Abstract
Extrapyramidal disorders are common adverse events in antipsychotic therapy. However, their diagnosis is difficult due to broad differential diagnosis, and often their specific clinical variant is not recognized, and timely intervention is not performed, which leads to severe patient suffering. This affects the quality of life of patients with schizophrenia and leads to their refusal to receive therapy, which aggravates the course of the disease. The article presents a clinical case of a 33-year-old patient at a psychiatric hospital with schizophrenia combined with such rare severe extrapyramidal disorders as antipsychotic-induced tardive dyskinesia and tardive dystonia.The diagnosis was carried out in accordance with the criteria of the International Classification of Diseases, Tenth Revision (ICD-10). The intensity of clinical manifestations was assessed using the Positive and Negative Syndrome Scale (PANSS), the Abnormal Involuntary Movement Scale (AIMS), and the Barnes Akathisia Rating Scale (BARS). Compliance was assessed using the Method for Measuring Medication Adherence in Psychiatry. Detailed differential diagnosis of tardive dyskinesia and tardive dystonia with akathisia and Huntington’s disease was presented. Substantiated treatment strategy and positive clinical dynamics with increased compliance were described.
Highlights
Extrapyramidal disorders are common adverse events in antipsychotic therapy. Their diagnosis is difficult due to broad differential diagnosis, and often their specific clinical variant is not recognized, and timely intervention is not performed, which leads to severe patient suffering. This affects the quality of life of patients with schizophrenia and leads to their refusal to receive therapy, which aggravates the course of the disease
The article presents a clinical case of a 33-year-old patient at a psychiatric hospital with schizophrenia combined with such rare severe extrapyramidal disorders as antipsychotic-induced tardive dyskinesia and tardive dystonia
Директора по научной и лечебной работе, НИИ психического здоровья, Томский НИМЦ, г
Summary
Это влияет на качество жизни больных с шизофренией и приводит к отказу от приема терапии, что усугубляет течение заболевания. В статье представлен клинический случай 33-летнего пациента психиатрического стационара с шизофренией, сочетанной с такими редкими, но тяжелыми экстрапирамидными нарушениями, как тардивная дискинезия и тардивная дистония, индуцированными приемом антипсихотиков. Диагностика проводилась в соответствии с критериями Международной классификации болезней десятого пересмотра (МКБ-10). Проведена оценка комплаенса с помощью Метода прогнозирования медикаментозного комплаенса в психиатрии. Представлена развернутая дифференциальная диагностика тардивной дискинезии и поздней дистонии с акатизией и болезнью Гентингтона. Исследование выполнено при финансовой поддержке РФФИ в рамках научного проекта No 19-315-90010. Исследование одобрено этическим комитетом НИИ психического здоровья, Томский НИМЦ (протокол No 103 от 23.10.2017). Влияние экстрапирамидных антипсихотик-индуцированных нарушений на комплаенс пациента с шизофренией (клинический случай). The effect of antipsychotic-induced extrapyramidal disorders on patient’s compliance with schizophrenia (a clinical case)
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