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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.
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
5.
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
6.
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
7.
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
8.
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
10.
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
11.
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
12.
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
14.
J Clin Psychiatry ; 80(1)2019 01 08.
Artículo en Inglés | MEDLINE | ID: mdl-30695288

RESUMEN

BACKGROUND: Extrapyramidal side effects (EPS) have been identified as a complication of antipsychotic treatment. Previous meta-analyses have investigated EPS prevalence and risk factors in randomized clinical trials with highly selected patients, but studies in real-world schizophrenia are missing. OBJECTIVE: To examine the prevalence and clinical correlates associated with EPS in a nonselected national multicenter sample of stabilized patients with schizophrenia. METHODS: Between 2010 and 2016, patients suffering from schizophrenia (DSM-IV-TR criteria) were recruited through the FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ) network and data were collected during a comprehensive 1-day-long standardized evaluation. The Simpson-Angus Scale and the Abnormal Involuntary Movement Scale were used to assess drug-induced parkinsonism (DIP) and tardive dyskinesia, respectively. RESULTS: The overall prevalence of DIP and tardive dyskinesia was 13.2% and 8.3%, respectively, in this community-dwelling sample of 674 patients. DIP was associated with negative symptoms (Positive and Negative Syndrome Scale [PANSS] subscore) (adjusted odds ratio [aOR] = 1.102, P < .001), first-generation antipsychotic prescription (aOR = 2.038, P = .047), and anticholinergic drug administration (aOR = 2.103, P = .017) independently of sex, age, disorganization (PANSS disorganized factor), and antipsychotic polytherapy. Tardive dyskinesia was associated with PANSS disorganized factor (aOR = 1.103, P = .049) independently of sex, age, negative symptoms, excitation, first-generation antipsychotic prescription, and benzodiazepine and anticholinergic drug administration. CONCLUSIONS: Our results indicate the high prevalence of EPS in a nonselected community-dwelling clinically stable sample of outpatients with schizophrenia. In the monitoring of antipsychotic treatment, EPS should be systematically evaluated, especially when negative symptoms and disorganization or cognitive alteration are present. Monotherapy with a second-generation antipsychotic should be preferentially initiated for patients with these side effects.


Asunto(s)
Antipsicóticos/efectos adversos , Discinesia Inducida por Medicamentos , Enfermedad de Parkinson Secundaria , Esquizofrenia/tratamiento farmacológico , Discinesia Tardía , Adulto , Antipsicóticos/administración & dosificación , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Discinesia Inducida por Medicamentos/diagnóstico , Discinesia Inducida por Medicamentos/epidemiología , Discinesia Inducida por Medicamentos/prevención & control , Femenino , Francia/epidemiología , Humanos , Vida Independiente/estadística & datos numéricos , Masculino , Administración del Tratamiento Farmacológico/normas , Evaluación de Necesidades , Enfermedad de Parkinson Secundaria/inducido químicamente , Enfermedad de Parkinson Secundaria/diagnóstico , Enfermedad de Parkinson Secundaria/epidemiología , Enfermedad de Parkinson Secundaria/prevención & control , Prevalencia , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Esquizofrenia/epidemiología , Discinesia Tardía/inducido químicamente , Discinesia Tardía/diagnóstico , Discinesia Tardía/epidemiología , Discinesia Tardía/prevención & control
15.
J Craniofac Surg ; 30(2): e137-e138, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30614996

RESUMEN

A 68-year-old woman, presented with a squamous cell carcinoma of the malar region, and underwent wide local excision. During her clinical examination, repetitive protrusion and intrusion of the tongue as well as stereotypic, abnormal movements of the mouth and lips were observed, in a pattern that resembled chewing, sucking or lip pursing; dyskinesias ceased when she was speaking or bringing food to the mouth. She was unaware of the movements and the tongue was observed to move similar to choreiform movements, while revealing a giant "snake-like" macroglossia. She had history of mental retardation and alcohol abuse, and was under classic antipsychotic medications for several years. During a previous neurological investigation, type I Chiari malformation was diagnosed. In this case, concomitant Chiari malformation and neuroleptic-induced tardive dyskinesia, may together have been responsible for giant macroglossia, and to our best knowledege no similar observation has been reported in the literature.


Asunto(s)
Malformación de Arnold-Chiari/complicaciones , Macroglosia/etiología , Discinesia Tardía/complicaciones , Anciano , Alcoholismo/complicaciones , Antipsicóticos/efectos adversos , Femenino , Humanos , Discapacidad Intelectual/complicaciones , Discinesia Tardía/inducido químicamente
16.
Fortschr Neurol Psychiatr ; 87(4): 217-224, 2019 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-29996156

RESUMEN

Tardive dyskinesias (TDs) are still common long-term sequelae of antipsychotic treatment. They are generally irreversible and associated with cognitive deficits, a decrease in quality of life and increased mortality. Furthermore, they potentially contribute to further stigmatization of the affected patients. However due to limited treatment options, antipsychotic drugs are still one of the cornerstones in treatment of most severe mental illnesses. Therefore, knowledge about risk factors and prevention of TDs is crucial. If TDs occur, the immediate optimization of the antipsychotic drug regimen is required. Targeted medical treatments such as VMAT - 2 inhibitors can be considered. The novel VMAT-2 inhibitors are not yet approved in Germany. Other drugs that are currently used to treat TDs include clonazepam and gingko biloba. This review summarizes the current evidence of treatment options of TDs and seeks to formulate clinical recommendations for the prevention and management of TDs.


Asunto(s)
Antipsicóticos/efectos adversos , Discinesia Inducida por Medicamentos , Discinesia Tardía , Discinesia Inducida por Medicamentos/prevención & control , Discinesia Inducida por Medicamentos/terapia , Alemania , Humanos , Calidad de Vida , Discinesia Tardía/inducido químicamente , Discinesia Tardía/prevención & control , Discinesia Tardía/terapia
17.
J Affect Disord ; 244: 78-79, 2019 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-30321768

RESUMEN

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.


Asunto(s)
Compuestos de Litio/efectos adversos , Discinesia Tardía/inducido químicamente , Anciano , Femenino , Humanos
18.
Nervenarzt ; 90(5): 472-484, 2019 May.
Artículo en Alemán | MEDLINE | ID: mdl-30341543

RESUMEN

The treatment of schizophrenic psychoses with antipsychotic drugs (AP) is often associated with an increased risk of delayed occurrence of antipsychotic-associated movement disorders. Persistence and chronicity of such symptoms are very frequent. The risk of developing tardive dyskinesia (TD) is associated with the pharmacological effect profile of a particular AP, with treatment duration and age. This systematic review article summarizes the current study situation on prevalence, risk factors, prevention and treatment options and instruments for early prediction of TD in schizophrenic psychoses. The current data situation on treatment strategies for TD is very heterogeneous. For the treatment of TD there is preliminary evidence for reduction or discontinuation of the AP, switching to clozapine, administration of benzodiazepines (clonazepam) and treatment with vesicular monoamine transporter (VMAT2) inhibitors, ginkgo biloba, amantadine or vitamin E. Although TD can be precisely diagnosed it cannot always be effectively treated. Early detection and early treatment of TD can have a favorable influence on the prognosis and the clinical outcome.


Asunto(s)
Antipsicóticos , Trastornos Psicóticos , Discinesia Tardía , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Humanos , Trastornos Psicóticos/tratamiento farmacológico , Discinesia Tardía/inducido químicamente
19.
J Affect Disord ; 246: 217-223, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30583148

RESUMEN

BACKGROUND: Few studies have assessed the treatment of tardive dyskinesia (TD) in patients with primary mood disorders who are managed with antipsychotics. The effects of once-daily valbenazine on TD were evaluated in adults with a bipolar or depressive disorder. METHODS: Data were pooled from two 6-week double-blind placebo-controlled trials (KINECT 2 and KINECT 3; 114 mood participants) and a long-term blinded extension study (KINECT 3 extension; 77 mood participants) of valbenazine in adults with TD. Efficacy assessments included Abnormal Involuntary Movement Scale (AIMS) total score (sum of items 1-7), Clinical Global Impression of Change-Tardive Dyskinesia (CGI-TD), and Patient Global Impression of Change (PGIC). Safety assessments included treatment-emergent adverse events (TEAEs), Young Mania Rating Scale, and Montgomery-Åsberg Depression Rating Scale. RESULTS: At Week 6, mean improvements in AIMS total score were significantly greater with valbenazine versus placebo (40 mg/day, -3.1 [P < 0.01]; 80 mg/day, -3.5 [P < 0.001]; placebo, -0.9). Significant differences between valbenazine (80 mg/day) and placebo were also found for Week 6 AIMS response (≥50% total score improvement) and CGI-TD response ("much improved" or "very much improved"), but not PGIC response. Sustained improvements in AIMS, CGI-TD, and PGIC were found through 48 weeks. Valbenazine was generally well tolerated, with no unexpected TEAEs, worsening in psychiatric symptoms, or emergence of suicidality. LIMITATIONS: Pooled analyses were conducted post hoc, and neither study was designed to focus solely on mood disorder patients. CONCLUSIONS: In participants with primary mood disorders, once-daily treatment with valbenazine was generally well tolerated and resulted in 6-week and sustained TD improvements.


Asunto(s)
Trastornos del Humor/tratamiento farmacológico , Discinesia Tardía/tratamiento farmacológico , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/complicaciones , Discinesia Tardía/inducido químicamente , Discinesia Tardía/complicaciones , Tetrabenazina/efectos adversos , Tetrabenazina/uso terapéutico , Valina/efectos adversos , Valina/uso terapéutico
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