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Morgan M, Aubry RE, Kilbride K. Improving the clinical monitoring of extrapyramidal symptoms: a local quality improvement project. Ir J Med Sci 2024; 193:875-880. [PMID: 37805958 DOI: 10.1007/s11845-023-03539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Extrapyramidal symptoms (EPS) can cause significant morbidity and impact negatively on patients' quality of life. Clinical guidelines provide recommendations regarding screening frequency and the use of structured tools to ensure adequate monitoring of EPS. Despite this, the literature indicates that the documentation and monitoring of EPS remain suboptimal. AIMS To devise an intervention that would lead to the improvement in the documentation and hence monitoring of EPS. METHODS An initial paper chart survey was conducted to assess the current extent of documentation and monitoring of EPS carried out in patient files of three distinct settings in our Mental Health Service (MHS): inpatient, rehabilitation, and assertive outreach. An intervention aimed at improving practice was subsequently designed and implemented. This involved adoption by the MHS of a new EPS monitoring tool and delivery of an educational session regarding its use. The extent of documentation and monitoring of EPS was re-surveyed post-intervention. RESULTS Initially, only 14.8% of inpatient records contained evidence of EPS documentation while no evidence at all was found across the other two MHS settings. Following the intervention, there was evidence of guideline concordant EPS monitoring using a structured tool in the clinical records of 75% of inpatients, 79.6% in the rehabilitation setting, and 18% in the assertive outreach programme. CONCLUSION Documentation of EPS monitoring improved significantly across several settings affiliated with a Dublin North City MHS following the systematic adoption of the Extrapyramidal Symptom Scale (EPSS) and clinician education regarding its use.
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Affiliation(s)
- Micheal Morgan
- South Louth CAMHS, St. Mary's Hospital Campus, Dublin Road, Drogheda, Co. Louth, Ireland.
| | | | - Kevin Kilbride
- Program for the Homeless MHS, Usher's Island Day Hospital, Dublin 8, Ireland
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Chouinard G, Cosci F, Chouinard VA, Alphs L. The Extrapyramidal Symptom Rating Scale and Its Abbreviated Version: A Critical Review of Clinimetric Properties. Psychother Psychosom 2023; 92:359-366. [PMID: 38061344 DOI: 10.1159/000535113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/07/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND The Extrapyramidal Symptom Rating Scale - Abbreviated (ESRS-A) is an abbreviated version of the Extrapyramidal Symptom Rating Scale (ESRS) with instructions, definitions, and a semi-structured interview that follows clinimetric concepts of measuring clinical symptoms. Similar to the ESRS, the ESRS-A was developed to assess four types of drug-induced movement disorders (DIMD): parkinsonism, akathisia, dystonia, and tardive dyskinesia (TD). SUMMARY The present review of the literature provides the most relevant clinimetric properties displayed by the ESRS and ESRS-A in clinical studies. Comprehensive ESRS-A definitions, official scale, and basic instructions are provided. ESRS inter-rater reliability was evaluated in two pivotal studies and in multicenter international studies. Inter-rater reliability was high for assessing both antipsychotic-induced movement disorders and idiopathic Parkinson's disease. Guidelines were also established for inter-rater reliability and the rater certification processes. The ESRS showed good concurrent validity with 96% agreement between Abnormal Involuntary Movement Scale (AIMS) for TD-defined cases and ESRS-defined cases. Similarly, concurrent validity for ESRS-A total and subscores for parkinsonism, akathisia, dystonia, and dyskinesia ranged from good to very good. The ESRS was particularly sensitive for detecting DIMD-related movement differences following treatment with placebo, antipsychotics, and antiparkinsonian and antidyskinetic medications. ESRS measurement of drug-induced extrapyramidal symptoms was shown to discriminate extrapyramidal symptoms from psychiatric symptoms. KEY MESSAGES The ESRS and ESRS-A are valid clinimetric indices for measuring DIMD. They can be valuably implemented in clinical research, particularly in trials testing antipsychotic medications, and in clinics to detect the presence, severity, and response to treatment of movement disorders.
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Affiliation(s)
- Guy Chouinard
- University Mental Health Institute of Montreal, University of Montreal, Montreal, Québec, Canada
- Clinical Pharmacology and Toxicology Program, Royal College of Physicians and Surgeons, McGill University, Montreal, Québec, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
- International Lab of Clinical Measurements, University of Florence, Florence, Italy
| | - Virginie-Anne Chouinard
- Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Larry Alphs
- Larry Alphs Consulting, Princeton, New Jersey, USA
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Kong CH, Cho K, Min JW, Kim JY, Park K, Kim DY, Jeon M, Kang WC, Jung SY, Lee JY, Ryu JH. Oleanolic acid alleviates the extrapyramidal symptoms and cognitive impairment induced by haloperidol through the striatal PKA signaling pathway in mice. Biomed Pharmacother 2023; 168:115639. [PMID: 37812895 DOI: 10.1016/j.biopha.2023.115639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
Haloperidol, one of the representative typical antipsychotics, is on the market for schizophrenia but shows severe adverse effects such as extrapyramidal symptoms (EPS) or cognitive impairments. Oleanolic acid (OA) is known to be effective for tardive dyskinesia which is induced by long-term treatment with L-DOPA. This study aimed to investigate whether OA could ameliorate EPS or cognitive impairment induced by haloperidol. The balance beam, catalepsy response, rotarod and vacuous chewing movement (VCM) tests were performed to measure EPS and the novel object recognition test was used to estimate haloperidol-induced cognitive impairment. Levels of dopamine and acetylcholine, the phosphorylation levels of c-AMP-dependent protein kinase A (PKA) and its downstream signaling molecules were measured in the striatum. OA significantly attenuated EPS and cognitive impairment induced by haloperidol without affecting its antipsychotic properties. Valbenazine only ameliorated VCM. Also, OA normalised the levels of dopamine and acetylcholine in the striatum which were increased by haloperidol. Furthermore, the increased phosphorylated PKA, extracellular signal-regulated kinase (ERK) and cAMP response element-binding protein (CREB) levels and c-FOS expression level induced by haloperidol were significantly decreased by OA in the striatum. In addition, cataleptic behaviour of haloperidol was reversed by sub-effective dose of H-89 with OA. These results suggest that OA can alleviate EPS and cognitive impairment induced by antipsychotics without interfering with antipsychotic properties via regulating neurotransmitter levels and the PKA signaling pathway in the striatum. Therefore, OA is a potential candidate for treating EPS and cognitive impairment induced by antipsychotics.
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Affiliation(s)
- Chang Hyeon Kong
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kyungnam Cho
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Ji Won Min
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jae Youn Kim
- Department of Integrated Drug Development and Natural Products, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Keontae Park
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Do Yeon Kim
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Mijin Jeon
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Woo Chang Kang
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seo Yun Jung
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jae Yeol Lee
- Department of Chemistry, College of Sciences, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Jong Hoon Ryu
- Department of Biomedical and Pharmaceutical Sciences, Kyung Hee University, Seoul 02447, Republic of Korea; Department of Oriental Pharmaceutical Science, Kyung Hee University, Seoul 02447, Republic of Korea.
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Wu H, Siafis S, Wang D, Burschinski A, Schneider-Thoma J, Priller J, Davis JM, Leucht S. Antipsychotic-induced akathisia in adults with acute schizophrenia: A systematic review and dose-response meta-analysis. Eur Neuropsychopharmacol 2023; 72:40-49. [PMID: 37075639 DOI: 10.1016/j.euroneuro.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
Antipsychotic-induced akathisia is severely distressing. We aimed to investigate relationships between antipsychotic doses and akathisia risk. We searched for randomised controlled trials that investigated monotherapy of 17 antipsychotics in adults with acute schizophrenia until 06 March 2022. The primary outcome was the number of participants with akathisia, which was analysed with odds ratios (ORs). We applied one-stage random-effects dose-response meta-analyses using restricted cubic splines to model the dose-response relationships. We included 98 studies (343 dose arms, 34,225 participants), most of which were short-term and had low-to-moderate risk of bias. We obtained data on all antipsychotics except clozapine and zotepine. In patients with acute exacerbations of chronic schizophrenia, from moderate to high certainty of evidence, our analysis showed that sertindole and quetiapine carried negligible risks for akathisia across examined doses (flat curves), while most of the other antipsychotics had their risks increase initially with increasing doses and then either plateaued (hyperbolic curves) or continued to rise (monotonic curves), with maximum ORs ranging from 1.76 with 95% Confidence Intervals [1.24, 2.52] for risperidone at 5.4 mg/day to OR 11.92 [5.18, 27.43] for lurasidone at 240 mg/day. We found limited or no data on akathisia risk in patients with predominant negative symptoms, first-episode schizophrenia, or elderly patients. In conclusion, liability of akathisia varies between antipsychotics and is dose-related. The dose-response curves for akathisia in most antipsychotics are either monotonic or hyperbolic, indicating that higher doses carry a greater or equal risk compared to lower doses.
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Affiliation(s)
- Hui Wu
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dongfang Wang
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Angelika Burschinski
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Josef Priller
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany; University of Edinburgh and UK Dementia Research Institute, Edinburgh, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Neuropsychiatrie, Charité Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases, Berlin, Germany
| | - John M Davis
- Psychiatric Institute, University of Illinois at Chicago, Chicago, IL, USA; Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany; Institute of Psychiatry, Psychology and Neuroscience, Department of Psychiatry, Department of Psychosis Studies, King's College London, London, UK
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Biedermann F, Kurzthaler I, Haibach M, Pardeller S, Pichler T, Kemmler G, Holzner B, Hofer A. Driving fitness in clinically stable outpatients with chronic schizophrenia. Compr Psychiatry 2022; 118:152340. [PMID: 35868158 DOI: 10.1016/j.comppsych.2022.152340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Driving motorized vehicles is an integral part of individual mobility and a key parameter for employment and social integration. This naturalistic, cross-sectional study investigated the associations between driving fitness, residual symptomatology, olanzapine equivalent, and extrapyramidal symptoms (EPS) in long term stable outpatients with schizophrenia. METHODS Beside sociodemographic data, and driving habits, residual symptoms, and EPS were assessed using the Positive and Negative Syndrome Scale (PANSS), and the Modified Simpson Angus Scale (MSAS). PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. MSAS cut-off scores ≥3 were defined as positive for EPS. Driving skills were assessed using the Vienna Test System and an expert evaluation. RESULTS 50 patients were included into the study. Mean PANSS total scores indicated mild residual symptomatology and EPS were not present in 48% of study participants. 44% passed the driving fitness assessment and were considered as competent to drive, 20% were judged to be partially competent and 36% to be incompetent to drive. With the exception of disorganization (r = -0·287, p = 0·048) residual symptoms of schizophrenia did not correlate with driving fitness. However, moderate negative correlations were detected between driving fitness and the severity of EPS (r = -0·554, p = 0·000), age (r = -0·413, p = 0·003) as well as olanzapine equivalent doses (r = -0·432, p = 0·002). These results were not corrected for multiple comparison. DISCUSSION The present findings indicate that up to two thirds of clinically stable outpatients with chronic schizophrenia may be (partially) competent to drive. Both the presence of EPS as well as the dosage of antipsychotic medication seem to be of particular relevance in this regard.
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Affiliation(s)
- Falko Biedermann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria.
| | - Ilsemarie Kurzthaler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Maria Haibach
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Theresia Pichler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Bernhard Holzner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
| | - Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Division of Psychiatry I, Austria
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Diab E, Morin G, Hery L, Barbier V, Cottin G, Jobic F, Tir M. Catatonic syndrome and Baraitser Winter syndrome: Case report and review of the literature. Eur J Med Genet 2022; 65:104559. [PMID: 35803559 DOI: 10.1016/j.ejmg.2022.104559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/22/2022] [Accepted: 07/03/2022] [Indexed: 11/15/2022]
Affiliation(s)
- E Diab
- Department of Neurology, CHU Amiens Picardie, France.
| | - G Morin
- Department of Clinical Genetic, CHU Amiens Picardie, France
| | - L Hery
- Department of Pediatric Neurology, CHU Amiens Picardie, France
| | - V Barbier
- Department of Physical and Rehabilitation Medicine, CHU Amiens Picardie, France
| | - G Cottin
- Department of Psychiatry, CHU Amiens Picardie, France
| | - F Jobic
- Department of Clinical Genetic, CHU Amiens Picardie, France
| | - M Tir
- Department of Neurology, CHU Amiens Picardie, France
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Ohi K, Takai K, Kuramitsu A, Sugiyama S, Shioiri T. Switching from blonanserin oral tablets/powders to transdermal patches alleviates extrapyramidal symptoms in patients with schizophrenia: A 52-week open-label study. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110470. [PMID: 34740708 DOI: 10.1016/j.pnpbp.2021.110470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022]
Abstract
Blonanserin is a second-generation antipsychotic for the treatment of schizophrenia. Blonanserin has two different routes of administration: oral tablets/powder and transdermal patches. The aim of this study was to investigate as a post-hoc analysis of an original study whether switching from blonanserin tablets/powders to transdermal patches would reduce extrapyramidal symptoms (EPS) and/or the dose of antiparkinsonian drugs for the stabilization of blood pharmacokinetics in patients with schizophrenia. Patients with schizophrenia (n = 155) were enrolled in either cohort 1 or 2. In cohort 1 (n = 97), patients received 40-80 mg/day blonanserin transdermal patches for one year after taking 8-16 mg/day blonanserin tablets for 6 weeks, and the dose of patches was determined based on the dose of the tablets. In cohort 2 (n = 58), all patients started with 40 mg/day blonanserin patches and then received 40-80 mg/day for a year after taking blonanserin tablets/powders. Changes from the start of transdermal patch treatment in EPS and the dose of antiparkinsonian drugs at 3, 6, and 12 months were assessed using the Drug-Induced EPS Scale (DIEPSS) and biperiden equivalents of total antiparkinsonian drugs (BPD-eq), respectively. Among 155 patients, only four patients in cohort 1 discontinued owing to EPS during a patch period. Significant improvements from the start of patch treatment in the DIEPSS total score at any point were observed (mean change±SD): -0.44 ± 1.50 (p = 0.013), -0.07 ± 1.78 (p = 0.73), and - 0.14 ± 1.37 (p = 0.44) in cohort 1 and - 0.16 ± 1.32 (p = 0.40), -0.74 ± 1.92 (p = 0.020), and - 0.81 ± 2.22 (p = 0.047) in cohort 2 at 3, 6, and 12 months, respectively. In contrast, there were no significant changes from the start of patch treatment in BPD-eq at any month (p > 0.05). Transdermal patches of blonanserin are a more effective route of administration to diminish EPS than oral tablets/powder.
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Affiliation(s)
- Kazutaka Ohi
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan; Department of General Internal Medicine, Kanazawa Medical University, Ishikawa, Japan.
| | - Kentaro Takai
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ayumi Kuramitsu
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shunsuke Sugiyama
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiki Shioiri
- Department of Psychiatry, Gifu University Graduate School of Medicine, Gifu, Japan
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Seetharam JC, Maiti R, Mishra A, Mishra BR. Efficacy and safety of add-on sodium benzoate, a D-amino acid oxidase inhibitor, in treatment of schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2022; 68:102947. [PMID: 34890931 DOI: 10.1016/j.ajp.2021.102947] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of sodium benzoate, an NMDA receptor enhancer, in schizophrenia has been evaluated in a few clinical trials, but results are contradictory and inconclusive. The present meta-analysis has evaluated the efficacy and safety of add-on sodium benzoate for the treatment of schizophrenia. METHODS After performing a literature search on MEDLINE/PubMed, Scopus, Cochrane databases and International Clinical Trial Registry Platform, reviewers assessed eligibility and extracted data from four relevant articles. PRISMA guidelines were followed in the selection, analysis, and reporting of findings. The random-effect model was used to estimate effect size. Quality assessment was done using the risk of bias assessment tool, and sensitivity analysis was done in case of high heterogeneity. RESULTS Add-on sodium benzoate can improve positive symptoms of schizophrenia significantly (MD: -1.87; 95%CI: -3.25 to -0.48; p = 0.008) but had no significant favourable effect on negative symptoms (p = 0.84), general psychopathology (p = 0.49), and total PANSS score (p = 0.19) over the control. There was no significant improvement in GAF (p = 0.43), CGI (p = 0.58), cognitive function (p = 0.46) and quality of life (p = 0.73). Extrapyramidal symptoms were significantly higher (MD: 0.39; 95% CI:0.19-0.60; p = 0.0002) in the sodium benzoate group in comparison to the control group; however, there was no significant difference in respect to other adverse events. CONCLUSION Sodium benzoate can improve the positive symptoms of schizophrenia without any beneficial effect on other symptomatology, cognition, quality of life and functioning. Further studies are needed to evaluate long-term efficacy, safety and use in specific subgroups of patients.
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Affiliation(s)
| | - Rituparna Maiti
- Department of Pharmacology All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
| | - Archana Mishra
- Department of Pharmacology All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Biswa Ranjan Mishra
- Department of Psychiatry All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
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Monteleone P, Cascino G, Monteleone AM, Rocca P, Rossi A, Bertolino A, Aguglia E, Amore M, Collantoni E, Corrivetti G, Cuomo A, Bellomo A, D'Ambrosio E, Dell'Osso L, Frascarelli M, Giordano GM, Giuliani L, Marchesi C, Montemagni C, Oldani L, Pinna F, Pompili M, Roncone R, Rossi R, Siracusano A, Vita A, Zeppegno P, Galderisi S, Maj M. Prevalence of antipsychotic-induced extrapyramidal symptoms and their association with neurocognition and social cognition in outpatients with schizophrenia in the "real-life". Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110250. [PMID: 33484755 DOI: 10.1016/j.pnpbp.2021.110250] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
First generation antipsychotics (FGAs) are more likely to induce extrapyramidal side-effects (EPS) than second generation antipsychotics (SGAs), and EPS have been shown associated to cognitive deficits in schizophrenia. So far, no study has explored the relationships between EPS and social cognition (SC) in people with schizophrenia. Therefore, we assessed the prevalence of EPS in a large sample of drug-treated community-dwelling persons with schizophrenia and explored their relationships with patients' neurocognitive and SC abilities. 875 patients underwent EPS, psychopathological, neurocognitive and SC assessments by means of standardized measures. Relationships between EPS, psychopathology and neurocognitive and SC measures were investigated by correlation tests. Moreover, a partial correlation network was computed by means of a network analysis. 256 patients were treated with FGAs alone or in combination with SGA and 619 with SGAs. EPS were significantly more frequent in FGA-treated group than in the SGA-treated one. Patients with EPS disclosed a more severe psychopathology and were more impaired in neurocognitive and SC measures compared to those without EPS. Disorganization, expressive deficit, and duration of illness were significantly associated to both neurocognitive and SC measures while EPS were associated to neurocognitive measures only. The network analysis showed that parkinsonism was the sole EPS directly connected to both psychopathological and neurocognitive indices whereas no direct connection emerged between EPS and SC measures. Present findings confirm that EPS are still present in the era of SGAs and contribute, together with other clinical variables, to the neurocognitive but not to the SC impairment of patients with schizophrenia.
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Affiliation(s)
- Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Section of Neuroscience, University of Salerno, Salerno, Italy.
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Alessio Maria Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Paola Rocca
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Enrico Collantoni
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | - Giulio Corrivetti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Alessandro Cuomo
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Enrico D'Ambrosio
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Frascarelli
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Cristiana Montemagni
- Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Milan, Italy
| | - Federica Pinna
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Psychiatry and Clinical Psychology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy; Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Italy
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Citrome L, Yatham LN, Patel MD, Barabássy Á, Hankinson A, Earley WR. Cariprazine and akathisia, restlessness, and extrapyramidal symptoms in patients with bipolar depression. J Affect Disord 2021; 288:191-8. [PMID: 33915374 DOI: 10.1016/j.jad.2021.03.076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Akathisia is a neuropsychiatric syndrome that is commonly related to the use of dopamine receptor antagonists/partial agonists. The characteristics of cariprazine-related akathisia, restlessness, and extrapyramidal symptoms (EPS) were investigated in patients with bipolar I depression. METHODS Akathisia-related data from 3 fixed-dose clinical studies of cariprazine 1.5 mg/d and 3 mg/d in bipolar depression were evaluated in pooled post hoc analyses. Outcomes related to treatment-emergent adverse events (TEAEs) included incidence, time to onset, time to resolution, severity, discontinuations, and rescue medication use. RESULTS The incidence of akathisia was 7.6% for overall cariprazine (1.5 mg/d=5.5%; 3 mg/d=9.6%) and 2.1% for placebo; acute EPS occurred in 4.5% of cariprazine-treated (1.5 mg/d=3.8%; 3 mg/d=5.1%) and 2.1% of placebo-treated patients. Findings were similar for restlessness. Most TEAEs were mild/moderate (>95%), occurred during the first 3 weeks of cariprazine initiation or dose increase, and resulted in few discontinuations (<3%); median time to resolution of an akathisia or EPS TEAE after the last dose of cariprazine was ~1 week. Rescue medication was used by <3% of patients to manage akathisia/EPS events. LIMITATIONS Post hoc analyses; no active comparator. CONCLUSIONS In patients with bipolar depression, the incidence of cariprazine-related akathisia was higher than acute EPS or restlessness, with lower cariprazine doses associated with lower incidences of events. Akathisia and EPS TEAEs occurred early in treatment and were mild/moderate in severity. Few patients with akathisia or acute EPS discontinued treatment. Cariprazine-related akathisia and EPS can be minimized with conservative dosing and titration strategies. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01396447, NCT02670538, NCT02670551.
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Winkel I, Ermann N, Żelwetro A, Sambor B, Mroczko B, Kornhuber J, Paradowski B, Lewczuk P. Cerebrospinal fluid α synuclein concentrations in patients with positive AD biomarkers and extrapyramidal symptoms. J Neural Transm (Vienna) 2021; 128:817-825. [PMID: 34036433 PMCID: PMC8205875 DOI: 10.1007/s00702-021-02351-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 12/12/2022]
Abstract
Extrapyramidal symptoms (EP) are not uncommon in Alzheimer's Disease (AD); when present, they negatively influence the course of the disorder. A large proportion of AD patients shows concomitant Lewy bodies' pathology post mortem. Total α Synuclein (αSyn) concentrations are frequently increased in the cerebrospinal fluid (CSF) of AD patients, but are decreased in Parkinson's Disease (PD) and Dementia with Lewy Bodies (DLB). αSyn CSF concentrations in AD patients with EP (EP+) have not been reported so far. αSyn and the four Neurochemical Dementia Diagnostics (NDD) CSF biomarkers, (Aβ1-42, Aβ42/40, Tau, and pTau181), interpreted according to the Erlangen Score algorithm, were measured in patients with positive NDD results and presence of extrapyramidal symptoms (NDD + / EP+; n = 26), in patients with positive NDD results and absence of extrapyramidal symptoms (NDD+ / EP-; n = 54), and in subjects with negative NDD results (NDD-; n = 34). Compared to the NDD- controls (379.8 ± 125.2 pg/mL), NDD+ patients showed, on average, highly significantly increased CSF αSyn (519 ± 141.3 pg/mL, p < 0.01), but without differences between NDD+ / EP+ and NDD+ / EP- subgroups (p = 0. 38). Moderate but highly significant association was observed between concentrations of αSyn and Tau (r = 0.47, p < 0.01) and pTau181 (r = 0.65, p < 0.01). Adjusted for diagnoses, age, and sex, subjects with more advanced neurodegeneration on neuroimaging showed significantly lower αSyn concentrations (p < 0.02). In the setting AD versus controls, the area under the receiver operating characteristic (ROC) curve was 0.804 [0.712; 0.896] with the sensitivity and the specificity of 0.863 and 0.618, respectively. αSyn in AD patients does not differentiate between subjects with- and without EP. Its increased average concentration reflects probably neurodegenerative process, and is not specific for any pathophysiologic mechanisms. Further studies are necessary to explain the role of CSF αSyn as a potential biomarker.
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Affiliation(s)
- Izabela Winkel
- Dementia Disorders Center of the Medical University of Wrocław, Ścinawa, Poland.,Department and Clinic of Geriatrics, Medical University of Wrocław, Wrocław, Poland
| | - Natalia Ermann
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Agnieszka Żelwetro
- Interdyscyplinarne Studia Doktoranckie Uniwersytetu SWPS, II Wydział Psychologii, Wrocław, Poland
| | | | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany. .,Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland. .,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland. .,Department of Psychiatry and Psychotherapy, Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Schwabachanlage 6, 91054, Erlangen, Germany.
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Boloc D, Rodríguez N, Torres T, García-Cerro S, Parellada M, Saiz-Ruiz J, Cuesta MJ, Bernardo M, Gassó P, Lafuente A, Mas S, Arnaiz JA. Identifying key transcription factors for pharmacogenetic studies of antipsychotics induced extrapyramidal symptoms. Psychopharmacology (Berl) 2020; 237:2151-2159. [PMID: 32382784 DOI: 10.1007/s00213-020-05526-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 04/13/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We explore the transcription factors involved in the molecular mechanism of antipsychotic (AP)-induced acute extrapyramidalsymptoms (EPS) in order to identify new candidate genes for pharmacogenetic studies. METHODS Protein-protein interaction (PPI) networks previously created from three pharmacogenomic models (in vitro, animal, and peripheral blood inhumans) were used to, by means of several bioinformatic tools; identify key transcription factors (TFs) that regulate each network. Once the TFs wereidentified, SNPs disrupting the binding sites (TFBS) of these TFs in the genes of each network were selected for genotyping. Finally, SNP-basedassociations with EPS were analyzed in a sample of 356 psychiatric patients receiving AP. RESULTS Our analysis identified 33 TFs expressed in the striatum, and 125 SNPs disrupting TFBS in 50 genes of our initial networks. Two SNPs (rs938112,rs2987902) in two genes (LSMAP and ABL1) were significantly associated with AP induced EPS (p < 0.001). These SNPs disrupt TFBS regulated byPOU2F1. CONCLUSION Our results highlight the possible role of the disruption of TFBS by SNPs in the pharmacological response to AP.
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Affiliation(s)
- Daniel Boloc
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Teresa Torres
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Susana García-Cerro
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Mara Parellada
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Jeronimo Saiz-Ruiz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Hospital Ramon y Cajal, Universidad de Alcala, IRYCIS, Madrid, Spain
| | - Manuel J Cuesta
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Department of Psychiatry, Complejo Hospitalario de Navarra. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Miquel Bernardo
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Barcelona Clínic Schizophrenia Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- Spain The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Patricia Gassó
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Spain The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Amalia Lafuente
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Spain The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Sergi Mas
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain.
- Spain The August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Joan Albert Arnaiz
- Dept. Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain.
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Jackowiak EM, Chou KL. Severe parkinsonism caused by brexpiprazole: A case report. Parkinsonism Relat Disord 2019; 69:138-139. [PMID: 31756572 DOI: 10.1016/j.parkreldis.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Eric M Jackowiak
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Dilks S, Xavier RM, Kelly C, Johnson J. Implications of Antipsychotic Use: Antipsychotic-Induced Movement Disorders, with a Focus on Tardive Dyskinesia. Nurs Clin North Am 2019; 54:595-608. [PMID: 31703784 DOI: 10.1016/j.cnur.2019.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Antipsychotics can be life changing, but like all medications, they can also have unwanted effects, including drug-induced movement disorders such as tardive dyskinesia (TD). More patients are receiving antipsychotic treatment from non-psychiatry health care providers, including primary care and general practitioners. Despite misconceptions to the contrary, recent analyses suggest that the risk of drug-induced movement disorders such as TD has not been eliminated. Nurses across all care settings will increasingly encounter patients treated with antipsychotics. Nurses are critical for ensuring that patients exposed to antipsychotics receive screening and monitoring, care, and education.
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Obara K, Fujii A, Arie C, Harada N, Yamaki F, Matsuo K, Yoshio T, Tanaka Y. Inhibition of Recombinant Human Acetylcholinesterase Activity by Antipsychotics. Pharmacology 2019; 104:43-50. [PMID: 31067549 DOI: 10.1159/000500227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Extrapyramidal symptoms (EPS) are representative side effects of antipsychotics, caused by their inhibitory action on dopaminergic nerves in nigrostriatal pathways. EPS could be also caused by direct augmentation of cholinergic effects, for example, by acetylcholinesterase (AChE) inhibition. We investigated the potential inhibitory effects of 26 clinically available antipsychotics on the activity of recombinant human AChE (rhAChE) to predict the role of antipsychotic-induced AChE inhibition in EPS onset. METHOD The degree of rhAChE activity inhibition was calculated using the 5,5'-dithio-bis-(2-nitrobenzoic acid) method. RESULTS At a concentration of 10-5 mol/L, haloperidol, bromperidol, timiperone, nemonapride, pimozide, risperidone, blonanserin, aripiprazole, and brexpiprazole inhibited rhAChE activity by >20%. Risperidone, aripiprazole, and brexpiprazole inhibited rhAChE activity in a concentration-dependent manner, and their effects were more potent than those of other antipsychotics. The inhibitory effects of these 3 drugs were evident from 10-6 mol/L, and their pIC50 values were 4.74 ± 0.04, 4.80 ± 0.04, and 4.93 ± 0.06, respectively. Notably, the concentration range in which aripiprazole inhibited rhAChE activity (≥10-6 mol/L) overlapped with its clinically achievable blood levels. CONCLUSION Aripiprazole may cause EPS at clinical dosages by augmenting cholinergic effects via AChE inhibition, in addition to its suppressive effect on dopaminergic neurons.
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Affiliation(s)
- Keisuke Obara
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan,
| | - Ayano Fujii
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Chiaki Arie
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Natsuki Harada
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Fumiko Yamaki
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Kazuhiro Matsuo
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Takashi Yoshio
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
| | - Yoshio Tanaka
- Department of Chemical Pharmacology, Faculty of Pharmaceutical Sciences, Toho University, Funabashi-City, Japan
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Carmona-Huerta J, Castiello-de Obeso S, Ramírez-Palomino J, Duran-Gutiérrez R, Cardona-Muller D, Grover-Paez F, Fernández-Dorantes P, Medina-Dávalos R. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. BMC Psychiatry 2019; 19:78. [PMID: 30791883 PMCID: PMC6383213 DOI: 10.1186/s12888-019-2056-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/12/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups. METHODS We carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results. Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson's correlation was used. Student's T and Mann Whitney's U were used to compare 2 independent samples; multiple and linear regressions were carried out. RESULTS The mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days. CONCLUSIONS Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.
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Affiliation(s)
- J. Carmona-Huerta
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170 Zapopan, Jalisco México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
| | - S. Castiello-de Obeso
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
- Departament of Experimental Psychology, Oxford University, Guadalajara, Mexico
- ITESO, Univesidad Jesuita de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
| | - J. Ramírez-Palomino
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170 Zapopan, Jalisco México
| | - R. Duran-Gutiérrez
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170 Zapopan, Jalisco México
| | - D. Cardona-Muller
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
| | - F. Grover-Paez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
| | - P. Fernández-Dorantes
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170 Zapopan, Jalisco México
| | - R. Medina-Dávalos
- Instituto Jalisciense de Salud Mental, Avenida Zoquipan 1000-A, Zip code 45170 Zapopan, Jalisco México
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra mojada 950 Colonia independencia, Zip code 44340 Guadalajara, Jalisco México
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Abstract
Tardive dyskinesia is a movement disorder that develops during the course of long-term treatment with neuroleptic agents and is characterized primarily by choreiform and athetotic movements. We report the case of a 68-year old female suffering from Bipolar disorder, treated with lithium monotherapy 600 mg per day (serum levels 0.6) for the last 15 years. While her response was favorable she was rarely visiting the outpatient clinic. Over the last few months she developed a tardive dyskinesia-like syndrome. To our knowledge this is the first reported case of tardive dyskinesia with lithium monotherapy at low dosages.
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Affiliation(s)
| | - Thomas Tegos
- 1st Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Kimiskidis
- Laboratory of Clinical Neurophysiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ito T, Yamamoto K, Ohsawa F, Otsuka I, Hishimoto A, Sora I, Hirai M, Yano I. Association of CYP2D6 polymorphisms and extrapyramidal symptoms in schizophrenia patients receiving risperidone: a retrospective study. J Pharm Health Care Sci 2018; 4:28. [PMID: 30479825 PMCID: PMC6245770 DOI: 10.1186/s40780-018-0126-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Risperidone is mainly metabolized by cytochrome P450 (CYP) 2D6 in the liver. The gene encoding CYP2D6 is highly polymorphic. The average steady-state plasma concentration of risperidone active moiety is higher in the CYP2D6 intermediate metabolizers (IMs) compared with that in the extensive metabolizers (EMs). An association between drug-induced extrapyramidal symptoms scale (DIEPSS) score and CYP2D6 polymorphisms has not been reported to date. This study investigates the association of CYP2D6 polymorphisms with the severity of extrapyramidal symptoms in schizophrenia patients receiving risperidone therapy. Methods Schizophrenia patients undergoing risperidone treatment were recruited for the study in the Kobe University Hospital. We evaluated extrapyramidal symptoms of schizophrenia using the DIEPSS. CYP2D6*10 and CYP2D6*14 were analyzed using TaqMan® assays, and CYP2D6*5 was analyzed using the long-PCR method. Patients with CYP2D6*1/*5, *1/*14, *5/*10, *10/*10, and *10/*14 were classified as IMs, and patients with CYP2D6*1/*1 and *1/*10 were classified as EMs. Patients with CYP2D6*5/*5, *5/*14, and *14/*14 were classified as poor metabolizers (PMs). Results A total of 22 patients were included in the study. No patients were classified as PMs. The dose of risperidone (mg/day) was not significantly different between EMs (n = 15) and IMs (n = 7) (median with the interquartile range: 4.0 (2.0-6.0) vs. 4.0 (2.0-7.0) mg, p = 0.31). The age and disease duration of schizophrenia were not significantly different between the EMs and IMs. The DIEPSS score in the IMs was significantly higher than that in the EMs (median with the interquartile range: 5.0 (3.5-6.5) vs. 0.0 (0.0-3.0), p < 0.001). The multiple regression analysis showed that CYP2D6 IMs is a significant risk factor for the DIEPSS (p < 0.05). Conclusion Special attentions should be paid to the onset of extrapyramidal symptoms in schizophrenia patients identified as CYP2D6 IM undergoing risperidone therapy.
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Affiliation(s)
- Takahiro Ito
- 1Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Kazuhiro Yamamoto
- 1Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Fuminori Ohsawa
- 1Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ikuo Otsuka
- 2Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Akitoyo Hishimoto
- 2Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ichiro Sora
- 2Department of Psychiatry, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Midori Hirai
- 1Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ikuko Yano
- 1Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Li HQ, Xu JY, Gao YY, Jin L. Optimization of maintenance therapy of Risperidone with CYP2D6 genetic polymorphisms through an extended translational framework-based prediction of target occupancies/clinical outcomes. Pharmacol Res 2018; 137:135-147. [PMID: 30281999 DOI: 10.1016/j.phrs.2018.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022]
Abstract
Risperidone, one of the second-generation antipsychotics, can efficiently target dopamine D2 and serotonin 5-HT2A receptors. There actually exists significant implication of CYP2D6 genetic polymorphisms on the metabolic kinetics of risperidone, little is known about the extent of CYP2D6 impacting human D2 and 5-HT2A receptor occupancies as well as the clinical efficacy and efficacy in schizophrenia treatment. Here we assessed the influences of CYP2D6 gene polymorphisms on human target occupancies/clinical outcomes and optimized the maintenance therapy of risperidone. A translational framework, previously developed using in vitro and in vivo information in rats, was used as the basis for integrating the effects of CYP2D6 genetic polymorphisms on target occupancies and clinical outcomes. D2 occupancy as a biomarker was related to Positive and Negative Syndrome Scale (PANSS) response and Simpson-Angus Scale (SAS). The population approach was applied to characterize pharmacokinetic and pharmacodynamic (PK/PD) profiles of risperidone. Non-compartment analysis method was performed to calculate the steady state PK/PD parameters of both risperidone and 9-hydroxyrisperidone. The predictive power of this extended translational framework was determined by comparing the predictions of target occupancies and clinical outcomes with the reported human values of risperidone at clinically suggested dosage of 4.0 mg/day. This extended translational framework was adequately used to predict human target occupancies and clinical outcomes. At the steady state, D2 ROs were 75.8%, 79.3% and 86.0% for CYP2D6 poor metabolizer (PM), intermediate metabolizer (IM) and extensive metabolizer (EM), respectively; 5-HT2A ROs were 96.4%, 97.2% and 98.4% for CYP2D6 PM, IM and EM, respectively; PANSS changes from placebo were -5.3, -7.7 and -11.3 for CYP2D6 PM, IM and EM, respectively; SAS changes from placebo were 0.13, 0.15 and 0.18 for CYP2D6 PM, IM and EM, respectively. The predictions of human D2, 5-HT2A RO, PANSS and SAS changes for risperidone with CYP2D6 genetic polymorphisms were well in line with the reported values in clinic. 5.0, 4.0 and 2.5 mg/day were the equivalent dosages of risperidone for CYP2D6 PM, IM and EM, respectively. The optimized maintenance therapy of risperidone was provided through the Three-Step method and the dosage range was 2.5-5.0 mg/day for three CYP2D6 gene groups in the present study. Taken together, our findings demonstrate that this extended translational framework not only differentiates the effects of CYP2D6 genetic polymorphisms on target occupancies and clinical outcomes, but also constitutes a scientific basis to optimize the maintenance therapy of neuropsychiatric patients in clinic.
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Affiliation(s)
- Han Qing Li
- State Clinical Trial Institution of New Drugs, International Mongolian Hospital of Inner Mongolia, Hohhot, 010065, China.
| | - Jia Yin Xu
- Mongolian Pharmaceutical Preparation Center, International Mongolian Hospital of Inner Mongolia, Hohhot, 010065, China
| | - Yuan Yuan Gao
- State Clinical Trial Institution of New Drugs, International Mongolian Hospital of Inner Mongolia, Hohhot, 010065, China
| | - Liang Jin
- State Clinical Trial Institution of New Drugs, International Mongolian Hospital of Inner Mongolia, Hohhot, 010065, China
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Ward KM, Citrome L. Antipsychotic-Related Movement Disorders: Drug-Induced Parkinsonism vs. Tardive Dyskinesia-Key Differences in Pathophysiology and Clinical Management. Neurol Ther 2018; 7:233-48. [PMID: 30027457 DOI: 10.1007/s40120-018-0105-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Drug-induced parkinsonism (DIP) and tardive dyskinesia (TD) are stigmatizing movement disorders associated with exposure to dopamine receptor blocking agents such as antipsychotics, but they differ in their pathophysiology and clinical management. Treatment for one may worsen the other, and there are important diagnostic clues that assist in making an accurate assessment and instituting a rational treatment plan. Methods A literature review was executed to identify articles relating to the presentation, pathophysiology, epidemiology, and management of DIP and TD. Results DIP and TD prevalence estimates range from approximately 20 to 35% among antipsychotic users, but may be higher in select populations. DIP often presents as bradykinesia and rigidity, as well as rhythmic tremor, and the majority of cases appear within hours to weeks of initiation of therapy with an antipsychotic, or if dosage of the antipsychotic is increased. TD onset is delayed, typically appearing after at least 3 months or longer of treatment, and patients will commonly present with involuntary, abnormal facial movements such as lip smacking, puckering, chewing, or tongue protrusion. DIP often resolves with discontinuation of the causative agent, but TD may be permanent. Broadly, proposed mechanisms underlying these adverse events include decreased dopamine concentrations in the nigrostriatal pathway of the striatum and dopamine hypersensitivity, for DIP and TD, respectively. Pharmacologic treatment approaches for DIP have commonly included anticholinergic agents such as benztropine; however, anticholinergic medications can make TD worse. Switching the antipsychotic medication to one with lower propensity for DIP is an option for some patients. Amantadine, a non-anticholinergic agent used for the treatment of DIP, may be preferred in patients with comorbid DIP and TD. In TD, treatment options include the new reversible vesicular monoamine 2 transporter inhibitors, valbenazine and deutetrabenazine. Conclusions It is important for clinicians to be able to recognize DIP and TD in patients using antipsychotics so that they can minimize the impact of these adverse events on their patients’ quality of life. Accurate diagnosis will drive the selection of the correct treatment. Plain Language Summary Plain language summary available for this article.
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Nishida T, Nakajima M. A refractory head tremor appearing after volatile anesthesia combined with epidural anesthesia in a patient with spinocerebellar ataxia type 6. JA Clin Rep 2018; 4:13. [PMID: 32026951 PMCID: PMC6967294 DOI: 10.1186/s40981-018-0150-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
A 64-year-old female patient with spinocerebellar ataxia type 6 was referred to our department for pancreatic cancer and anesthetized with volatile anesthesia combined with epidural anesthesia for pancreaticoduodenectomy. No complications arose during surgery. On postoperative day 4, a head tremor was noticed at the time of mobilization. The tremor was a postural and "no-no" tremor rather than an intention or resting tremor. The head tremor caused difficulty in eating and in other activities of daily living. No abnormal results were obtained by magnetic resonance imaging of the brain. The tremor was resistant to drugs, including anti-Parkinson drugs and benzodiazepines, and was therefore difficult to treat.
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Affiliation(s)
- Takaya Nishida
- Department of Anesthesiology, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki-shi, Osaka-fu 569-1192 Japan
| | - Masayori Nakajima
- Department of Anesthesiology, Takatsuki General Hospital, 1-3-13, Kosobe-cho, Takatsuki-shi, Osaka-fu 569-1192 Japan
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Su YA, Yan F, Li Q, Xiang YT, Shu L, Yu X, Ning YP, Zhang KR, Li T, Mei QY, Li KQ, Si TM. Anticholinergic use trends in 14,013 patients with schizophrenia from three national surveys on the use of psychotropic medications in China (2002-2012). Psychiatry Res 2017; 257:132-136. [PMID: 28755603 DOI: 10.1016/j.psychres.2017.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/25/2017] [Accepted: 07/21/2017] [Indexed: 02/05/2023]
Abstract
Our previous study demonstrated that there have been changes in the patterns of prescription antipsychotic use in China over the period from 2002 to 2012. The aim of this study was to evaluate whether time trends were present for the prescription of anticholinergic medications (ACMs) during the observation period. A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were surveyed in 2002, 2006 and 2012. Basic socio-demographic and clinical characteristics and the prescription of psychotropic drugs were recorded using a standardized protocol and data collection procedure. The frequency of ACM prescription was 25.9% in the whole sample (29.5%, 21.6%, and 27.4% in 2002, 2006 and 2012, respectively). In addition, different temporal trends were observed across age groups. Multiple logistic regression analysis of the entire sample showed that ACM prescriptions were predicted by females, outpatients, patients receiving high doses of antipsychotic medication, select study years, benzodiazepine users, patients displaying extrapyramidal side effects, as well as antipsychotic prescription patterns. Although there was more widespread use of second-generation antipsychotics over the past decade, the frequency of ACM use only slightly decreased. How to use ACM appropriately is still a therapeutic issue that needs to foster evidence-based prescription practice.
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Affiliation(s)
- Yun-Ai Su
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Feng Yan
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China; Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Qian Li
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yu-Tao Xiang
- The National Clinical Research Center for Mental Disorders, China & Center of Depression, Beijing Institute for Brain Disorders & Beijing Anding Hospital, Capital Medical University, Beijing, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Liang Shu
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | | | - Ke-Rang Zhang
- The First Hospital of Shanxi Medical University, Shanxi province, China
| | - Tao Li
- West China Hospital, Sichuan University, China
| | - Qi-Yi Mei
- Suzhou Guangji Hospital, Suzhou, China
| | - Ke-Qing Li
- Hebei Mental Health Center, Hebei, China
| | - Tian-Mei Si
- Peking University Sixth Hospital (Institute of Mental Health) & National Clinical Research Center for Mental Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
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Jang S, Woo J. Five Month-Persistent Extrapyramidal Symptoms following a Single Injection of Paliperidone Palmitate: A Case Report. Clin Psychopharmacol Neurosci 2017; 15:288-291. [PMID: 28783941 PMCID: PMC5565081 DOI: 10.9758/cpn.2017.15.3.288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022]
Abstract
Long-acting injectable (LAI) antipsychotics are useful in the treatments for schizophrenic patients with poor adherence due to their maintaining feature of therapeutic plasma level without daily administrations. However, their long-lasting property can cause complicated problems such as a long-lasting side effect. We report a patient who experienced LAI-induced extrapyramidal symptoms (EPSs) for 5 months after a single injection. During that period, every trial to ameliorate this condition turned out to be a failure. The 3-month formulation of paliperidone palmitate is now close at hand. We have to be aware of possible long-lasting adverse events and confirm the tolerability to LAI before use.
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Affiliation(s)
- Seoyoung Jang
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jungmin Woo
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea
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Jiao J, Zhou F, Kang H, Liu C, Yang M, Hu J. Unexpected extrapyramidal symptoms and pulmonary aspergillosis in exertional heatstroke with fulminant liver failure: a case report. J Med Case Rep 2017; 11:37. [PMID: 28183359 PMCID: PMC5301367 DOI: 10.1186/s13256-016-1184-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/25/2016] [Indexed: 03/11/2023] Open
Abstract
Background Exertional heatstroke is a life-threatening condition with high mortality because of the rapid progress of multiple organ dysfunction syndrome even if aggressive treatments are initiated rapidly. Mild to moderate hepatic injury is common in exertional heatstroke, while fulminant liver failure is rare. Extrapyramidal symptoms and pulmonary aspergillosis secondary to liver failure induced by exertional heatstroke have never been reported in prior cases. Case presentation A 25-year-old Han Chinese man presented with exertional heatstroke with fulminant liver failure, subsequent pulmonary aspergillosis, and extrapyramidal symptoms. Moreover, he also presented with coma, rhabdomyolysis, acute kidney injury, and disseminated intravascular coagulation. He recovered under conservative treatment including therapeutic plasma exchange plus continuous veno-venous hemofiltration, fluid resuscitation, antibiotics, and other support therapy. Conclusions Therapeutic plasma exchange plus continuous veno-venous hemofiltration could be effective for patients with heatstroke who suffer liver failure and other organ failure. Patients with liver failure are at high risk for pulmonary aspergillosis. Movement disorder in these patients might be extrapyramidal symptoms induced by consistent low level of cholinesterase resulted from hepatic injury besides brain injury.
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Affiliation(s)
- Jie Jiao
- Critical Care Medicine, Hainan Branch of Chinese PLA General Hospital, Haitangwan District, Sanyan, Hainan Province, 572000, China
| | - Feihu Zhou
- Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hongjun Kang
- Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Chao Liu
- Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mengmeng Yang
- Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jie Hu
- Critical Care Medicine, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, 100853, China.
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25
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Fervaha G, Caravaggio F, Mamo DC, Mulsant BH, Pollock BG, Nakajima S, Gerretsen P, Rajji TK, Mar W, Iwata Y, Plitman E, Chung JK, Remington G, Graff-Guerrero A. Lack of association between dopaminergic antagonism and negative symptoms in schizophrenia: a positron emission tomography dopamine D2/3 receptor occupancy study. Psychopharmacology (Berl) 2016; 233:3803-3813. [PMID: 27557949 PMCID: PMC5065392 DOI: 10.1007/s00213-016-4415-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE Several pre-clinical studies suggest that antipsychotic medications cause secondary negative symptoms. However, direct evidence for a relationship among antipsychotic medications, their direct effects on neurotransmitter systems, and negative symptoms in schizophrenia remains controversial. OBJECTIVE The objective of this study was to examine the relationship between antipsychotic-related dopamine D2/3 receptor occupancy and negative symptoms in patients with schizophrenia. METHODS Forty-one clinically stable outpatients with schizophrenia participated in this prospective dose reduction positron emission tomography (PET) study. Clinical assessments and [11C]-raclopride PET scans were performed before and after participants underwent gradual dose reduction of their antipsychotic medication by up to 40 % from the baseline dose. RESULTS No significant relationship was found between antipsychotic-related dopamine D2/3 receptor occupancy and negative symptom severity at baseline or follow-up. Similar null findings were found for subdomains of negative symptoms (amotivation and diminished expression). Occupancy was significantly lower following dose reduction; however, negative symptom severity did not change significantly, though a trend toward reduction was noted. Examination of change scores between these two variables revealed no systematic relationship. CONCLUSIONS Our cross-sectional and longitudinal results failed to find a significant dose-dependent relationship between severity of negative symptoms and antipsychotic-related dopaminergic antagonism in schizophrenia. These findings argue against the notion that antipsychotics necessarily cause secondary negative symptoms. Our results are also in contrast with the behavioral effects of dopaminergic antagonism routinely reported in pre-clinical investigations, suggesting that the role of this variable in the context of chronic treatment and schizophrenia needs to be re-examined.
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Affiliation(s)
- Gagan Fervaha
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Fernando Caravaggio
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - David C. Mamo
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Bruce G. Pollock
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Shinichiro Nakajima
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Philip Gerretsen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Tarek K. Rajji
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Wanna Mar
- Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yusuke Iwata
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Eric Plitman
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jun Ku Chung
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada
,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
,Institute of Medical Science, University of Toronto, Toronto, Canada
,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ariel Graff-Guerrero
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada. .,Institute of Medical Science, University of Toronto, Toronto, ON, Canada. .,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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MacNeil RR, Müller DJ. Genetics of Common Antipsychotic-Induced Adverse Effects. Mol Neuropsychiatry 2016; 2:61-78. [PMID: 27606321 DOI: 10.1159/000445802] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/24/2016] [Indexed: 12/12/2022]
Abstract
The effectiveness of antipsychotic drugs is limited due to accompanying adverse effects which can pose considerable health risks and lead to patient noncompliance. Pharmacogenetics (PGx) offers a means to identify genetic biomarkers that can predict individual susceptibility to antipsychotic-induced adverse effects (AAEs), thereby improving clinical outcomes. We reviewed the literature on the PGx of common AAEs from 2010 to 2015, placing emphasis on findings that have been independently replicated and which have additionally been listed to be of interest by PGx expert panels. Gene-drug associations meeting these criteria primarily pertain to metabolic dysregulation, extrapyramidal symptoms (EPS), and tardive dyskinesia (TD). Regarding metabolic dysregulation, results have reaffirmed HTR2C as a strong candidate with potential clinical utility, while MC4R and OGFR1 gene loci have emerged as new and promising biomarkers for the prediction of weight gain. As for EPS and TD, additional evidence has accumulated in support of an association with CYP2D6 metabolizer status. Furthermore, HSPG2 and DPP6 have been identified as candidate genes with the potential to predict differential susceptibility to TD. Overall, considerable progress has been made within the field of psychiatric PGx, with inroads toward the development of clinical tools that can mitigate AAEs. Going forward, studies placing a greater emphasis on multilocus effects will need to be conducted.
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Affiliation(s)
- Raymond R MacNeil
- Mood Research Laboratory, Department of Psychology, Queen's University, Kingston, Ont., Canada
| | - Daniel J Müller
- Departments of Psychiatry, University of Toronto, Toronto, Ont., Canada; Departments of Pharmacology and Toxicology, University of Toronto, Toronto, Ont., Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ont., Canada
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Ikai S, Uchida H, Suzuki T, Tsunoda K, Fujii Y, Mimura M. Postural sway and flexibility in patients with schizophrenia-spectrum disorders: A cross-sectional study. Asian J Psychiatr 2016; 19:14-8. [PMID: 26957329 DOI: 10.1016/j.ajp.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/29/2015] [Accepted: 11/29/2015] [Indexed: 11/30/2022]
Abstract
Coordinated bodily balance is necessary to prevent falls, where postural sway and/or body inflexibility should be relevant. We aimed to assess postural sway and flexibility in patients with schizophrenia and identify clinical characteristics. Postural sway (length and range of trunk motion, and Romberg ratio) and flexibility (anteflexion in sitting) were measured in schizophrenia. The Positive and Negative Syndrome Scale (PANSS) and the Drug Induced Extrapyramidal Symptoms Scale (DIEPSS) were used for the assessment of psychopathology and extrapyramidal symptoms, respectively. Characteristics associated with postural sway and flexibility were examined with regression analysis. A total of 100 patients (68 men, mean ± S.D. age: 49.3 ± 13.8 years, PANSS score: 83.4 ± 15.1, DIEPSS score: 2.2 ± 2.2) participated in this study. The anteflexion in sitting was not significantly correlated with length of trunk motion, range of trunk motion, or Romberg ratio. Postural instability was associated with higher DIEPSS overall severity score and PANSS positive symptoms. A significant correlation was also found between less flexibility and increased PANSS negative symptoms. In conclusion, flexibility and postural stability might be regarded as separate elements of physical fitness in schizophrenia. Prospective exercise intervention would be worthy of investigation to enhance postural stability and flexibility in an effort to prevent falls.
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Affiliation(s)
- Saeko Ikai
- Department of Neuropsychiatry, Keio University School of Medicine, 160-8582, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, 160-8582, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan; Geriatric Psychiatry Division, Centre for Addiction and Mental Health, 1001, Queen St W, Toronto, ON, Canada M6 J 1H4
| | - Takefumi Suzuki
- Department of Neuropsychiatry, Keio University School of Medicine, 160-8582, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan; Department of Psychiatry, Inokashira Hospital, 181-0012, 4-14-1, Kamirenjaku, Mitaka, Tokyo, Japan
| | - Kenichi Tsunoda
- Department of Psychiatry, Minamihanno Hospital, 357-0042, 415, Soya, Hanno, Saitama, Japan
| | - Yasuo Fujii
- Department of Neuropsychiatry, Yamanashi Prefectural Kita Hospital, 407-0046, 3314-13, Kamijo Minamiwari Asahi-machi, Nirasaki, Yamanashi, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 160-8582, 35, Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Meduri M, Gregoraci G, Baglivo V, Balestrieri M, Isola M, Brambilla P. A meta-analysis of efficacy and safety of aripiprazole in adult and pediatric bipolar disorder in randomized controlled trials and observational studies. J Affect Disord 2016; 191:187-208. [PMID: 26674213 DOI: 10.1016/j.jad.2015.11.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/27/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Aripiprazole (ARP) has been shown to be effective in the treatment of bipolar disorder (BD). However, no prior investigation considered both randomized clinical trials (RCTs) and non-RCTs. We here evaluated the efficacy and safety of ARP compared with placebo (PCB) and other drugs at 3- and 12-weeks in adult and pediatric population including, for the first time, both observational and controlled studies. METHODS All studies were systematically located by searching electronic sources (EMBASE, MEDLINE, CINHAIL, PsychINFO, Cochrane Central Register of Controlled Trials, Scopus and ClinicalTrials.gov) till June 30th, 2015. The primary outcome was ARP efficacy (mean change from baseline in Young Mania Rating Scale); secondary outcomes regarded acceptability and safety. Results Sixteen RCTs and 6 non-RCTs met our inclusion criteria; 2505 and 2932 patients were included in the analyses of acute and stabilization phase, respectively. In both the acute and stabilization phases ARP efficacy was superior to PCB and comparable to other drugs. The safety profile was similar to other drugs considering in particular sedation, akathisia, weight gain, extrapyramidal and gastroenteric symptoms, with a significant lower risk of hyperprolactinemia particularly at 12-weeks. LIMITATIONS Data on failed trials are generally limited. CONCLUSIONS ARP resulted to be an effective treatment in children and adults with BD at 3- and 12-weeks both in a controlled experimental setting or in the real world clinical practice, being poorly associated with hyperprolactinemia. Larger studies are needed to confirm our results related to the maintenance phases and to the pediatric bipolar population.
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Affiliation(s)
- Martina Meduri
- Department of Experimental and Clinical Medical Sciences, ICBN, University of Udine, Udine, Italy
| | - Giorgia Gregoraci
- Department of Biological and Medical Sciences, University of Udine, Udine, Italy
| | - Valentina Baglivo
- Department of Experimental and Clinical Medical Sciences, ICBN, University of Udine, Udine, Italy
| | - Matteo Balestrieri
- Department of Experimental and Clinical Medical Sciences, ICBN, University of Udine, Udine, Italy
| | - Miriam Isola
- Department of Biological and Medical Sciences, University of Udine, Udine, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Psychiatric Clinic, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Sciences, University of Texas Health Science Center at Houston, TX, USA.
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Demirci S, Demirci K, Taskiran E, Koyuncuoglu HR. Unilateral suppression of probable antipsychotic drug-induced parkinsonism. Acta Neurol Belg 2015; 115:827-8. [PMID: 25786356 DOI: 10.1007/s13760-015-0449-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/18/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Seden Demirci
- Department of Neurology, Research and Training Hospital, School of Medicine, Süleyman Demirel University, Isparta, Turkey.
| | - Kadir Demirci
- Department of Psychiatry, School of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Esra Taskiran
- Department of Neurology, Research and Training Hospital, School of Medicine, Süleyman Demirel University, Isparta, Turkey
| | - Hasan Rifat Koyuncuoglu
- Department of Neurology, Research and Training Hospital, School of Medicine, Süleyman Demirel University, Isparta, Turkey
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Dodgen TM, Eloff A, Mataboge C, Roos LJL, van Staden WCW, Pepper MS. Risperidone-associated adverse drug reactions and CYP2D6 polymorphisms in a South African cohort. Appl Transl Genom 2015; 5:40-6. [PMID: 26937359 PMCID: PMC4745369 DOI: 10.1016/j.atg.2015.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/02/2015] [Indexed: 11/26/2022]
Abstract
Background Contradictory information exists regarding the influence of CYP2D6 polymorphisms on adverse drug reactions (ADRs) (extrapyramidal symptoms (EPS) and weight gain) related to risperidone treatment. This prompted us to evaluate the influence of CYP2D6 genetic variation in a cohort of South African patients who presented with marked movement disorders and/or weight gain while on risperidone treatment. Methods Patients who were experiencing marked risperidone ADRs were recruited from Weskoppies Public Psychiatric Hospital. As poor or intermediate metabolism was expected, comprehensive CYP2D6 sequence variations were evaluated using XL-PCR + Sequencing. Results No statistically significant association was found between CYP2D6 poor metabolism and risperidone ADRs. An inverse relationship between EPS and weight gain was however identified. A novel CYP2D6 allele was identified which is unlikely to affect metabolism based on in silico evaluation. Conclusion CYP2D6 variation appeared not to be a good pharmacogenetic marker for predicting risperidone-related ADRs in this naturalistic South African cohort. Evaluation of a larger cohort would be needed to confirm these observations, including an examination of the role of potential intermediaries between the hypothesised genetic and clinical phenotypes.
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Affiliation(s)
- Tyren M Dodgen
- Department of Pharmacology, School of Medicine, University of Pretoria, South Africa; Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Arinda Eloff
- Department of Immunology, School of Medicine, University of Pretoria, South Africa
| | - Connie Mataboge
- Department of Psychiatry, School of Medicine, University of Pretoria, South Africa
| | - Louw J L Roos
- Department of Psychiatry, School of Medicine, University of Pretoria, South Africa
| | | | - Michael S Pepper
- Department of Immunology, School of Medicine, University of Pretoria, South Africa; Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, South Africa; Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Matsuura Y, Fujino H, Hashimoto R, Yasuda Y, Yamamori H, Ohi K, Takeda M, Imura O. Standing postural instability in patients with schizophrenia: Relationships with psychiatric symptoms, anxiety, and the use of neuroleptic medications. Gait Posture 2015; 41:847-51. [PMID: 25813604 DOI: 10.1016/j.gaitpost.2015.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/16/2014] [Accepted: 03/08/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to assess postural instability in patients with schizophrenia using a pressure-sensitive platform and to examine the effects of anxiety, psychiatric symptoms, and the use of neuroleptic medications on postural sway. Participants were 23 patients with schizophrenia and 23 healthy controls. We found that the patients showed greater overall postural instability than the controls. Furthermore, they demonstrated greater instability when the test was performed with the eyes closed than with the eyes open. However, removal of visual input had less impact on the indices of postural instability in the patients than in the controls, suggesting that schizophrenia is associated with difficulties in integrating visual information and proprioceptive signals. Furthermore, in contrast to the controls, anxiety exacerbated postural instability in the patients. There were significant associations between postural stability and psychiatric symptoms in the patients without extrapyramidal symptoms, whereas medication dose did not significantly correlate with postural stability.
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Affiliation(s)
- Yukako Matsuura
- Graduate School of Human Sciences, Osaka University, 1-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Haruo Fujino
- Graduate School of Human Sciences, Osaka University, 1-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Ryota Hashimoto
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Hidenaga Yamamori
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan; Department of Molecular Neuropsychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Kazutaka Ohi
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Masatoshi Takeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 5650871, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, 1-2, Yamadaoka, Suita, Osaka 5650871, Japan.
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Graux J, Courtine JB, Bruneau N, Camus V, El-Hage W. Higher fundamental voice frequency is related to extrapyramidal symptoms in schizophrenia. Schizophr Res 2015; 161:517-8. [PMID: 25468179 DOI: 10.1016/j.schres.2014.10.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/20/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022]
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Mas S, Gassó P, Ritter MA, Malagelada C, Bernardo M, Lafuente A. Pharmacogenetic predictor of extrapyramidal symptoms induced by antipsychotics: multilocus interaction in the mTOR pathway. Eur Neuropsychopharmacol 2015; 25:51-9. [PMID: 25499605 DOI: 10.1016/j.euroneuro.2014.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/22/2014] [Accepted: 11/20/2014] [Indexed: 12/31/2022]
Abstract
Antipsychotic (AP) treatment-emergent extrapyramidal symptoms (EPS) are acute adverse reactions of APs. The aim of the present study is to analyze gene-gene interactions in nine genes related to the mTOR pathway, in order to develop genetic predictors of the appearance of EPS. 243 subjects (78 presenting EPS: 165 not) from three cohorts participated in the present study: Cohort 1, patients treated with risperidone, (n=114); Cohort 2, patients treated with APs other than risperidone (n=102); Cohort 3, AP-naïve patients with first-episode psychosis treated with risperidone, paliperidone or amisulpride, n=27. We analyzed gene-gene interactions by multifactor dimensionality reduction assay (MDR). In Cohort 1, we identified a four-way interaction, including the rs1130214 (AKT1), rs456998 (FCHSD1), rs7211818 (Raptor) and rs1053639 (DDIT4), that correctly predicted 97 of the 114 patients (85% accuracy). We validated the predictive power of the four-way interaction in Cohort 2 and in Cohort 3 with 86% and 88% accuracy respectively. We develop and validate a powerful pharmacogenetic predictor of AP-induced EPS. For the first time, the mTOR pathway has been related to EPS susceptibility and AP response. However, validation in larger and independent populations will be necessary for optimal generalization.
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Tybura P, Trześniowska-Drukała B, Bienkowski P, Beszlej A, Frydecka D, Mierzejewski P, Samochowiec A, Grzywacz A, Samochowiec J. Pharmacogenetics of adverse events in schizophrenia treatment: comparison study of ziprasidone, olanzapine and perazine. Psychiatry Res 2014; 219:261-7. [PMID: 24930580 DOI: 10.1016/j.psychres.2014.05.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/09/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
The primary aim of the present study was to assess the possible associations between dopaminergic, serotonergic, and glutamatergic system-related genes and adverse events after antipsychotic treatment in paranoid schizophrenia patients. The second aim of the study was to compare the intensity of these symptoms between atypical (ziprasidone and olanzapine) and typical (perazine) antipsychotic drugs. One-hundred and ninety-one Polish patients suffering from paranoid schizophrenia were genotyped for polymorphisms of DRD2, DAT1, COMT, MAOA, SERT, 5HT2A, and GRIK3. The patients were randomized to treatment with perazine, olanzapine or ziprasidone monotherapy for 3 months. The intensity of side effects (changes in body weights and extrapyramidal symptoms (EPS)) was measured at baseline and after 12 weeks of antipsychotic treatment. After 3 months of therapy, the weight increase was the greatest in the group treated with olanzapine and the least in the group treated with ziprasidone. None of the examined gene polymorphisms was associated with the body weight changes. Perazine treatment was associated with the significantly highest intensity of EPS. None of the examined polymorphisms was associated with the changes in extrapyramidal adverse events after antipsychotic treatment. The selected polymorphisms are not primarily involved in changes in body weights and EPS related to antipsychotic treatment in paranoid schizophrenia patients.
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Affiliation(s)
- Piotr Tybura
- Department of Psychiatry, Pomeranian Medical University, ul. Broniewskiego 26, 71-460 Szczecin, Poland
| | | | | | | | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Pawel Mierzejewski
- Department of Pharmacology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, Szczecin, Poland
| | - Anna Grzywacz
- Department of Psychiatry, Pomeranian Medical University, ul. Broniewskiego 26, 71-460 Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, ul. Broniewskiego 26, 71-460 Szczecin, Poland.
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Woo J, Rim HD. Acamprosate-induced Extrapyramidal Symptoms in an Elderly Patient with Alcohol Dependence. Clin Psychopharmacol Neurosci 2014; 12:166-8. [PMID: 25191510 PMCID: PMC4153866 DOI: 10.9758/cpn.2014.12.2.166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 11/18/2022]
Abstract
Acamprosate reduces the craving for alcohol by decreasing glutamate activity and increasing gamma-aminobutyric acid (GABA) action in patients with alcohol dependence. Acamprosate has tolerable side effects that include diarrhea, headache, dizziness and pruritus. In this study, we report acamprosate-induced extrapyramidal symptoms in an elderly patient with no history of neurologic disease. Severe extrapyramidal symptoms developed two days after the administration of acamprosate and improved over one week after the acamprosate was stopped. Extrapyramidal symptoms are commonly associated with dopamine receptor antagonists. However, there have been several reports of extrapyramidal symptoms occurring with drugs targeting other systems, including GABA, glutamate and serotonin. Acamprosate may decrease dopamine levels in the ventral tegmental area mediated by glutamatergic action and thus cause extrapyramidal symptoms. We suggest that acamprosate carries the risk of causing extrapyramidal symptoms.
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Affiliation(s)
- Jungmin Woo
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hyo-Deog Rim
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Korea
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Rybakowski JK, Vansteelandt K, Remlinger-Molenda A, Fleischhacker WW, Kahn RS, Peuskens J. Extrapyramidal symptoms during treatment of first schizophrenia episode: results from EUFEST. Eur Neuropsychopharmacol 2014; 24:1500-5. [PMID: 25085534 DOI: 10.1016/j.euroneuro.2014.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 06/29/2014] [Accepted: 07/11/2014] [Indexed: 12/13/2022]
Abstract
The European First Episode Schizophrenia Trial (EUFEST) included first-episode schizophrenia patients, assessing the efficacy of five antipsychotic drugs (haloperidol, amisulpride, olanzapine, quetiapine and ziprasidone) over one year. Baseline frequency of extrapyramidal symptoms (EPS) in this group of patients (n=490) was as follows: parkinsonism 10.8%, akathisia 10.0%, dystonia 1.8%, and dyskinesia 0.6%. The frequency of parkinsonism at baseline was greater in patients with a brief prior exposure to antipsychotics (≤2 weeks) compared with antipsychotic-naïve ones, and was positively correlated with the intensity of negative symptoms and negatively with depressive symptoms. After one month of treatment, the increase of parkinsonism was highest in patients receiving haloperidol (+13%), that of akathisia in patients treated with ziprasidone (+14%), and 10.1% of the patients were taking anticholinergic drugs, most frequently in the haloperidol group (24%). In 291 patients remaining on treatment after one year, both parkinsonism and akathisia had decreased: the frequency of parkinsonism was 3%, highest in the haloperidol group (9.1%), that of akathisia was 3%, highest in the quetiapine group (7.5%), and 4% of patients were taking anticholinergic drugs, most frequently those receiving haloperidol (10.5%). The results obtained suggest that in first-episode schizophrenia patients during the first year of antipsychotic treatment (in this case amisulpride, haloperidol in low doses, olanzapine, quetiapine and ziprasidone), EPS were present as manageable clinical problems.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
| | - Kristof Vansteelandt
- University Psychiatric Centre KU Leuven, Campus UC St Joseph Kortenberg, Leuven, Belgium
| | | | | | - René S Kahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, UMC Utrecht, The Netherlands
| | - Joseph Peuskens
- University Psychiatric Centre KU Leuven, Campus UC St Joseph Kortenberg, Leuven, Belgium
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Lemercier S, Haegelen C, Riffaud L. [Intracerebral cysts revealed by extrapyramidal symptoms]. Neurochirurgie 2014; 60:59-61. [PMID: 24613423 DOI: 10.1016/j.neuchi.2013.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/23/2013] [Accepted: 11/13/2013] [Indexed: 11/27/2022]
Abstract
We report 3 cases of intracerebral cyst revealed by an unusual evolution of extrapyramidal symptoms. Diagnosis was based on MRI and the patients were treated by a cystoperitoneal or a cysto-atrial shunt. The surgical procedure was successful in the 3 cases, resulting in the rapid disappearance of symptoms.
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Affiliation(s)
- S Lemercier
- Service de neurologie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - C Haegelen
- Service de neurochirurgie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - L Riffaud
- Service de neurochirurgie, CHU Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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38
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Bošković M, Grabnar I, Terzič T, Kores Plesničar B, Vovk T. Oxidative stress in schizophrenia patients treated with long-acting haloperidol decanoate. Psychiatry Res 2013; 210:761-8. [PMID: 24041751 DOI: 10.1016/j.psychres.2013.08.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/03/2013] [Accepted: 08/18/2013] [Indexed: 11/24/2022]
Abstract
In this study the role of oxidative stress in schizophrenia was investigated by evaluating the relationship of oxidative stress markers with neurochemistry, psychopathology, and extrapyramidal symptoms. Antioxidant activity of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, and concentrations of malondialdehyde, protein carbonyls, nitrite, nitrate, glutathione, dopamine, noradrenaline, adrenaline, and serotonin were measured in 52 outpatients with DSM-IV diagnosis of schizophrenia treated with haloperidol decanoate. Psychopathology and extrapyramidal symptoms were assessed by positive and negative syndrome scale, global assessment of functioning, abnormal involuntary movement scale, Simpson Angus scale, and Barnes akathisia rating scale. Haloperidol dose was positively correlated with plasma protein carbonyls. Longer duration of illness was associated with decreased levels of glutathione peroxidase. Increased activity of superoxide dismutase was associated with increased levels of catalase, glutathione peroxidase, glutathione reductase and reduced glutathione, and decreased concentration of malondialdehyde, indicating joint action of various antioxidative systems. Increased levels of nitrite and noradrenaline were associated with decreased level of malondialdehyde. Akathisia was greater in patients with decreased catalase activity, indicating involvement of impaired antioxidant defense in developing extrapyramidal symptoms. These results confirm the hypothesis that oxidative stress is involved in pathophysiology of schizophrenia and severity of extrapyramidal symptoms.
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Affiliation(s)
- Marija Bošković
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva cesta 7, SI-1000 Ljubljana, Slovenia
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Shimizu S, Mizuguchi Y, Tatara A, Kizu T, Andatsu S, Sobue A, Fujiwara M, Morimoto T, Ohno Y. 5-HT1A agonist alleviates serotonergic potentiation of extrapyramidal disorders via postsynaptic mechanisms. Prog Neuropsychopharmacol Biol Psychiatry 2013; 46:86-91. [PMID: 23838274 DOI: 10.1016/j.pnpbp.2013.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022]
Abstract
We previously demonstrated that 5-HT stimulants, including selective serotonin reuptake inhibitors (SSRIs), potentiated antipsychotic-induced extrapyramidal symptoms (EPS) by stimulating 5-HT2A/2C, 5-HT3 and 5-HT6 receptors. Here, we studied the effects of the 5-HT1A agonist (±)-8-hydroxy-2-(di-n-propylamino) tetralin ((±)-8-OH-DPAT) on the fluoxetine enhancement of EPS (i.e., bradykinesia and catalepsy) to determine if the 5-HT1A agonist can counteract the serotonergic potentiation of EPS. Fluoxetine did not induce EPS signs by itself, but significantly potentiated haloperidol-induced bradykinesia in mice. (±)-8-OH-DPAT (0.1-1mg/kg, i.p.) significantly attenuated the fluoxetine enhancement of haloperidol-induced bradykinesia in a dose-dependent manner. A selective 5-HT1A antagonist (s)-WAY-100135 completely reversed the anti-EPS action of (±)-8-OH-DPAT. Microinjection studies using rats revealed that local application of (±)-8-OH-DPAT into the dorsolateral striatum or the motor cortex significantly diminished fluoxetine-enhanced catalepsy. In contrast, (±)-8-OH-DPAT injected into the medial raphe nucleus failed to affect EPS induction. The present results illustrate that 5-HT1A agonist can alleviate the SSRI enhancement of EPS by activating postsynaptic 5-HT1A receptors in the striatum and cerebral cortex.
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Affiliation(s)
- Saki Shimizu
- Laboratory of Pharmacology, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan
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de Kuijper G, Mulder H, Evenhuis H, Scholte F, Visser F, Hoekstra PJ. Determinants of physical health parameters in individuals with intellectual disability who use long-term antipsychotics. Res Dev Disabil 2013; 34:2799-2809. [PMID: 23792429 DOI: 10.1016/j.ridd.2013.05.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/04/2013] [Accepted: 05/06/2013] [Indexed: 06/02/2023]
Abstract
Individuals with intellectual disability frequently use antipsychotics for many years. This may have detrimental health effects, including neurological symptoms and metabolic and hormonal dysregulation, the latter possibly affecting bone metabolism. There is large variability in the degree in which antipsychotic agents lead to these health problems. In the current study we investigated potential determinants of physical symptoms and biological parameters known to be associated with use of antipsychotics in a convenience sample of 99 individuals with intellectual disability who had used antipsychotics for more than one year for behavioural symptoms. We focused on extrapyramidal symptoms; on overweight and presence of components of the metabolic syndrome; and on elevated plasma prolactin and bone turnover parameters. As predictor variables, we used patient (sex, age, genetic polymorphisms, and severity of intellectual disability) and medication use (type and dosage) characteristics. We found extrapyramidal symptoms to be present in 53%, overweight or obesity in 46%, and the metabolic syndrome in 11% of participants. Hyperprolactineaemia and one or more elevated bone turnover markers were present in 17% and 25%, respectively. Higher age and more severe intellectual disability were associated with dyskinesia and a higher dosage of the antipsychotic drug was associated with parkinsonism. Less severe intellectual disability was related to higher Body Mass Index. Use of atypical antipsychotics was associated with higher diastolic blood pressure and elevated fasting glucose. Clinicians who prescribe antipsychotics in individuals with intellectual disability should carefully balance the potential benefits of prolonged treatment against the risk of health hazards associated with the use of antipsychotics.
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Affiliation(s)
- Gerda de Kuijper
- Vanboeijen, Intellectual Disability Centre, Assen, The Netherlands.
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Abstract
I report here an elderly woman receiving perphenazine together with terbinafine. After 1 week of terbinafine treatment she experienced extrapyramidal symptoms and, in particular, akathisia. Her symptoms did not disappear for 6 weeks, and so at 2 weeks prior to this most recent admission she had stopped taking terbinafine. However, these symptoms persisted for 3 weeks after discontinuing terbinafine. It is well known that terbinafine inhibits CYP2D6 and that perphenazine is metabolized mainly by CYP2D6. Thus, when terbinafine and perphenazine are coadministrated, the subsequent increase in the concentration of perphenazine may induce extrapyramidal symptoms. Thus, terbinafine therapy may be associated with the induction and persistence of extrapyramidal symptoms, including akathisia. This case report emphasizes the importance of monitoring drug-drug interactions in patients undergoing terbinafine and perphenazine therapy.
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Affiliation(s)
- Young-Min Park
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
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Ghosh K, Sengupta N, Sau TJ, Chatterjee A. Rare presentation of a common disease: Idiopathic hypoparathyroidism presenting with extrapyramidal symptoms and status epilepticus. Indian J Endocrinol Metab 2012; 16:1035-1036. [PMID: 23226661 PMCID: PMC3510935 DOI: 10.4103/2230-8210.103035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report of an 18-year-old male who presented with an epileptiform disorder, features of hypocalcemia, and an extrapyramidal symptom in the form of choreoathetosis. On evaluation he had idiopathic hypoparathyroidism with extensive calcifications in the extrapyramidal system of the brain; basal ganglion, as well as in the cerebral cortex and cerebellum, which is a rare entity. We report the rare presentation of a common disorder, which requires to be considered in evaluating hypoparathyroidism.
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Affiliation(s)
- Kaushik Ghosh
- Department of Medicine, NRS Medical College, Kolkata, India
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Pringsheim T, Panagiotopoulos C, Davidson J, Ho J. [Not Available]. Paediatr Child Health 2012; 17:12B-21B. [PMID: 24082813 PMCID: PMC3486685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The use of antipsychotics, especially second-generation antipsychotics (SGAs), for children with mental health disorders in Canada has increased dramatically over the past five years. These medications have the potential to cause major metabolic and neurological complications with chronic use. OBJECTIVE To synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children, and provide evidence-based recommendations for the monitoring of these side effects. METHODS A systematic review of controlled clinical trials of SGAs involving children was performed. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. When there was inadequate evidence, recommendations were based on consensus and expert opinion. A multidisciplinary consensus group reviewed all relevant evidence and reached consensus on the recommendations. RESULTS The present guidelines provide evidence-based recommendations for monitoring SGA safety. The strength of recommendations for specific physical examination manoeuvres and laboratory tests are provided for each SGA medication at specific time points. CONCLUSION Multiple randomized controlled trials evaluated the efficacy of many of the SGAs in paediatric mental health disorders. These benefits, however, are not without risks - both metabolic and neurological side effects occur in children treated with SGAs. The risk of weight gain, increased body mass index and abnormal lipid levels is greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of the treatment is greatest with risperidone, olanzapine and aripiprazole. Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications.
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Affiliation(s)
- Tamara Pringsheim
- Département de neurosciences cliniques et de pédiatrie, université de Calgary (Alberta)
| | | | - Jana Davidson
- département de psychiatrie, université de la Colombie-Britannique, Vancouver (Colombie-Britannique)
| | - Josephine Ho
- département de pédiatrie, université de Calgary (Alberta)
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Contreras-Ferrer P, de Paz NM, Cejas-Mendez MR, Rodríguez-Martín M, Souto R, Bustínduy MG. Ziprasidone in the treatment of delusional parasitosis. Case Rep Dermatol 2012; 4:150-3. [PMID: 22807899 PMCID: PMC3398084 DOI: 10.1159/000341112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Delusional parasitosis is characterized by a patient's fixed false belief of being infested with parasites or small creatures. The first-line treatment options are typical antipsychotics such as pimozide. However, the accompanying extrapyramidal side effects might limit their use. We report on a patient with a good response to pimozide combined with ziprasidone. Ziprasidone is an atypical antipsychotic drug with a lower risk of extrapyramidal symptoms; thus, it might be considered a good first or second treatment option for delusional parasitosis.
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Affiliation(s)
- P Contreras-Ferrer
- Department of Dermatology, Hospital Universitario de Canarias, La Laguna, Spain
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Pringsheim T, Panagiotopoulos C, Davidson J, Ho J. Evidence-based recommendations for monitoring safety of second-generation antipsychotics in children and youth. Paediatr Child Health 2011; 16:581-589. [PMID: 23115502 PMCID: PMC3223902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2011] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The use of antipsychotics, especially second-generation antipsychotics (SGAs), for children with mental health disorders in Canada has increased dramatically over the past five years. These medications have the potential to cause major metabolic and neurological complications with chronic use. OBJECTIVE To synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children, and provide evidence-based recommendations for the monitoring of these side effects. METHODS A systematic review of controlled clinical trials of SGAs involving children was performed. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. When there was inadequate evidence, recommendations were based on consensus and expert opinion. A multidisciplinary consensus group reviewed all relevant evidence and reached consensus on the recommendations. RESULTS The present guidelines provide evidence-based recommendations for monitoring SGA safety. The strength of recommendations for specific physical examination manoeuvres and laboratory tests are provided for each SGA medication at specific time points. CONCLUSION Multiple randomized controlled trials evaluated the efficacy of many of the SGAs in paediatric mental health disorders. These benefits, however, are not without risks - both metabolic and neurological side effects occur in children treated with SGAs. The risk of weight gain, increased body mass index and abnormal lipid levels is greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of the treatment is greatest with risperidone, olanzapine and aripiprazole. Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications.
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Affiliation(s)
- Tamara Pringsheim
- Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta
| | | | - Jana Davidson
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Alberta
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