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2.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31995677

RESUMEN

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Asunto(s)
Antipsicóticos , Antagonistas Colinérgicos , Tamizaje Masivo/métodos , Administración del Tratamiento Farmacológico/normas , Examen Neurológico/métodos , Discinesia Tardía , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Antagonistas Colinérgicos/administración & dosificación , Antagonistas Colinérgicos/efectos adversos , Consenso , Técnica Delfos , Monitoreo de Drogas/métodos , Monitoreo de Drogas/normas , Humanos , Guías de Práctica Clínica como Asunto , Medición de Riesgo/métodos , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Discinesia Tardía/terapia , Proteínas de Transporte Vesicular de Monoaminas/antagonistas & inhibidores
3.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31995679

RESUMEN

Valbenazine and deutetrabenazine are FDA-approved as treatment for tardive dyskinesia (TD). Both medications are vesicular monoamine transporter type 2 (VMAT2) inhibitors, and both are effective for reducing TD symptoms. Clinicians need to be aware of the adverse effects of valbenazine and deutetrabenazine, as well as other key differences between the two, in order to individualize treatment. Using the Abnormal Involuntary Movement Scale assists clinicians in assessing progress for each patient. Treating TD effectively with these new medications will reduce the burden of the condition for patients.


Asunto(s)
Examen Neurológico/métodos , Discinesia Tardía , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Proteínas de Transporte Vesicular de Monoaminas/antagonistas & inhibidores , Monitoreo de Drogas/métodos , Humanos , Administración del Tratamiento Farmacológico , Moduladores del Transporte de Membrana/administración & dosificación , Moduladores del Transporte de Membrana/efectos adversos , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/normas , Psiquiatría/educación , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Discinesia Tardía/tratamiento farmacológico , Tetrabenazina/administración & dosificación , Tetrabenazina/efectos adversos , Resultado del Tratamiento , Valina/administración & dosificación , Valina/efectos adversos
4.
Soins Gerontol ; 24(140): 41-42, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31806178

RESUMEN

In the absence of a therapeutic alternative, the use of neuroleptics in geriatrics should be limited to the bare minimum, given their potentially serious deleterious effects in frail elderly patients. Dyskinesia is one of their most common side effects. Case of an elderly patient in whom the dyskinesia was revealed following abrupt cessation of a neuroleptic taken in the long term with discussions of the etiological hypotheses of this rare situation, which nevertheless deserve to be known.


Asunto(s)
Antipsicóticos , Discinesia Inducida por Medicamentos , Discinesia Tardía , Anciano , Anciano de 80 o más Años , Antipsicóticos/administración & dosificación , Antipsicóticos/efectos adversos , Humanos
5.
Medicine (Baltimore) ; 98(45): e17863, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702651

RESUMEN

RATIONALE: In the past decade, only a few studies have focused on simultaneous bilateral ulnar neuropathy. PATIENT CONCERNS: A 54-year-old Asian male who has suffered from paranoid schizophrenia for 2 years. He reported that flexion contracture occurring over his fourth and fifth fingers on both hands appeared since six months after he started taking the antipsychotic drug. The electromyogram revealed bilateral ulnar neuropathy with chronic axonal degeneration at the elbow level. McGowan classification was performed to evaluate the severity of the ulnar nerve injury, and the patient was diagnosed with a grade 3 injury on his left hand and a grade 2 injury on his right hand. DIAGNOSIS: Simultaneous bilateral ulnar neuropathy at the elbow, a complication caused by tardive dyskinesia in a patient under the high-dose, first-generation, antipsychotic drug. INTERVENTIONS: We consulted a psychiatrist to assist in adjusting the patient's kind of the antipsychotic drug and performed the anterior transposition of ulnar nerve to avoid nerve entrapment caused by tardive dyskinesia. OUTCOMES: Numbness of the palms continued to regress over the following 6 months after the anterior transposition of the ulnar nerve. Regression of the involuntary movements, including repeated bending of the elbows, and shaking of both feet, was noted from the patient but was incomplete. LESSONS: Two literatures concluded that parkinsonian rigidity is the main cause of simultaneous bilateral ulnar neuropathy by Sampath et al and Kurlan et al. Unlike the cases of stereotyped posture-caused neural compression reported previously, we inferred that repeated involuntary motion caused by first-generation antipsychotic drug might have been one of the causes of the patient's nerve compression.


Asunto(s)
Antipsicóticos/efectos adversos , Haloperidol/efectos adversos , Discinesia Tardía/inducido químicamente , Neuropatías Cubitales/inducido químicamente , Antipsicóticos/administración & dosificación , Relación Dosis-Respuesta a Droga , Haloperidol/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Esquizofrenia Paranoide/tratamiento farmacológico
6.
Nurs Clin North Am ; 54(4): 595-608, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31703784

RESUMEN

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.


Asunto(s)
Antipsicóticos/efectos adversos , Rol de la Enfermera , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Antipsicóticos/uso terapéutico , Humanos
7.
Expert Opin Pharmacother ; 20(18): 2209-2221, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31613641

RESUMEN

Introduction: Huntington's disease (HD)-associated chorea and tardive dyskinesia (TD) are hyperkinetic movement disorders that can have deleterious effects on patients' quality of life (QoL). Deutetrabenazine, a vesicular monoamine transporter 2 (VMAT2) inhibitor, was approved by the US Food and Drug Administration (FDA) for the treatment of HD-associated chorea and TD. It is structurally similar to tetrabenazine, an FDA-approved compound for treatment of chorea that is widely used off-label for treatment of TD, but has deuterium modifications that improve its pharmacokinetic profile.Areas covered: Herein, the authors cover the key clinical trials with deutetrabenazine in patients with HD-associated chorea (First-HD and ARC-HD) and in patients with TD (ARM-TD, AIM-TD, and RIM-TD).Expert opinion: Deutetrabenazine demonstrates consistent efficacy across patient types regardless of underlying psychiatric illness, or through use of dopamine-receptor antagonists (DRAs), which are the primary cause of TD. The safety profile of deutetrabenazine in clinical trials is similar to that of placebo. Long-term extension studies in both HD-associated chorea and TD show consistent efficacy and safety. Deutetrabenazine will likely be an integral part of the treatment strategy for HD-associated chorea and TD. Meanwhile, its potential to treat other hyperkinetic movement disorders is still under investigation.


Asunto(s)
Enfermedad de Huntington/tratamiento farmacológico , Discinesia Tardía/tratamiento farmacológico , Tetrabenazina/análogos & derivados , Corea/tratamiento farmacológico , Antagonistas de Dopamina/uso terapéutico , Humanos , Calidad de Vida , Tetrabenazina/uso terapéutico
8.
Qual Life Res ; 28(12): 3303-3312, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31435866

RESUMEN

PURPOSE: Tardive dyskinesia (TD) is a common but serious hyperkinetic movement disorder and side effect of antipsychotic medications used to treat bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ). The purpose of this study was to evaluate health-related quality of life (HRQoL) in a population with diagnoses for BD, MDD, or SZ by comparing patients with TD (n = 197) with those without TD (n = 219). HRQoL in each group was also compared with HRQoL of the general population. METHODS: This study employed a cross-sectional web-based survey. HRQoL was assessed by four instruments: the SF-12 Health Survey, Version 2 (SF-12v2), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), the Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale (SW-ISMI); and two questions on movement disorders. RESULTS: Patients with TD had significantly worse HRQoL and social withdrawal than those without. The differences were more pronounced for physical HRQoL domains than for mental health domains. Patients with more-severe TD, assessed through either self-rating or clinician rating, experienced significantly worse HRQoL than did those with less-severe TD. The impact of TD was substantially greater in patients with SZ than in those with BD or MDD. Compared with the general population, patients with BD, MDD, or SZ experienced significantly worse HRQoL regardless of TD status, although this deficit in HRQoL was greater among those with TD. CONCLUSIONS: The presence of TD is associated with worse HRQoL and social withdrawal. The most severe impact of TD is on physical aspects of patients' HRQoL.


Asunto(s)
Antipsicóticos/efectos adversos , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo Mayor/tratamiento farmacológico , Calidad de Vida/psicología , Esquizofrenia/tratamiento farmacológico , Discinesia Tardía/psicología , Adulto , Trastorno Bipolar/psicología , Estudios Transversales , Trastorno Depresivo Mayor/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicología del Esquizofrénico , Encuestas y Cuestionarios
9.
Continuum (Minneap Minn) ; 25(4): 1081-1098, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31356294

RESUMEN

PURPOSE OF REVIEW: This article reviews the history, nosology, clinical features, epidemiology, and treatment of tardive syndromes. RECENT FINDINGS: The major advance in the field of tardive syndromes has been the development and US Food and Drug Administration (FDA) approval of two vesicular monoamine transporter type 2 inhibitors, valbenazine and deutetrabenazine, for treating tardive syndromes. These medications are derivatives of tetrabenazine and reduce dyskinetic movements by reducing dopamine stimulation. Treatment is not curative, and the medications reduce, or "mask," symptoms but presumably without adding to the long-term risk of increased involuntary movements believed to accrue from suppressive treatment with dopamine receptor-blocking drugs. A confounding advance has been the accumulation of data finding that second-generation antipsychotics, also known as atypical antipsychotics, may not be safer than first-generation antipsychotics in causing tardive syndromes. The public health risk of tardive syndromes may actually have increased as some second-generation antipsychotics, widely promoted to both doctors and patients, are increasingly used as antidepressants. SUMMARY: Tardive syndromes remain a public health risk. Second-generation antipsychotics have not been proven to have less risk than first-generation drugs in causing tardive syndromes and are nevertheless being used more widely to treat depression, bipolar disease, and insomnia. Symptomatic treatment for tardive syndromes is available, although expensive.


Asunto(s)
Discinesia Tardía/diagnóstico , Discinesia Tardía/fisiopatología , Anciano , Antioxidantes/administración & dosificación , Antipsicóticos/administración & dosificación , Ensayos Clínicos como Asunto/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Discinesia Tardía/tratamiento farmacológico , Tetrabenazina/administración & dosificación , Proteínas de Transporte Vesicular de Monoaminas/antagonistas & inhibidores
10.
Continuum (Minneap Minn) ; 25(4): 1141-1144, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31356297

RESUMEN

This medicolegal article examines a physician's liability when he or she has knowledge of adverse effects associated with a prescription medication and suggests ways to mitigate that liability risk. The article also discusses the circumstances under which pharmaceutical companies face liability for side effects such as tardive dyskinesia.


Asunto(s)
Responsabilidad Legal , Mala Praxis , Educación del Paciente como Asunto/normas , Médicos/normas , Antagonistas de los Receptores de Dopamina D2/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Humanos , Metoclopramida/efectos adversos , Discinesia Tardía/inducido químicamente , Discinesia Tardía/prevención & control
11.
BMC Neurol ; 19(1): 174, 2019 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-31325958

RESUMEN

BACKGROUND: Tardive dyskinesia (TD) is a serious, often irreversible movement disorder caused by prolonged exposure to antipsychotics; identifying patients at risk for TD is critical to preventing it. Predictive models for the occurrence of TD can improve patient monitoring and inform implementation of counteractive interventions. This study aims to identify risk factors associated with TD and to develop a model using a retrospective data analysis to predict the incidence of TD among patients taking antipsychotic medications. METHODS: Adult patients with schizophrenia, major depressive disorder, or bipolar disorder taking oral antipsychotics were identified in a Medicaid claims database (covering six US states from 1997 to 2016) and divided into cohorts based on whether they developed TD within 1 year after the first observed claim for antipsychotics. Patient characteristics between cohorts were compared, and univariate Cox analyses were used to identify potential TD risk factors. A cross-validated version of the least absolute shrinkage and selection operator regression method was used to develop a parsimonious multivariable Cox proportional hazards model to predict diagnosis of TD. RESULTS: A total of 189,415 eligible patients were identified. Potential TD risk factors were identified based on the cohort analysis within a sample of 151,280 patients with at least 1 year of continuous eligibility. The prediction model had a clinically meaningful concordance of 70% and was well calibrated (P = 0.32 for Hosmer-Lemeshow goodness-of-fit test). Age (hazard ratio [HR] = 1.04, P < 0.001), diagnosis of schizophrenia (HR = 1.99, P < 0.001), antipsychotic dosage (up to 100 mg/day chlorpromazine equivalent; HR = 1.65, P < 0.01), and comorbid bipolar and related disorders (HR = 1.39, P < 0.01) were significantly associated with an increased risk of TD. Other potential risk factors included history of extrapyramidal symptoms (HR = 1.35), other movement disorders (parkinsonism, HR = 1.43; bradykinesia, HR = 1.44; tremors, HR = 2.12, and myoclonus, HR = 2.33), and diabetes (HR = 1.13). A modest reduction in the risk of TD was associated with the use of second-generation antipsychotics (HR = 0.85) versus first-generation drugs. CONCLUSIONS: This study identified factors associated with development of TD among patients taking antipsychotics. The prediction model described herein can enable physicians to better monitor patients at high risk for TD and recommend appropriate treatment plans to help maintain quality of life.


Asunto(s)
Antipsicóticos/efectos adversos , Discinesia Tardía/inducido químicamente , Adulto , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo Mayor/tratamiento farmacológico , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Esquizofrenia/tratamiento farmacológico
12.
J Manag Care Spec Pharm ; 25(7): 810-816, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31232207

RESUMEN

BACKGROUND: Tardive dyskinesia (TD) is an often-irreversible movement disorder affecting any part of the body. Patients experience debilitating symptoms that lower quality of life and increase mortality. Prolonged exposure to dopamine antagonists, which are frequently prescribed for psychiatric disorders as neuroleptic (antipsychotic) drugs, is a common cause of TD. The estimated prevalence of TD is 20%-50% among patients on antipsychotics, and the reported incidence of TD ranges from < 1% to 42%, depending on the antipsychotics studied. However, there are few real-world studies examining health care utilization and the economic burden of TD. OBJECTIVE: To assess health care utilization and costs in a sample of patients with TD from the commercially insured and Medicare supplemental U.S. METHODS: A retrospective analysis was conducted using Truven MarketScan Commercial and Medicare administrative claims data. Patients were included in the TD group if they had the first TD diagnosis (index date) between January 1, 2008, and September 30, 2014, with ≥ 1 inpatient or ≥ 2 outpatient nondiagnostic claims for TD (ICD-9-CM code 333.85). Patients without TD were randomly assigned an index date. Further inclusion criteria for all patients were ≥ 12 months of pre- and post-index medical and pharmacy continuous enrollment and no evidence of TD claims during the pre-index period. Patients with TD were directly matched to patients without TD within subgroups for schizophrenia, major depressive disorder, bipolar disorder, and other psychiatric disorders and propensity matched on other demographic and clinical factors. Descriptive statistics on the incidence of resource utilization and costs of health care were reported. RESULTS: Of 3,397 patients with TD, 834 met the selection criteria and were matched to 834 non-TD controls. Patients with TD generally had significantly greater utilization during the 12 months after TD diagnosis than in the 12 months before TD diagnosis. Their rates for health care utilization and costs were also substantially higher than for those without TD. During the post-TD-diagnosis time, inpatient admissions (55.5% vs. 26.1%; P < 0.001) and emergency room visits (61.5% vs. 50.6%; P < 0.001) occurred more for patients with TD than for patients without TD. Total health care costs were significantly greater for patients with TD than for those without TD ($54,656 vs. $28,777; P < 0.001). CONCLUSIONS: Patients diagnosed with TD demonstrate significantly higher health care utilization and costs compared with non-TD patients. DISCLOSURES: This study was funded by Teva Pharmaceuticals (Petach Tikva, Israel). Truven Health Analytics, an IBM Watson Health Company, received payment from Teva Pharmaceuticals for the analysis in this study. Carroll is employed by Teva Pharmaceuticals and Irwin is employed by Truven Health Analytics, an IBM Watson Health Company.


Asunto(s)
Antipsicóticos/efectos adversos , Prestación de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Discinesia Tardía/terapia , Anciano , Anciano de 80 o más Años , Antipsicóticos/administración & dosificación , Costo de Enfermedad , Femenino , Humanos , Seguro de Salud/economía , Masculino , Medicare/economía , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Calidad de Vida , Estudios Retrospectivos , Discinesia Tardía/economía , Discinesia Tardía/etiología , Estados Unidos
13.
PLoS One ; 14(6): e0216044, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31163035

RESUMEN

BACKGROUND: Tardive dyskinesia (TD) is a movement disorder resulting from treatment with typical and atypical antipsychotics. An estimated 16-50% of patients treated with antipsychotics have TD, but this number may be underestimated. The objectives of this study were to build an algorithm for use in electronic health records (EHRs) for the detection and characterization of TD patients, and to estimate the prevalence of TD in a population of patients exposed to antipsychotic medications. METHODS: This retrospective observational study included patients identified in the Optum EHR Database who received a new or refill prescription for an antipsychotic medication between January 2011 and December 2015 (follow-up through June 2016). TD mentions were identified in the natural language-processed clinical notes, and an algorithm was built to classify the likelihood that the mention represented documentation of a TD diagnosis as probable, possible, unlikely, or negative. The final TD population comprised a subgroup identified using this algorithm, with ≥1 probable TD mention (highly likely TD). RESULTS: 164,417 patients were identified for the antipsychotic population, with1,314 comprising the final TD population. Conservatively, the estimated average annual prevalence of TD in patients receiving antipsychotics was 0.8% of the antipsychotic user population. The average annual prevalence may be as high as 1.9% per antipsychotic user per year, allowing for a more-inclusive algorithm using both probable and possible TD. Most TD patients were prescribed atypical antipsychotics (1049/1314, 79.8%). Schizophrenia (601/1314, 45.7%), and paranoid and schizophrenia-like disorders (277/1314, 21.1%) were more prevalent in the TD population compared with the entire antipsychotic drug cohort (13,308/164,417; 8.1% and 19,359/164,417; 11.8%, respectively). CONCLUSIONS: Despite a lower TD prevalence than previously estimated and the predominant use of atypical antipsychotics, identified TD patients appear to have a substantial comorbidity burden that requires special treatment and management consideration.


Asunto(s)
Antipsicóticos/efectos adversos , Esquizofrenia/epidemiología , Discinesia Tardía/epidemiología , Adulto , Anciano , Algoritmos , Antipsicóticos/uso terapéutico , Comorbilidad , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia Paranoide/tratamiento farmacológico , Esquizofrenia Paranoide/epidemiología , Discinesia Tardía/inducido químicamente , Estados Unidos/epidemiología , Adulto Joven
15.
BMJ Case Rep ; 12(5)2019 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-31147409

RESUMEN

Domperidone has difficulty passing the blood-brain barrier, thus rarely causes tardive dyskinesia. Furthermore, its symptoms in adults are generally mild. Although both alcohol and diabetes are thought to increase the risk of development of tardive dyskinesia, their impact remains controversial, especially diabetes, and factors related to worsened tardive dyskinesia have not been clearly elucidated. A 59-year-old man with type 2 diabetes and history of alcohol misuse, who had been chronically prescribed domperidone at 15 mg/day, showed severe tardive dyskinesia, which was remitted within several days by stopping the drug. In our case, albuminocytological dissociation and white matter hyperintensity on MRI were confirmed, which were thought to be related to blood-brain barrier dysfunction. This present findings indicate that alcohol misuse and type 2 diabetes, as well as albuminocytological dissociation and white matter hyperintensity may result in severe tardive dyskinesia, even in individuals receiving domperidone.


Asunto(s)
Alcoholismo , Diabetes Mellitus Tipo 2 , Domperidona/efectos adversos , Antagonistas de Dopamina/efectos adversos , Discinesia Tardía/diagnóstico , Barrera Hematoencefálica/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen
16.
J Clin Psychopharmacol ; 39(4): 336-343, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31205194

RESUMEN

PURPOSE/BACKGROUND: Dopamine receptor blocking agents (DRBAs), also known as antipsychotics, are medications widely used to treat a growing number of mental health diagnoses. However, their utility is limited by the potential to cause serious adverse movement reactions. Akathisia, dystonia, parkinsonism, and tardive dyskinesia (collectively known as extrapyramidal symptoms or EPSs) are associated with reduced social and occupational functioning, negative patient attitudes toward treatment, and nonadherence to pharmacotherapy. Neuroleptic malignant syndrome is a life-threatening reaction that can result from DRBA use and cause musculoskeletal dysfunction. The aim of this study is to profile patients who have developed DRBA-related movement adverse effects and identify risk factors significantly associated with each subtype of EPSs or other movement disorders (OMDs) such as neuroleptic malignant syndrome. METHODS/PROCEDURES: A report of all potential DRBA-related EPSs or OMDs occurrences within a large community hospital network was generated using International Classification of Diseases, Ninth Revision (ICD-9) and 10th Revision (ICD-10) billing codes. Each patient encounter was manually reviewed to confirm that a documented case of DRBA-related EPSs or OMDs had indeed occurred and subsequently determine the likely causative agent(s). FINDINGS/RESULTS: The resultant cohort of 148 patients experiencing unique DRBA-related EPS or OMD events was analyzed. The average patient was female, middle-aged, and overweight. The most common DRBAs precipitating EPSs or OMDs were haloperidol and quetiapine. In the population studied, age was significantly associated with the subtype of EPSs experienced such that those patients with akathisia and dystonia tended to be younger, whereas those with tardive dyskinesia tended to be older. Body mass index (BMI) category was also negatively correlated with the incidence of dystonia. In addition, it was observed that exposure to specific DRBAs, classes, and routes of administration significantly affected the risk of developing different subtypes of EPSs or OMDs in the study population. IMPLICATIONS/CONCLUSIONS: To our knowledge, this is the first study to describe an association between age and BMI with the risk of akathisia and dystonia, respectively, in patients taking DRBAs. Other trends observed with age and BMI in patients developing DRBA-related EPSs support previously reported findings. Expanding the knowledge base of individual characteristics associated with the risk of developing different subtypes of EPSs or OMDs can help providers and patients anticipate and attempt to mitigate these reactions, and may ultimately improve adherence to DRBA therapy.


Asunto(s)
Antipsicóticos/efectos adversos , Enfermedades de los Ganglios Basales/inducido químicamente , Enfermedades de los Ganglios Basales/etiología , Antagonistas de Dopamina/efectos adversos , Síndrome Neuroléptico Maligno/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Acatisia Inducida por Medicamentos/etiología , Antipsicóticos/uso terapéutico , Estudios de Cohortes , Antagonistas de Dopamina/uso terapéutico , Distonía/inducido químicamente , Distonía/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Movimiento , Oportunidad Relativa , Trastornos Parkinsonianos/inducido químicamente , Trastornos Parkinsonianos/etiología , Pacientes , Factores de Riesgo , Discinesia Tardía/inducido químicamente , Discinesia Tardía/etiología
17.
J Psychosoc Nurs Ment Health Serv ; 57(5): 11-14, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-31042295

RESUMEN

Tardive dyskinesia (TD), the choreoathetoid movements of fingers, arms, legs, and trunk and irregular stereotypical movements of the mouth, face, and tongue, has been the scourge of antipsychotic medications since the approval of chlorpromazine. TD tends to occur late in treatment and sometimes remains after discontinuation of the antipsychotic medication. With the recent approval of two medications, valbenazine (Ingrezza®) and deutetrabenazine (Austedo®), there are now treatments for this disfiguring consequence of dopamine-blocking medications. The current article distinguishes the movement disorder adverse effects of dopamine antagonists, explains the putative mechanism of action, and describes how best to treat TD with the new vesicular monamine transporter 2 (VMAT2) medications now approved by the U.S. Food and Drug Administration. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 11-14.].


Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Discinesia Tardía/tratamiento farmacológico , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Antipsicóticos/uso terapéutico , Clorpromazina/uso terapéutico , Humanos , Enfermería Psiquiátrica , Tetrabenazina/farmacología , Tetrabenazina/uso terapéutico , Valina/farmacología , Valina/uso terapéutico
19.
Neurosci Lett ; 704: 208-211, 2019 06 21.
Artículo en Inglés | MEDLINE | ID: mdl-30986441

RESUMEN

It is known that trace amine-associated receptor 5 (TAAR5) is expressed in various regions of the central nervous system. However, very limited information is available on the behavioral effects of TAAR5 activation and the TAAR5 functional role, in general. We studied the effect of TAAR5 agonist (2-(alpha-naphthoyl) ethyltrimethylammonium iodide) systemic administration on animal behavior. The study was performed on male C57BL/6 mice. It was observed that α-NETA in 10 mg/kg dose caused specific impairment of motor behavior, similar to the manifestations of tardive dyskinesia in humans. It can be assumed that trace amines and TAAR5 may be involved in the human tardive dyskinesia pathogenesis.


Asunto(s)
Actividad Motora/efectos de los fármacos , Naftalenos , Compuestos de Amonio Cuaternario , Receptores Acoplados a Proteínas G/agonistas , Discinesia Tardía/psicología , Animales , Masculino , Ratones Endogámicos C57BL , Discinesia Tardía/inducido químicamente
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