Abnormal Involuntary Movement Scale Research Articles

The Incidence of Tardive Dyskinesia in the Study of Pharmacotherapy for Psychotic Depression

Tardive dyskinesia (TD) is a debilitating adverse effect associated with antipsychotic treatment. Older age and the presence of mood disorder have been identified as risk factors for the development of TD. Thus, we assessed the incidence of TD in younger and older patients with major depressive disorder with psychotic features who participated in a 12-week clinical trial comparing olanzapine plus sertraline versus olanzapine plus placebo. All subjects (n = 259) were assessed with the Abnormal Involuntary Movement Scale at baseline and after 4, 8, and 12 weeks of treatment (or at termination). We used 7 different published criteria to estimate the prevalence of TD at baseline and the incidence over the duration of the trial. We compared the incidence of TD in subjects 60 years or older and those younger than 60 years. The overall prevalence and incidence of TD varied almost 10-fold, depending on the criteria (prevalence range, 1.2%-8.9%; incidence range, 0.0%-5.9%). Tardive dyskinesia was observed as a clinical adverse event in only 1 subject (0.4%). Whereas older subjects had a higher prevalence of TD at baseline, the incidence in younger and older subjects did not differ significantly. The incidence of TD was relatively low in both younger and older patients with major depressive disorder with psychotic features treated acutely with olanzapine. However, the estimate of the risk of TD varies widely, depending on the criteria used to define TD.

Prevalencia de los efectos extrapiramidales por neurolépticos en personas hospitalizadas con esquizofrenia

The aim of the study was to detect and determine the prevalence of extrapyramidal effects (akathisia, parkinsonism and tardive dyskinesias) in admitted people with schizophrenia who have been treated with typical and atypical neuroleptics. Descriptive and cross-sectional study on Zaldibar's Hospital, with a sample of 28 admitted persons over 18 years diagnosed with schizophrenia, treated with typical and atypical neuroleptics for a period longer than 6 months. The variables studied were sex, age, treatment with neuroleptics, treatment duration and extrapyramidal effects (akathisia, parkinsonism and tardive dyskinesias). To measure extrapyramidal effects were used: the Simpson-Angus Scale for parkinsonism, the Barnes Scale for akathisia and Abnormal Involuntary Movement Scale for tardive dyskinesias. In the study the 21.4% of patients had extrapyramidal effects (akathisia, parkinsonism and tardive dyskinesias). Depending on the type of extrapyramidal effects 14.3% of patients had parkinsonism, 7.1% of patients had akathisia and 3.6% of patients had tardive dyskinesias. The clinical assessment of adverse effects is an important aspect. Encourage the use of specific assessment scales for these adverse effects may be useful as a guarantee of the quality of care and improved patient safety. Nurses have an important role in the assessment of adverse effects.

Association of the dopamine β‐hydroxylase 19 bp insertion/deletion polymorphism with positive symptoms but not tardive dyskinesia in schizophrenia

Overactivity of dopaminergic neurotransmission is a putative mechanism of tardive dyskinesia (TD). Dopamine beta-hydroxylase (DBH) is a key enzyme in the conversion of dopamine to norepinephrine, and plasma DBH activity is altered in TD patients. This study examined whether the functional DBH 5'-Ins/Del polymorphism was associated with TD severity in Chinese patients with schizophrenia. We compared the rate of this polymorphism in patients with (n = 312) and without TD (n = 435), and healthy controls (n = 625). The severity of TD was assessed using the Abnormal Involuntary Movement Scale (AIMS) and psychopathology using the Positive and Negative Syndrome Scale (PANSS). There were no significant differences in the distribution of the allele and genotype frequencies between the patients and controls, or between the patients with and without TD. Also, there was no significant difference in the AIMS total score between the three genotype groups. However, the PANSS positive symptom subscore was significantly higher in patients with Del/Del genotype (13.2 ± 5.2) than those with Ins/Del (11.2 ± 4.9) and Ins/Ins (11.1 ± 3.1) genotypes (both p < 0.05). These results suggest that although the DBH 5'-Ins/Del polymorphism was not associated with susceptibility to TD in patients with schizophrenia, it might be related to positive symptoms of schizophrenia.

Bilateral pallidal stimulation for Wilson's disease

To report on the clinical efficacy of bilateral globus pallidus internus deep brain stimulation in a 29-year-old patient with severe generalized dystonia secondary to Wilson's disease. The primary outcome measure was the Burke-Fahn-Marsden Dystonia Scale motor severity score (blinded assessment) and the secondary outcome measures were the Abnormal Involuntary Movement Scale (blinded assessment) and the Zaritt Caregiver Burden Interview score, at 20-week postoperative follow up. There was a 14% improvement in the Burke-Fahn-Marsden Dystonia Scale motor severity score. Abnormal Involuntary Movement Scale score remained unchanged while the Zaritt Caregiver Burden Interview score improved by 44.4%. Bilateral globus pallidus deep brain stimulation can be effective in ameliorating dystonia and caregiver burden in Wilson's disease. Outcomes may depend on the stage of the disease at which the surgical procedure is completed. © 2013 Movement Disorder Society.

Yokukansan (TJ-54) for treatment of very-late-onset schizophrenia-like psychosis: An open-label study

BackgroundAlthough schizophrenia affects all age groups, late or very-late-onset schizophrenia-like psychosis has not been well studied, and various treatment issues remain unresolved. The objective of the present study was to evaluate the efficacy and safety of yokukansan (TJ-54), Japanese herbal medicine, monotherapy in a diagnostically homogenous group of elderly patients without cognitive impairment suffering from very-late-onset schizophrenia. MethodsForty patients of mean age 73.1±4.8 years, fulfilling both the recent consensus criteria for very late-onset schizophrenia-like psychosis and the DSM-IV-TR criteria for schizophrenia, were assessed by the brief psychiatric rating scale, the clinical global impression scale-severity, and positive and negative syndrome scale at baseline and after 4 weeks administration of TJ-54 (2.5–7.5g/day). In addition, abnormal movements were evaluated with the Simpson-Angus scale, Barnes Akathisia scale, and abnormal involuntary movement scale. ResultsA highly significant (p<0.001) improvement on all measures of psychotic symptomatology was observed in all patients. TJ-54 was very well tolerated by the patients, and no clinically significant adverse effects were observed. Scores on all abnormal movement scales did not differ significantly prior to and after TJ-54 treatment. ConclusionPreliminary results indicate that TJ-54 appears to be an efficacious and safe herbal medicine for treatment of very-late-onset schizophrenia-like psychosis.

Which dyskinesia scale best detects treatment response?

Numerous scales assess dyskinesia in Parkinson's disease (PD), variably focusing on anatomical distribution, phenomenology, time, severity, and disability. No study has compared these scales and their relative ability to detect change related to an established treatment. We conducted a randomized placebo-controlled trial of amantadine, assessing dyskinesia at baseline and at 4 and 8 weeks using the following scales: Unified Dyskinesia Rating Scale (UDysRS), Lang-Fahn Activities of Daily Living Dyskinesia Rating Scale (LF), 26-Item Parkinson's Disease Dyskinesia scale (PDD-26), patient diaries, modified Abnormal Involuntary Movements Scale (AIMS), Rush Dyskinesia Rating Scale (RDRS), dyskinesia items from the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Clinical Global Impression (severity and change: CGI-S, CGI-C). Scale order was randomized at each visit, but raters were aware of each scale as it was administered. Sensitivity to treatment was assessed using effect size. Sixty-one randomized dyskinetic PD subjects (31 amantadine, 30 placebo) completed the study. Four of the 8 scales (CGI-C, LF, PDD-26, and UDysRS) detected a significant treatment. The UDysRS Total Score showed the highest effect size (η(2) = 0.138) for detecting treatment-related change, with all other scales having effect sizes < 0.1. No scale was resistant to placebo effects. This study resolves 2 major issues useful for future testing of new antidyskinesia treatments: among tested scales, the UDysRS, having both subjective and objective dyskinesia ratings, is superior for detecting treatment effects; and the magnitude of the UDysRS effect size from amantadine sets a clear standard for comparison for new agents.

A naturalistic comparison of the efficacy and safety of intramuscular olanzapine and intramuscular levomepromazine in agitated elderly patients with schizophrenia.

BackgroundThere have not been any reports in Japan clarifying the efficacy and safety of intramuscular (IM) olanzapine and IM levomepromazine in agitated elderly patients with schizophrenia. This study was a comparative investigation of the clinical efficacy and safety of IM olanzapine and IM levomepromazine in agitated elderly patients with schizophrenia at 2 hours post-dose.MethodsThe subjects were 52 inpatients who were diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV. Their clinical symptoms were assessed using the Positive and Negative Syndrome Scale Excited Component (PANSS-EC), PANSS, and Agitation Calmness Evaluation Scale (ACES), and their safety was assessed using the Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Rating Scale (BARS), Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), and glucose test.ResultsThe PANSS-EC total score, the ACES score, and the glucose level significantly decreased from baseline in both the IM olanzapine group and the levomepromazine injection group; however, no between-group differences were observed. Mean change from baseline in the PANSS total score, positive score, the BARS score, and the DIEPSS total score was significantly greater in the IM olanzapine injection group compared with the levomepromazine injection group.ConclusionThe results of this study suggest that agitated elderly patients rapidly respond to IM olanzapine and IM levomepromazine treatment. Furthermore, these results suggest that IM olanzapine is safer than IM levomepromazine and causes greater improvement in positive symptoms.

Incidence and time course of extrapyramidal symptoms with oral and long-acting injectable paliperidone: a posthoc pooled analysis of seven randomized controlled studies

BackgroundThe purpose of this study was to compare incidence rates and time course of extrapyramidal symptom (EPS)-related treatment-emergent adverse events (TEAEs) between oral and long-acting injectable (LAI) paliperidone.MethodsThe analysis included pooled data (safety analysis set, 2,256 antipsychotic-treated and 865 placebo-treated patients with schizophrenia) from seven randomized, double-blind, placebo-controlled paliperidone studies (three oral [6 weeks each] and four LAI [9–13 weeks]) and assessed comparable doses (oral, 3–15 mg; LAI, 25–150 mg eq. [US doses 39–234 mg]). We summarized incidence rates and time of onset for EPS-related TEAE, categorized by EPS group terms, ie, tremor, dystonia, hyperkinesia, parkinsonism, and dyskinesia, and use of anti-EPS medication. Mean scores over time for the Abnormal Involuntary Movement Scale (AIMS, for dyskinesia), Barnes Akathisia Rating Scale (BARS, for akathisia), and Simpson Angus Rating Scale (SAS, for parkinsonism) were graphed.ResultsIncidence rates for all categories of spontaneously reported EPS-related TEAEs except for hyperkinesia, were numerically lower in pooled LAI studies than in pooled oral studies. Highest rates were observed in the first week of paliperidone-LAI (for all EPS symptoms except dyskinesia) and oral paliperidone treatment (except parkinsonism and tremor). Anti-EPS medication use was significantly lower in LAI (12%) versus oral studies (17%, P = 0.0035). Mean values for EPS scale scores were similar between LAI and oral treatment at endpoint, and no dose response was evident. Mean reductions (standard deviation) from baseline to endpoint in EPS scale scores were larger for LAI (AIMS, −0.10 [1.27]; BARS, −0.09 [1.06]; SAS, −0.04 [0.20]) versus oral studies (AIMS, −0.08 [1.32]; BARS, −0.03 [1.24]; SAS, 0.0 [0.23]). These changes favored LAI for BARS (P = 0.023) and SAS (P < 0.0001), but not for AIMS (P = 0.49), at endpoint for the studies.ConclusionIn this posthoc descriptive analysis, incidence rates of spontaneously reported EPS-related TEAEs were numerically lower following approximately 90 days of exposure with LAI and approximately 40 days with oral paliperidone at comparable doses.

Orobuccolingual Dyskinesia After Long-Term Use of Black Cohosh and Ginseng

Back to table of contents Previous article Next article LettersFull AccessOrobuccolingual Dyskinesia After Long-Term Use of Black Cohosh and GinsengA. Sen, M.D.A. SenSearch for more papers by this author, M.D.Published Online:1 Oct 2013https://doi.org/10.1176/appi.neuropsych.12120395AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Black cohosh (BC), also known as Cimicifuga racemosa, is a frequently used herbal remedy for alleviating menopausal symptoms.1 Ginseng has been widely used as herbal medicine in eastern Asia.2 We report a on a patient who developed orobuccolingual dyskinesia (OBLD) while being treated with an herbal supplement containing BC and ginseng.Case ReportA 46-year-old woman was admitted to our hospital with a 3-month history of OBLD that interfered with her speech, tongue-biting, and eating difficulties. Her neurological examination was otherwise normal except for OBLD (Abnormal Involuntary Movement Scale Score [AIMSS]: 8). Her personal and family history were not relevant for neuropsychiatric disorders. The patient denied any exposure to dopamine-blocking drugs or other medications. She reported the use of a 2-tablet/day dose of a plant-based preparation containing 20 mg BC and 50 mg Panax ginseng to treat her menopausal symptoms for at least 15 months. The general physical examination, routine blood examinations, and comprehensive tests for movement disorders (also including genetic tests) were all normal. Her cranial computerized tomography, contrast-enhanced cranial magnetic resonance imaging, and cranial fluorodeoxyglucose positron emission tomography were also normal. The preparation was stopped. She improved substantially with a combination of baclofen 40 mg/day and clonazepame 2 mg/day (AIMSS: 2).CommentTo our knowledge, this is the first reported case of OBLD observed after the combined use of BC and ginseng. The action mechanisms, pharmacokinetics, and metabolites of BC have not been totally identified. Recent data have demonstrated that BC may have an effect on dopaminergic, serotoninergic, and GABAergic systems.1 It has been suggested that unknown dopaminergic compounds may contribute to the pharmacological activity of BC.3 More than 30 different ginsenosides, the main components responsible for the actions of ginseng, have been isolated and identified from ginseng.2 In spite of some in-vivo studies indicating that some ginsenosides can be neuroprotective to striatal neurons,4 the results from a recently-published in-vitro study were mixed. This study has shown that low doses of some ginsenosides exhibited striatal neuroprotective effects, whereas overdoses have caused striatal toxic effects.2 Wu et al.2 reported that there could only be a fine line between the neuroprotective and toxic effects of ginsenosides. The use of ginseng can cause complications when used in combination with other medications. Adverse effects, including nervousness and insomnia,2 have been reported from long-term use and high doses of ginseng; BC has been linked to liver, cardiovascular, CNS, and peripheral nervous system adverse events. It was reported that mono-preparation of BC is safe in the short term for otherwise-healthy menopausal women, and Huntley3 recommended limiting its use to 6 months.Estrogens have well-known neuroprotective activity. Postmenopausal estrogen deficiency leaves the dopaminergic system vulnerable to neurotoxicity.5We suggest that BC together with ginseng could be responsible for the OBLD. Previous use of BC together with ginseng should be investigated carefully in patients with OBLD. Further studies on basic pharmacological mechanisms of actions and toxicity of BC and ginsenosides are needed.Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, TurkeyCorrespondence: e-mail: [email protected]comFinancial Disclosure Statement: The author has not received any financial support for this clinical/scientific note.References1 Cicek SS, Khom S, Taferner B, et al.: Bioactivity-guided isolation of GABA(A) receptor-modulating constituents from the rhizomes of Actaea racemosa. J Nat Prod 2010; 73:2024–2028Crossref, Medline, Google Scholar2 Wu J, Jeong HK, Bulin SE, et al.: Ginsenosides protect striatal neurons in a cellular model of Huntington’s disease. J Neurosci Res 2009; 87:1904–1912Crossref, Medline, Google Scholar3 Huntley A: The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa). Expert Opin Drug Saf 2004; 3:615–623Crossref, Medline, Google Scholar4 Lian XY, Zhang Z, Stringer JL: Protective effects of ginseng components in a rodent model of neurodegeneration. Ann Neurol 2005; 57:642–648Crossref, Medline, Google Scholar5 Vegeto E, Benedusi V, Maggi A: Estrogen anti-inflammatory activity in brain: a therapeutic opportunity for menopause and neurodegenerative diseases. Front Neuroendocrinol 2008; 29:507–519Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByEthnobotany, Phytochemistry, Traditional and Modern Uses of Actaea racemosa L. (Black cohosh): A Review17 April 2021Journal of Ethnopharmacology, Vol. 209Reactions Weekly, Vol. 1510, No. 1 Volume 25Issue 4 Fall 2013Pages E50-E50 Metrics PDF download History Published online 1 October 2013 Published in print 1 October 2013

Objective Motion Sensor Assessment Highly Correlated with Scores of Global Levodopa-Induced Dyskinesia in Parkinson's Disease

Chronic use of medication for treating Parkinson's disease (PD) can give rise to peak-dose dyskinesia. Adjustments in medication often sacrifice control of motor symptoms, and thus balancing this trade-off poses a significant challenge for disease management. To determine whether a wrist-worn motion sensor unit could be used to ascertain global dyskinesia severity over a levodopa dose cycle and to develop a severity scoring algorithm highly correlated with clinician ratings. Fifteen individuals with PD were instrumented with a wrist-worn motion sensor unit, and data were collected with arms in resting and extended positions once every hour for three hours after taking a levodopa dose. Two neurologists blinded to treatment status viewed subject videos and rated global and upper extremity dyskinesia severity based on the modified Abnormal Involuntary Movement Scale (mAIMS). Linear regression models were developed using kinematic features extracted from motion sensor data and extremity, global, or combined (average of extremity and global) mAIMS scores. Dyskinesia occurring during a levodopa dose cycle was successfully measured using a wrist-worn sensor. The logarithm of the power spectrum area between 0.3-3 Hz and the combined clinician scores resulted in the best model performance, with a correlation coefficient between clinician and model scores of 0.81 and root mean square error of 0.55, both averaged across the arms resting and extended postures. One sensor unit worn on either hand can effectively predict global dyskinesia severity during the arms resting or extended positions.

Does Tardive Dysmentia Really Exist?

Tardive dysmentia has been described as the behavioral equivalent of tardive dyskinesia in patients with schizophrenia. Its association with tardive dyskinesia and psychopathology has been controversial. The authors assessed 123 inpatients with chronic schizophrenia for presence of tardive dysmentia symptoms/signs. Psychopathology and tardive dyskinesia were also assessed. Of the group, 24 patients (19.5%) had at least one tardive dysmentia symptom/sign, whereas only 1 patient (0.8%) fulfilled the syndromal criteria for tardive dysmentia. Those with tardive dysmentia had higher psychopathology scores, higher Abnormal Involuntary Movement Scale total scores, higher number of women and family psychiatric illness, and higher rates of persistent tardive dyskinesia. Tardive dysmentia symptoms/signs are frequently seen in chronic schizophrenia, but the complete syndrome may be rare.

Dyskinésies tardives sous neuroleptiques classiques : à propos d’une population tunisienne de schizophrènes

The term tardive dyskinesia (TD) is used to describe abnormal movement, primarily associated with typical antipsychotic drugs, which are used to treat psychotic states such as schizophrenia. TD is characterised by repetitive involuntary purposeless muscle contractions that force parts of the body into abnormal, and sometimes painful, movements or postures. These movements are involuntary and are difficult or impossible to control. TD usually begins with the face, mouth, lips and tongue, and includes grimacing, lip-smacking, tongue movements and rapid blinking. It may also involve the rest of the body and produce involuntary gestures, tics and writhing movements. TD is severe physically and socially disabling. Schizophrenia is thought to be the psychiatric diagnosis the most frequently associated with TD. The purpose of this article is to study the characteristics of TD in a Tunisian sample of 157 schizophrenics. A variety of demographic and clinical information was obtained by a questionnaire. Diagnoses of schizophrenia and TD were determined by using DSM-VI-R criteria. TD was assessed using the Abnormal Involuntary Movements Scale (AIMS). The average age in this sample was 37 ± 6 years. The intermediate duration of evolution of the disease was 8 ± 3 years with a medium full number of hospitalizations of 4 ± 3. We found 58% of the paranoid sub-type. The intermediate duration of exposure to classical neuroleptics was 7 ± 3 years. The average of daily neuroleptic amount was 572.9 ± 145.3 equivalent milligrams of chlorpromazine. Extended release antipsychotics were used in 64.3% of cases, with fluphenazine deaconate in 90% and haloperidol deaconate in 10%. Anticholinergics were used by 74.5% of patients, with use of biperidene in 96% of cases. Therapeutic observance was good in 89.2% of patients. The prevalence of TD was an estimated 35%. The average of AIMS score was 17 ± 9, with a minimal score of 3 and a maximal one of 34. The distribution of patients according to severity found a prevalence of 52.7% of subjects with moderate TD, 38.2% with light TD and 9.1% with severe TD. The distribution of patients according to type, according to DSM-IV criteria, found 78.4% of cases with choreiform TD, 17.5% of cases with athetosic TD and 4.1% of cases with rhythmic TD. The intermediate duration of evolution of TD was estimated at 18 ± 6 months with a minimal duration of 3 months and a maximum of 72 months. The distribution of subjects according to duration of evolution of TD found that approximately three quarter of patients presented with TD that had evolved since one duration, lower or equal to one year. The average age of patients at the moment of installation of TD was estimated at 36 ± 6 years with 22 years as a minimal and 46 years as a maximal age. Among them, 81.8% of patients were aged over 30 at the time of the installation of TD. The majority of patients with schizophrenia in Tunisia are still treated with typical antipsychotic drugs, and that's why the prevalence of TD remains relatively high.

17 Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments

Background The present study was devised: (a) to test whether an intensive multidisciplinary rehabilitation treatment (60 h) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 h) and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Methods Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive (group-1) and 20 for a standard treatment (group-2). The rating scales used for the clinical evaluation were: Unified Parkinson’s Disease Rating Scales (UPDRS) II, III, IV, Parkinson’s disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS). Results All outcome measurements improved in both groups of patients, but patients group-1 presented better results: UPDRS II was reduced by 33% in group-1 and by 22% in group-2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg ( p p = 0.08) in group-2. Conclusion Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive.

There is no evidence for an association between the serotonin receptor 3A gene C178T polymorphism and tardive dyskinesia in Korean schizophrenia patients

Background: Tardive dyskinesia (TD) is a potential adverse effect of long-term treatment with antipsychotics. Previous studies have suggested a link between brain serotonergic systems and TD vulnerability. A recent report described that a serotonin 3 receptor (5-HTR3) agonist induced rhythmic movements in mice with complete paraplegia. Furthermore, it has been reported that the 5-HTR3 antagonist ondansetron is efficacious in the treatment of Gilles de la Tourette syndrome (GTS). Aim: The aim of the present study was to determine whether the 5-HTR3A gene C178T polymorphism is associated with antipsychotic-induced TD in Korean schizophrenia patients. Methods: We investigated 280 Korean schizophrenia patients. Subjects with TD (n = 105) and without TD (n = 175) were matched for antipsychotic drug exposure and other relevant variables. Results: The distributions of genotypic (chi-squared = 3.55, p = 0.169) and allelic (chi-squared = 0.40, p = 0.528) frequencies did not differ between patients with and without TD. The total score on the Abnormal Involuntary Movement Scale also did not differ between the two genotype groups (F = 0.94, p = 0.391). Conclusions: The findings of the present study do not support the involvement of the 5-HTR3A gene C178T polymorphism in TD in Korean schizophrenia subjects.

No difference in extrapyramidal side effects between first-generation and second-generation antipsychotics

QUESTION Question: Do second-generation antipsychotics (SGAs) reduce extra-pyramidal side effects (EPS) compared with first-generation antipsychotics (FGAs)? Patients: 227 adults (18–65 years) with DSM-IV schizophrenia or schizophreniform, schizoaffective or delusional disorders....

Low‐dose aripiprazole in the treatment of selective serotonin reuptake inhibitors‐induced orofacial and buccal dystonia

SEVERAL PUBLISHED REPORTS suggest that selective serotonin reuptake inhibitors (SSRI) might induce abnormal movement disorders.1 In that event, clinicians face difficult treatment decisions, especially in cases whereby SSRI cannot be discontinued or decreased. In the following, we report for the first time the case of a patient suffering from severe panic disorder with agoraphobia (PD-A) and severe paroxetine-induced orofacial and buccal dystonia, successfully treated with low-dose aripiprazole. This is the case of a 39-year-old woman with a 1-year history of severe PD-A and concomitant depressive mood, resistant to her previous treatment with fluoxetine 60 mg/d for the last 6 months. On her first consultation at our department, paroxetine was incrementally substituted for fluoxetine, titrated up to 60 mg/d. At this dosage of paroxetine, along with sessions of cognitive behavior therapy, the patient's panic attacks subsided completely within the next 4 weeks with a marked improvement of her agoraphobia. However, on her next appointment the patient complained of severe orofacial movements. Her examination by means of the Abnormal Involuntary Movement Scale (AIMS) – section for rating facial and oral movements – yielded a score of 14 with moderate to severe orofacial and buccal dystonia (dystonic movements of the face, jaw, lips, tongue, perioral area and blinking). At that time, aripiprazole 10 mg/d was added to the patient's regimen and, on her re-examination 10 days later, her abnormal movements had improved markedly (AIMS facial and oral movements score: 4). The patient's improvement was fully preserved until her last follow-up visit 4 months later. Orofacial and buccal motor activity is controlled by dopaminergic neurons of the mesocortical tract. Dopamine inhibits spontaneous movement whereas serotonin inhibits dopaminergic transmission in this tract and thus, releases the characteristic repetitive muscle contractions of orofacial and buccal dystonia. Activation of 5-HT1A auto- and hetero-receptors reduces serotoninergic inhibition of the dopaminergic mesocortical tract and thus, helps restore dopaminergic control of spontaneous orofacial and buccal movements. Extant case reports suggest that the 5-HT1A agonists buspirone and tandospirone are efficacious in the treatment of SSRI-induced abnormal movements, especially bruxism.2, 3 Aripiprazole is a partial agonist/antagonist at dopamine D2 and D3 and serotonin 5-HT1A receptors and antagonist at the 5-HT2A receptors. We hypothesize that its beneficial effect on a patient's orofacial and buccal dystonia is attributable to its partial-agonist activity on dopamine receptors and above all to its partial-antagonist action on 5-HT1A receptors, jointly overwhelming its antagonism of the 5-HT2A receptors. Although anecdotal, our case suggests that low-dose aripiprazole might be a promising new treatment modality of sub-acute SSRI-induced abnormal movements.

Low-Dose Aripiprazole in the Treatment of SSRI-Induced Bruxism

Low-Dose Aripiprazole in the Treatment of SSRI-Induced Bruxism

Brain-Derived Neurotrophic Factor Levels and Its Val66Met Gene Polymorphism Predict Tardive Dyskinesia Treatment Response to Ginkgo Biloba

Tardive dyskinesia (TD) has no well-accepted treatments or known pathophysiology, but low brain-derived neurotrophic factor (BDNF) may play an important role in its pathophysiology. Ginkgo biloba (EGb-761) is a potent antioxidant that has neuroprotective effects mediated through enhancing BDNF levels. We hypothesized that treatment with EGb-761 would increase serum BDNF levels and reduce TD, particularly among schizophrenia patients who have the BDNF valine 66 to methionine (Val66Met) genotype (Val/Val). Serum BDNF levels and genotyping for the BDNF gene Val66Met polymorphism were assessed in Chinese schizophrenic patients with (n = 368) and without (n = 563) TD as well as healthy control subjects (n = 546). About half of the TD patients (n = 157) then participated in a double-blind, randomized, placebo-control 12-week treatment with 240 mg per day of EGb-761. Serum BDNF levels were measured again at posttreatment. Clinical efficacy was determined using the Abnormal Involuntary Movement Scale (AIMS). TD patients had lower BDNF levels than the non-TD patients and healthy controls. EGb-761 treatment improved symptoms of TD and increased BDNF levels compared with placebo treatment. Moreover, the improvement of AIMS total score correlated with the increase in BDNF levels. Furthermore, improvement in the AIMS score was greatest in those with the Val/Val allele and lowest with the Met/Met allele. The BDNF system may be implicated in the pathophysiology of TD and its improvement with antioxidant treatment. Furthermore, patients with the genetic potential for greater BDNF release (Val/Val at 66) may obtain a greater reduction in TD from EGb-761 treatment.

Rehabilitation improves dyskinesias in Parkinsonian patients: A pilot study comparing two different rehabilitative treatments

The present study was devised: (a) to test whether an intensive (60 hours in 4 weeks) multidisciplinary rehabilitation treatment (involving physiotherapy, exercises to improve gait and balance using treadmill and stabilometric platform, occupational therapy) for Parkinsonian patients is effective in improving dyskinesia and motor performance compared to a control group undergoing a non-intensive non multidisciplinary rehabilitation treatment (30 hours in 4 weeks involving physiotherapy only); and (b) to verify whether rehabilitation may lead to a reduction in levodopa dosage. Forty Parkinsonian patients suffering from dyskinesias were admitted to study: 20 for an intensive multidisciplinary (Group1) and 20 for a non-intensive non multidisciplinary rehabilitation treatment (Group2). The rating scales used for the clinical evaluation were: Unified Parkinson's Disease Rating Scales (UPDRS) II, III, IV, Parkinson's disease disability scale (PDDS), Abnormal Involuntary Movement Scale (AIMS). All outcome measurements improved in both groups of patients, but patients Group1 presented better results: UPDRS II was reduced by 33% in Group1 and by 22% in Group2, UPDRS III 29% vs. 22%, UPDRS IV 74% vs. 10%, PDDS 18% vs. 12%, and AIMS 71% vs. 8%. A different behaviour was observed for levodopa dosage at baseline and after treatment: dosage decreased by an average value of 210 mg (p< 0.0001) in Group1 and was virtually unchanged (30 mg reduction, p=0.08) in Group2. Our findings suggest that a rehabilitation protocol should be considered as a valid non-invasive therapeutic support for patients who show dyskinesias and that there are better results when the treatment is intensive.

Cigarette Smoking and Cognitive Function in Chinese Male Schizophrenia: A Case-Control study

Schizophrenic patients have higher smoking rates than the general population. Studies show that smoking may be a form of self-medication in an attempt to alleviate cognitive deficits in schizophrenic patients of European background. This study examined the relationships between smoking and cognitive deficits in Chinese schizophrenic patients, which have previously received little systemic study. We recruited 580 male chronic patients meeting DSM-IV criteria for schizophrenia and 175 male control subjects who were matched on age and education. The subjects completed a detailed cigarette smoking questionnaire, the Fagerstrom Test for Nicotine Dependence (FTND), and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Patients also were rated on the Positive and Negative Symptom Scale (PANSS), the Simpson and Angus Extrapyramidal Symptom Rating Scale (SAES), and the Abnormal Involuntary Movement Scale (AIMS). All five RBANS subscales except for the Visuospatial/Constructional index showed significantly lower cognitive performance for schizophrenics than normal controls. The schizophrenic smokers scored lower than the schizophrenic non-smokers on the RBANS total score and the Visuospatial/Constructional and Immediate Memory indices. Similarly, the control smokers scored lower than the control non-smokers on the RBANS total score and the Immediate Memory index . Also, the schizophrenic smokers consistently performed the poorest on the cognitive domains of the RBANS. Among the schizophrenic patients, smokers displayed significantly fewer negative symptoms than non-smokers. Using multivariate regression analysis the following variables were independently associated with the RBANS total score: years of education, PANSS negative symptom score, age at schizophrenia onset, and number of hospitalizations. Our results show that smoking is associated with significant cognitive impairment in both schizophrenic patients and normal controls, but the smokers with schizophrenia had a reduced level of negative symptoms, suggesting that the benefits of smoking for those with schizophrenia may be limited to certain aspects of a given clinical phenotype.