article  PubMed  CAS  Google Scholar 

  • 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: 336–340

    Article  PubMed  CAS  Google Scholar 

  • Faurbye A, Rasch PJ, Bender Peterson P, Brandenborg G, Pakkenberg H (1964) Neurologic symptoms in the pharmacotherapy of psychoses. Acta Psychiatr Scand 40: 10–26

    Article  PubMed  CAS  Google Scholar 

  • 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: 199–201

    Article  CAS  Google Scholar 

  • 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 98–103

    Chapter  Google Scholar 

  • Gerlach J, Reisby N, Randrup A (1974) Dopaminergic hypersensitivity and cholinergic hypo- function in the pathophysiology of tardive dyskinesia. Psychopharmacologia (Berlin) 34: 21–35

    Article  CAS  Google Scholar 

  • 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 119–147

    Google Scholar 

  • Glassman RB, Glassman HN (1980) Oral dyskinesia in brain-damaged rats withdrawn from a neuroleptic: implication for models of tardive dyskinesia. Psychopharmacology (Berlin) 69: 19–25

    Article  CAS  Google Scholar 

  • Gunne LM, Barany S (1976) Haloperidol-induced tardive dyskinesia in monkeys. Psychopharmacology (Berlin) 50: 237–240

    Article  CAS  Google Scholar 

  • 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 191–193

    Chapter  Google Scholar 

  • Hansen LB, Larsen NE, Vestergard P (1981) Plasma levels of perphenazine ( Trilafon) related to development of extrapyramidal side effects. Psychopharmacology (Berlin) 74: 306–309

    Article  CAS  Google Scholar 

  • 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 2–14

    Google Scholar 

  • Jellinek T, Gardos G, Cole JO (1981) Adverse effects of antiparkinson drug withdrawal. Am J Psychiatry 138: 1567–1571

    PubMed  CAS  Google Scholar 

  • Jeste DV, Wyatt RJ (1982) Therapeutic strategies against tardive dyskinesia. Arch Gen Psychiatry 39: 803–816

    Article  PubMed  CAS  Google Scholar 

  • Jeste DV, Potkin SG, Sinha S, Feder S, Wyatt RJ (1979) Tardive dyskinesia — reversible and irreversible. Arch Gen Psychiatry 36: 585–590

    Article  PubMed  CAS  Google Scholar 

  • 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 15–32

    Google Scholar 

  • Kane JM, Smith JM (1982) Tardive dyskinesia: prevalence and risk factors, 1959 to 1979. Arch Gen Psychiatry 39: 473–481

    Article  PubMed  CAS  Google Scholar 

  • 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: 387–389

    Google Scholar 

  • 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 22–28

    Google Scholar 

  • 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 99–108

    Google Scholar 

  • 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 139–157

    Google Scholar 

  • Keepers GA, Clappison VJ, Casey DE (1983) Initial anticholinergic prophylaxis for neuroleptic- induced extrapyramidal syndromes. Arch Gen Psychiatry 40: 1113–1117

    Article  PubMed  CAS  Google Scholar 

  • Keepers GA, Hansen TE, Casey DE (1986) Prospective prediction of vulnerability to neuroleptic-induced extrapyramidal syndromes. Proc Soc Biol Psychiatry 170: 222

    Google Scholar 

  • Klawans HL, Rubovits R (1972) An experimental model of tardive dyskinesia. J Neural Transm 33: 235–246

    Article  PubMed  Google Scholar 

  • Kraepelin E (1907) Clinical psychiatry. MacMillan, New York, p 229

    Google Scholar 

  • Lipinski JF, Zubenko GS, Cohen BM, Barreira PJ (1984) Propranolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 141: 412–415

    PubMed  Google Scholar 

  • 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: 659–661

    Article  PubMed  CAS  Google Scholar 

  • 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: 114–116

    PubMed  CAS  Google Scholar 

  • McEvoy JP (1983) The clinical use of anticholinergic drugs as treatment for extrapyramidal side effects of neuroleptic disorders. J Clin Psychopharmacol 3: 288–302

    Article  PubMed  CAS  Google Scholar 

  • Mclnnis M, Petursson H (1985) Withdrawal of trihexyphenidyl. Acta Psychiatr Scand 71: 297–303

    Article  Google Scholar 

  • 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: 492–496

    PubMed  CAS  Google Scholar 

  • Orlov P, Kasparian G, DiMascio A, Cole JO (1971) Withdrawal of antipsychotic drugs. Arch Gen Psychiatry 25: 410–412

    Article  PubMed  CAS  Google Scholar 

  • Owens DGC, Johnstone EC, Frith CD (1982) Spontaneous involuntary disorders of movement. Arch Gen Psychiatry 39: 452–461

    Article  PubMed  CAS  Google Scholar 

  • Quitkin F, Rifkin A, Gochfeld L, Klein DF (1977) Tardive dyskinesia: are first signs reversible? Am J Psychiatry 134: 84–87

    PubMed  CAS  Google Scholar 

  • Rupniak NMJ, Jenner P, Marsden CD (1983) Cholinergic manipulation of perioral behavior induced by chronic neuroleptic administration to rats. Psychopharmacology (Berlin) 79: 226–230

    Article  CAS  Google Scholar 

  • Rupniak NMJ, Jenner P, Marsden CD (1986) Acute dystonia induced by neuroleptic drugs. Psychopharmacology (Berlin) 88: 403–419

    Article  CAS  Google Scholar 

  • Sayers AC, Burki HR, Ruch W, Asper H (1976) Anticholinergic properties of antipsychotic drugs and their relation to extrapyramidal side effects. Psychopharmacology (Berlin) 51: 15–22

    Article  CAS  Google Scholar 

  • Schelkunov EL (1967) Adrenergic effect of chronic administration of neuroleptics. Nature 214: 1210–1212

    Article  PubMed  CAS  Google Scholar 

  • Schönecker M (1957) Ein eigentümliches Syndrom im oralen Bereich bei Megaphen-Applikation. Nervenarzt 28: 35–36

    Google Scholar 

  • 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: 751–755

    CAS  Google Scholar 

  • Snyder S, Greenberg D, Yamamura H (1974) Antischizophrenic drugs and brain cholinergic receptors. Arch Gen Psychiatry 31: 58–61

    Article  PubMed  CAS  Google Scholar 

  • 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 1021–1032

    Google Scholar 

  • 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: 305–309

    PubMed  CAS  Google Scholar 

  • Tarsy D, Baldessarini RJ (1973) Pharmacologically induced behavioral supersensitivity to apomorphine. Nature 245: 262–263

    CAS  Google Scholar 

  • Toenniessen LM, Casey DE, McFarland BH (1985) Tardive dyskinesia in the aged. Arch Gen Psychiatry 42: 278–284

    Article  PubMed  CAS  Google Scholar 

  • Tune L, Coyle JT (1981) Acute extrapyramidal side effects: serum levels of neuroleptics. Psychopharmacology (Berlin) 75: 9–15

    Article  CAS  Google Scholar 

  • Uhrbrand L, Faurbye A (1960) Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine, and electroconvulsive therapy. Psychopharmacologia (Berlin) 1: 408–418

    Article  Google Scholar 

  • Ungerstedt U (1971) Post-synaptic supersensitivity after 6-hydroxydopamine-induced degeneration of the nigrostriatal dopamine system. Acta Physiol Scand 82 [Suppl] 367: 69–93

    CAS  Google Scholar 

  • Van Putten T, Mutalipassi LR, Malkin MD (1974) Phenothiazine-induced decompensation. Arch Gen Psychiatry 30: 102–105

    Article  PubMed  Google Scholar 

  • Villeneuve A (1972) The rabbit syndrome: a peculiar extrapyramidal reaction. Can Psychiatr Assoc J 17: 69–72

    Google Scholar 

  • 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: 530–532

    Article  PubMed  CAS  Google Scholar 

  • Winslow RS, Stillner V, Coons DJ, Robinson MW (1986) Prevention of acute dystonic reactions in patients beginning high-potency neuroleptics. Am J Psychiatry 143: 706–710

    PubMed  CAS  Google Scholar 

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© 1988 Springer-Verlag Berlin Heidelberg

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Casey, D.E., Keepers, G.A. (1988). Neuroleptic Side Effects: Acute Extrapyramidal Syndromes and Tardive Dyskinesia. In: Casey, D.E., Christensen, A.V. (eds) Psychopharmacology: Current Trends. Psychopharmacology Series, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73280-5_7

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  • DOI: https://doi.org/10.1007/978-3-642-73280-5_7

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