Biomedical subjects
Publications and source records attributed to D E Casey.
Tardive dyskinesia, a delayed side effect of neuroleptic drugs, requires early recognition and a systematic treatment plan. An outline is presented which offers guidelines for management strategies and drug treatments, along with a summary of recent developments.
Tardive dyskinesia (TD) may be a clinical manifestation of a relative imbalance between the inversely related dopaminergic (DA) and acetylcholinergic (ACh) influences in the central nervous system (CNS). Six patients were evaluated with single challenge doses of a DA agonist, levodopa, and antagonist, droperidol, as well as with an ACh agonist, physostigmine, an antagonist, benztropine, and a placebo. A single blind trial with deanol and placebo followed. Responses, measured by an electrophysiological technique, formed two subgroups. The patients who improved with a DA antagonist or an ACh agonist improved while taking deanol. Another group of patients were made worse with a DA antagonist or ACh agonist and were worsened or had no response while taking deanol. While the results add support to the concept of counterbalancing DA-ACh influences in TD, further investigation of TD subtypes and predictors of drug response is warranted.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A patient who developed severe tardive dyskinesia after the termination of long-term phenothiazine therapy was successfully treated with deanol, a possible precursor of acetylcholine. Physiological measurements were obtained to quantify the clinical course. The authors discuss the practical and heuristic implications of these observations and suggest further consideration of therapy directed toward enhancement of cholinergic activity in the central nervous system.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Neuroleptic (antipsychotic) drug-induced acute extrapyramidal syndromes (EPS) and the late onset tardive dyskinesia (TD) are the major side effects that limit the use of these highly efficacious agents. The appropriate strategy for controlling these side effects is based on the clinical presentations, pathophysiological mechanisms, and contributions of patient and treatment-related risk factors. New information about the mechanisms of action of neuroleptics and the long-term outcome of acute EPS and TD provide valuable insights into these syndromes. The most effective method for maximizing the benefits and minimizing the risks of neuroleptics is to use the lowest effective dose of both neuroleptic and antiEPS drugs in patients who benefit from them. The next major advancement will be to develop new compounds which effectively control psychotic symptoms and are free of the undesirable acute and tardive motor syndromes.
X ray computed tomography has been used since its introduction to evaluate patients with tardive dyskinesia (TD). A critical review of the 18 reports which have appeared since 1976 suggests that TD may be associated with neuroanatomical abnormalities. In particular, a meta-analysis of the reports of ventricular brain ratio found a trend for patients with TD to have larger lateral ventricles than unaffected patients. The magnitude of the difference appears to be small, however, and several well conducted studies have reported negative results. A careful analysis revealed that low statistical power, concurrent neuroleptic treatment, insensitive measures of ventricular dilatation, and variable diagnostic criteria for TD may have led to negative findings in most of the investigations. The possible significance of these results and suggestions for further research are discussed.
The incidence, morbidity, and risk factors for acute extrapyramidal syndromes (EPS) such as akathisia and drug-induced parkinsonism (DIP) in neuroleptic-treated elders have not been systematically explored. This study presents data on 17 elderly patients who were prospectively examined for up to 4 weeks for acute EPS, functional and cognitive status, and behavioral disturbances. Seventy-one percent of subjects developed DIP, and 18% developed akathisia. Predictors of DIP included pre-neuroleptic treatment parkinsonian signs and neuroleptic dose, despite use of low doses of neuroleptics. Development of acute EPS was associated with failure to improve behaviorally. New-onset urinary incontinence was the most common functional abnormality.
Diabetes mellitus is the fourth leading cause of death in the United States and a major cause of blindness and heart disease. Often, physicians do not comply with American Diabetes Association standards of practice. We report improved resident physicians' compliance with American Diabetes Association (ADA) standards of care for patients with Type 2 diabetes mellitus after the implementation of a disease management tool for diabetes mellitus.