scholarly journals Extrapyramidal syndromes caused by antipsychotics

2012 ◽  
Vol 65 (11-12) ◽  
pp. 521-526 ◽  
Author(s):  
Milana Poznic-Jesic ◽  
Aleksandar Jesic ◽  
Jasmina Babovic-Filipovic ◽  
Olga Zivanovic
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Therapy ◽  
Conventional Antipsychotics ◽  
Repetitive Movements ◽  
Extrapyramidal Syndromes ◽  
The One ◽  
The Individual ◽  
Continuous Use

Introduction. Extrapyramidal syndromes are significant side effects of antipsychotic therapy due to their severity, frequent occurrence and complications. This paper gives a brief summary of the literature with the emphasis on epidemiology, etiology, diagnosis and differential diagnosis, as well as the treatment of extrapyramidal disorders induced by antipsychotics. Dystonia. Sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It may appear either as an acute or delayed, i.e. tardive sign. The incidence of dystonia is 2-3% among the patients treated with antipsychotics, and 50% among the ones cured with conventional antipsychotics. Akathisia. The main feature of this curious adverse effect is the psychomotor restlessness and the inability to remain motionless. Although akathisia is not very frequent, its incidence and prevalence ranges from 5 to 50% among the treated patients. It is most probably a result of the blockage of dopaminergic receptors. Parkinsonism. The most frequent secondary Parkinsonism is the one caused by drugs. The characteristic parkinsonian signs regress 4 to 16 weeks after the discontinuation of antipsychotic therapy. In the era of atypical antipsychotics this adverse effect appears less frequently. Tardive dyskinesia. Involuntary choreatic movements may appear days and months after the introduction of continuous use of antipsychotics. The individual susceptibility may play the major role in the development of this side effect. Conclusion. Numerous studies have compared conventional and atypical antipsychotics as well as atypical ones with one another in order to decrease the risk of development of extrapyramical side effects as well as to prevent their occurrence and improve their treatment.

First-line atypical antipsychotics for schizophrenia are appropriate – with psychosocial interventions

2001 ◽  
Vol 25 (8) ◽  
pp. 287-288 ◽  
Author(s):  
A. M. Mortimer
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Treatment Resistance ◽  
Psychosocial Interventions ◽  
First Line ◽  
Conventional Antipsychotics ◽  
Increased Risk ◽  
Loss Of Libido ◽  
The Individual

Conventional antipsychotics, historically the mainstay of schizophrenia treatment, were ineffective in many patients, at least 30% fitting treatment-resistance criteria (Kane & Lieberman, 1987). All had the same mechanism of action: none was any more effective in the individual than any other. Therapeutic nihilism accepted poorly controlled positive symptoms and disabling negative symptoms: nearly all patients suffered side-effects (Barnes & Edwards, 1993), particularly extrapyramidal side-effects (EPS) and hyperprolactinaemia. Conventional antipsychotics raise prolactin to a range associated with sexual dysfunction or even macroprolactinoma: effects in men include erectile dysfunction and hypospermatogenesis; in women, galactorrhoea, oligo- or amenorrhoea, hirsutism and increased risk of osteoporosis. In both men and women there is loss of libido, and a link between hyperprolactinaemia and weight gain.

Switching Antipsychotic Therapies

2000 ◽  
Vol 34 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Prakash S Masand ◽  
Sarah L Berry
Keyword(s):  
Adverse Effect ◽  
Atypical Antipsychotic ◽  
Atypical Antipsychotics ◽  
Psychotic Symptoms ◽  
Double Blind ◽  
Medline Search ◽  
Mood Symptoms ◽  
Conventional Antipsychotics ◽  
Hospitalization Rates ◽  
Study Selection

BACKGROUND: Atypical antipsychotics are superior to conventional antipsychotics in improving positive and negative psychotic symptoms. Atypical antipsychotics do not exacerbate mood symptoms, and may improve mood symptoms and cognitive functioning; additionally, they have better adverse effect profiles than conventional antipsychotics. OBJECTIVE: To review the benefits of switching patients with schizophrenia or schizoaffective disorder from a conventional to an atypical antipsychotic, or from one atypical antipsychotic to another. In spite of the higher acquisition cost of atypical antipsychotics, overall treatment costs may decrease due to lower relapse and hospitalization rates. DATA SOURCES: A MEDLINE search (January 1977–January 1999) was conducted for articles written in English about efficacy, adverse effects, compliance, and pharmacoeconomics for atypical and conventional antipsychotics. STUDY SELECTION: Large, multicenter, double-blind, controlled studies were used for efficacy, safety, tolerability, and pharmacoeconomic data. Where appropriate, recent review articles were also used. RESULTS: Atypical antipsychotics are superior to conventional antipsychotics in the treatment of schizophrenia. Atypical and conventional antipsychotics have different adverse effect profiles, costs, and compliance rates. CONCLUSIONS: Some patients may benefit by switching from a conventional to an atypical antipsychotic, from an atypical to a conventional antipsychotic, or from one atypical antipsychotic to another. Methods of switching antipsychotic therapies include tapering and cross-over strategies.

Current use of atypical antipsychotics

2002 ◽  
Vol 17 (S4) ◽  
pp. 377s-384s ◽  
Author(s):  
F. Müller-Spahn
Keyword(s):  
Side Effects ◽  
Negative Symptoms ◽  
Atypical Antipsychotics ◽  
Term Treatment ◽  
Dopamine Neurons ◽  
Positive Symptoms ◽  
Onset Of Action ◽  
Conventional Antipsychotics ◽  
Long Term Treatment ◽  
Insufficient Response

SummaryIn terms of the phenomenology of schizophrenia, there are four targets for drug treatments: positive symptoms, negative symptoms, affective dysfunction, and cognitive dysfunction. Because of the side-effects of both conventional antipsychotics and the new atypicals, there still is a need to search for better-tolerated antipsychotics. Conventional antipsychotics have two principal limitations: 30–40% of patients have an insufficient response to them, and they have a large variety of adverse effects. Side-effects will reduce patients’ compliance with treatment, as well as their immediate quality of life, and may therefore unfavorably affect rehabilitation. Four principal features differentiate atypical from conventional antipsychotics, yet have not been established for all atypicals: fewer extrapyramidal side-effects, greater efficacy in the treatment of negative symptoms, specific pharmacological receptor binding profiles, and greater selective effect on the mesolimbic dopamine neurons than on nigrostriatal neurons. The pharmacological profile of amisulpride is completely different to that of other atypical antipsychotics. It has a high selectivity for D2 and D3 dopamine receptors, and thus would be expected to be devoid of unwanted side-effects associated with action on other neurotransmitter systems. It acts preferentially on the mesocortical and mesolimbic systems. It has an earlier onset of action than haloperidol. Amisulpride is a compound with a dual mode of action. At low doses it blocks presynaptic dopamine autoreceptors, inducing an increased dopaminergic neurotransmission, and at high doses it blocks postsynaptic dopaminergic activity. It is at least as effective as haloperidol, flupenthixol, and risperidone in controlling positive symptoms, as well as having efficacy for negative symptoms. It has less propensity to induce weight gain than do other atypical antipsychotics. For the 60–80% of patients with schizophrenia who require long-term treatment, drug tolerability is crucially important, as it will improve compliance, and therefore reduce relapse rate.

Is it worth while changing clinically stable schizophrenic out-patients with mild to moderate residual symptoms and/or side effects from conventional to atypical antipsychotics? A prospective, randomised study with olanzapine

2004 ◽  
Vol 19 (8) ◽  
pp. 516-518 ◽  
Author(s):  
Björn Appelberg ◽  
Katinka Tuisku ◽  
Grigori Joffe
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotics ◽  
Residual Symptoms ◽  
Randomised Study ◽  
Conventional Antipsychotics ◽  
Schizophrenic Outpatients ◽  
Prospective Randomised Study

AbstractFifty clinically stable, schizophrenic outpatients, suffering from residual schizophrenic symptoms and/or neurological side effects, were randomised to either continue their conventional neuroleptic(s) or change it to olanzapine. After 12 weeks patients on olanzapine exhibited significant improvement in neurological side effects and psychotic symptomatology as compared to patients on conventional antipsychotics.

scholarly journals An audit assessing the monitoring of SSRIS after initiation in children and adolescents

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S41-S41
Author(s):  
Ella McGowan
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Alternative Plan ◽  
Medication Dose ◽  
The Common ◽  
The One ◽  
Accurate Record

AimsTo identify children and adolescents started on SSRIs to see if they are being followed up in accordance to NICE and Maudsley guidelinesObjectivesHas the patient been followed up after a week to check for adverse effects or improvement in their mental state?Has the patient been re-evaluated every 4-6 weeks, if not is there an alternative plan?If there is no improvement has the dose been increased?If there is an adverse effect has the dose been lowered or the medication stopped?MethodPaper case notes including clinic letters and handwritten notes were reviewed on the 19/10/2020. The following data were collected anonymously.AgeGenderDate seen / Date medication startedName of medicationDate medication startedDate of Follow-upMonitoring of improvementMonitoring of adverse effectsOutcome of monitoringResultA total of 18 sets of cases were identified.Follow-up occurred in 17 of the 18 cases.The one case that had not been followed up had started the medication 8 weeks before the audit. The median follow-up time was 42 days (6 weeks). No cases were followed up within a week.Monitoring of improvement was recorded in 88% of case notes reviewed.Monitoring for adverse effects occurred in 36% of case notes and none of these patients had reported any side effects. 53% of cases did not have monitoring of adverse effects documented. There were two patients (11%) who did not take the medication as prescribed. One out of choice and one their parent had not collected it.The medication dose was increased in 22% of patients without clear documentation of monitoring for adverse effects.ConclusionAfter discussion with the clinical lead it was decided it is impractical to follow up patients a week after starting medication. However, patients and their carers should be informed of the side effects and advised to contact CAMHS if adverse effects occur.The area of practice that can be improved is the documentation of adverse effects at follow-up.Recommendations:All patients to be informed of the common side effects of the medication before it is initiated and advised to contact the CAMHS team if they have concernsAll CAMHS patients started on SSRIs should be followed up within 4-6 weeksAt follow-up any adverse events and clinical response should be discussedAn accurate record of the exchanges of the above information should be documented in the notesRe-audit

Understanding the Results of CATIE in the Context of the Field

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S7) ◽  
pp. 40-47 ◽  
Author(s):  
Ira D. Glick
Keyword(s):  
Side Effects ◽  
Treatment Adherence ◽  
Atypical Antipsychotics ◽  
Phase 1 ◽  
Metabolic Effects ◽  
Valid Assessment ◽  
The Individual ◽  
Meta Analyses ◽  
Term Management

AbstractThe Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study was undertaken to provide a valid assessment of the differences between conventional and atypical antipsychotics and among the atypicals themselves in patients with schizophrenia. The CATIE investigators reported that while none of the study medications were ideal, olanzapine was the most effective in terms of treatment discontinuation, and there were no significant differences in effectiveness between the conventional antipsychotic perphenazine and the atypicals quetiapine, risperidone, and ziprasidone. Each drug differed slightly in rates of side effects, with more patients discontinuing perphenazine due to extrapyramidal side effects and more patients discontinuing olanzapine due to weight gain and metabolic effects. In order for data from phase 1 of the CATIE study to be interpreted within the appropriate context, physicians must understand how aspects of study design and statistical methods affect interpretation, and how this trial weighs against other data in the literature. This article enumerates the factors that complicate our understanding of the CATIE results and compares these findings with those from previously published meta-analyses. It is clear that therapeutic and side effects of antipsychotics vary from person to person. The goal of schizophrenia management is to maintain pharmacotherapeutic efficacy and tolerability over the long-term in order to maximize treatment adherence and benefits. What should emerge from CATIE is a renewed commitment to tailor schizophrenia treatment to the individual patient for long-term management.

Impact of Side-Effects of Atypical Antipsychotics on Non-Compliance, Relapse and Cost

2003 ◽  
Vol 31 (3) ◽  
pp. 188-196 ◽  
Author(s):  
A Mortimer ◽  
P Williams ◽  
D Meddis
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Atypical Antipsychotics ◽  
Antipsychotic Agents ◽  
Conventional Antipsychotics ◽  
State Transition Model ◽  
Cost Implications ◽  
The Cost ◽  
The Impact ◽  
Relapse Rates

Atypical antipsychotics generally have milder side-effects than conventional antipsychotics, but also differ among themselves in this respect. This study aimed to compare the impact of different side-effect profiles of individual atypical antipsychotics on non-compliance, relapse and cost in schizophrenia. A state-transition model was built using literature data supplemented by expert opinion. The model found that quetiapine and ziprasidone were similar in estimated non-compliance and relapse rates. Olanzapine and risperidone had higher estimated non-compliance and relapse rates, and incremental, 1-year, per-patient direct costs, using US-based cost data, of ~$530 (95% confidence interval [CI] ~$275, $800), and ~$485 (95% CI ~$235, $800), respectively, compared with quetiapine. Incremental costs attributable to different side-effect profiles were highly significant. This study shows that differing side-effect profiles of the newer antipsychotic agents are likely to lead to different compliance rates, and consequent variation in relapse rates. The cost implications of these heterogenous clinical outcomes are substantial.

Critical analysis and comparison of the side-effect and safety profiles of the new antipsychotics*

1999 ◽  
Vol 174 (S38) ◽  
pp. 34-43 ◽  
Author(s):  
Thomas R. E. Barnes ◽  
Mike A. McPhillips
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Individual Case ◽  
New Drugs ◽  
Risks And Benefits ◽  
Conventional Antipsychotics ◽  
Wide Range ◽  
New Antipsychotics

The conventional antipsychotic drugs are associated with a wide range of unwanted effects (Barnes & Guy Edwards, 1993; Guy Edwards & Barnes, 1993). These side-effects represent part of the burden of patients given antipsychotic medication, affect compliance with treatment, and contribute to the prescribing clinician's weigh-ing-up of the risks and benefits of a particular antipsychotic in an individual case. The conventional drugs show differences in their side-effect profiles, particularly with regard to sedation and extrapyramidal problems, and it is probably a reasonable generalisation to state that these have largely governed clinicians' choice. The newer ‘atypical’ antipsychotics (such as clozapine, risperidone, sertindole, olanzapine, quetiapine and amisulpride) are less liable to cause extrapyramidal symptoms than the conventional antipsychotics. However, this advantage is greater for some of the new drugs than for others, and their safety profiles also differ in other key respects. Thus, in terms of side-effects and safety, each of these newer drugs must be evaluated individually.

scholarly journals Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 2: Incidence and Management Strategies in Patients with Schizophrenia

2005 ◽  
Vol 50 (11) ◽  
pp. 703-714 ◽  
Author(s):  
Howard C Margolese ◽  
Guy Chouinard ◽  
Theodore T Kolivakis ◽  
Linda Beauclair ◽  
Robert Miller ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Tardive Dyskinesia ◽  
Atypical Antipsychotics ◽  
De Novo ◽  
Management Strategies ◽  
Antipsychotic Agents ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Conventional Antipsychotic

Objective: Tardive dyskinesia (TD), the principal adverse effect of long-term conventional antipsychotic treatment, can be debilitating and, in many cases, persistent. We sought to explore the incidence and management of TD in the era of atypical antipsychotics because it remains an important iatrogenic adverse effect. Methods: We conducted a review of TD incidence and management literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, management, therapy, neuroleptics, antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. Additional articles were obtained by searching the bibliographies of relevant references. We considered articles that contributed to the current understanding of both the incidence of TD with atypical antipsychotics and management strategies for TD. Results: The incidence of TD is significantly lower with atypical, compared with typical, antipsychotics, but cases of de novo TD have been identified. Evidence suggests that atypical antipsychotic therapy ameliorates long-standing TD. This paper outlines management strategies for TD in patients with schizophrenia. Conclusion: The literature supports the recommendation that atypical antipsychotics should be the first antipsychotics used in patients who have experienced TD as a result of treatment with conventional antipsychotic agents. The other management strategies discussed may prove useful in certain patients.

Quetiapine-induced neuroleptic malignant syndrome

2011 ◽  
Vol 26 (S2) ◽  
pp. 1239-1239
Author(s):  
R.M. Freire Lucas
Keyword(s):  
Side Effects ◽  
Neuroleptic Malignant Syndrome ◽  
Atypical Antipsychotic ◽  
Autonomic Dysfunction ◽  
Antipsychotic Medication ◽  
Atypical Antipsychotics ◽  
Scientific Literature ◽  
Recent Literature ◽  
Altered Consciousness ◽  
Conventional Antipsychotics

Neuroleptic Malignant Syndrome (NMS) is the most serious of acute neurological side effects produced by antipsychotic medication, the prevalence of which varies from 0,4–1,4%. It is typically characterized by hyperthermia, rigidity, altered consciousness and autonomic dysfunction. NMS is induced less by atypical antipsychotics than by conventional antipsychotics, and one particular atypical antipsychotic - quetiapine - rarely causes NMS. In this work, we describe a case of quetiapine-induced NMS, while reviewing the recent literature on this condition.We searched for scientific articles about this topic on the databases MEDLINE, LILACS and PsycINFO, using the search words “neuroleptic malignant syndrome” and “quetiapine”. We chose to preferentially include original articles and recent reviews, or those considered classical articles in the scientific literature.

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