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D V Jeste

Publications and source records attributed to D V Jeste.

At least 19 recordsLinked to original sources
PubMed1992

Metoclopramide-associated tardive dyskinesia. An analysis of 67 cases.

OBJECTIVE: To summarize information regarding the frequency, risk factors, clinical characteristics, treatment, and course of metoclopramide hydrochloride-associated tardive dyskinesia obtained from an analysis of 67 case reports. DATA SOURCES: All the case reports of metoclopramide-associated tardive dyskinesia involving human patients in the literature in English obtained by using Index Medicus and Med-Search. The indexing terms used were as follows: metoclopramide, tardive dyskinesia, dyskinesia, parkinsonism, and extrapyramidal side effects. STUDY SELECTION: For a patient to be included, the main published research criteria had to be met based on the information provided. These criteria included exposure to metoclopramide for at least 30 days before the onset of dyskinesia. Fifty-two patients met these criteria. DATA EXTRACTION: One author independently extracted the data. DATA SYNTHESIS: The incidence and prevalence of tardive dyskinesia associated with metoclopramide have not been well studied. The mean (+/- SD) length of treatment with metoclopramide before the onset of symptoms was 20 +/- 15 months. The most common location of the dyskinetic movements was the face (28 [60%] of 47) followed by the tongue (21 [45%] of 47). In 15 (71%) of 21 patients on whom long-term follow-up was provided, the symptoms were still present 6 months or more after discontinuation of metoclopramide. CONCLUSION: Persistent tardive dyskinesia is a serious potential side effect associated with metoclopramide treatment.

Adult↗
PubMed1992

Study of neuropathologic changes in the striatum following 4, 8 and 12 months of treatment with fluphenazine in rats.

Persistent tardive dyskinesia is a serious side effect of long-term treatment with neuroleptics. Although striatal pathologic changes are believed to underlie this potentially irreversible iatrogenic syndrome, the nature of the neuroleptic-induced neuropathology is unclear. In the present study, we treated rats with either vehicle or fluphenazine decanoate (5 mg/kg, IM) every 2 weeks for 4, 8 or 12 months. Four to nine weeks after the last injection, the animals were sacrificed and the density of cells in the central part of the striatum was measured with a computerized image-analysis system. The control and experimental animals did not differ in body weight with 4 and 8 months of treatment, but the rats treated with fluphenazine for 12 months had significantly lower body weights than comparable controls. Four months of neuroleptic use produced no significant neuropathologic changes. The animals treated with fluphenazine for 8 months had a significantly lower density of the large neurons. In the 12-month-treated group, there was no significant difference between the control and experimental animals, probably because of a 'floor effect': the density of the large neurons was significantly lower in the 12-month-treated compared to the 8-month-treated control rats.

Animals↗
PubMed1992

Metoclopramide-associated tardive dyskinesia in hemodialysis patients with diabetes mellitus. Two case reports.

Metoclopramide, a drug used almost exclusively for medical indications, is a dopamine (D-2) receptor blocker and has been reported to cause extrapyramidal side effects. We present two case reports of hemodialysis patients who were treated with metoclopramide for diabetic gastroparesis. Within 12 months of beginning treatment, both patients developed persistent tardive dyskinesia. These cases highlight the fact that some patients who benefit from metoclopramide may also have a relatively high risk of developing persistent tardive dyskinesia. The consultation-liaison psychiatrist can play an important role in the education of the medical staff regarding metoclopramide-induced tardive dyskinesia.

Adult↗
PubMed1992

Gender differences in tardive dyskinesia: a critical review of the literature.

We analyzed data from 76 selected studies on prevalence of tardive dyskinesia (TD), published through 1989. The primary focus was on gender differences. The overall prevalence of TD in the 39,187 patients included in these reports was 24.2 percent, and prevalence was significantly higher in women (26.6%) than in men (21.6%). The gender difference in TD prevalence appeared to narrow intriguingly in more recent studies. Overall, the TD prevalence seemed to reach its peak in the 50-70-year-old age group in men and continued to rise after age 70 in women. Also, women tended to have more severe TD than men. Spontaneous dyskinesia too was found to be more common in women. The material was also analyzed for cultural differences by comparing studies in four continents: North America, Europe, Africa, and Asia. Although grouping together studies from different countries in a continent into a single group is somewhat problematic, we found that Asian patients had lower prevalence of TD than North American, European, and African patients. Limitations of our review (including differences among studies in diagnostic criteria, observer bias, etc.) as well as possible explanations for the reported differences in the risk for TD are discussed.

Antipsychotic Agents↗
PubMed1992

Cognitive deficits of patients with Alzheimer's disease with and without delusions.

OBJECTIVE: The goal of this investigation was to study the prevalence of delusions in Alzheimer's disease and to compare the performance of the delusional and nondelusional groups on a neuropsychological test battery. METHOD: The authors studied 107 patients with Alzheimer's disease and 51 age- and education-comparable normal subjects using a standardized psychiatric interview and a neuropsychological test battery. RESULTS: Thirty-seven patients with Alzheimer's disease had delusions with or without hallucinations. Patients with delusions were significantly more impaired than those without delusions (and the normal comparison group) on the Mini-Mental State examination; Blessed Information-Memory-Concentration Test; Dementia Rating Scale, especially its conceptualization and memory subtests; and a test of verbal fluency. The delusional group also tended to be somewhat more impaired than the nondelusional group on the modified Wisconsin Card Sorting Test and the similarities subtest of the Wechsler Adult Intelligence Scale-revised. CONCLUSIONS: Approximately one-third of patients with Alzheimer's disease had developed psychotic symptoms sometime after the onset of dementia. The presence of psychotic symptoms in Alzheimer's disease was associated with greater cognitive impairment, especially frontal/temporal dysfunction, and possibly with a more rapidly progressive dementia.

Alzheimer Disease↗
PubMed1992

Distinguishing neuroleptic malignant syndrome (NMS) from NMS-like acute medical illnesses: a study of 34 cases.

A study of 34 hospitalized patients with suspected neuroleptic malignant syndrome (NMS) found that 24 had NMS and the other 10 had acute, usually serious, medical problems. There were no demographic, psychopathologic, or treatment-related differences between the groups. NMS patients had more dehydration, cogwheeling, diaphoresis, disorientation, drooling, dysphagia, and rigidity and higher diastolic blood pressure. The groups had similar fevers, heart rates, creatine kinase levels, and white blood cell counts. Three non-NMS patients died during their acute illnesses. Results suggest that considering NMS as a diagnosis and ruling out other acute illnesses such as pneumonia are equally important when a patient on neuroleptic medication becomes medically ill.

Adult↗
PubMed1992

High incidence of tardive dyskinesia in older outpatients on low doses of neuroleptics.

We are conducting a prospective study of tardive dyskinesia (TD) in psychiatric patients over age 45, a large proportion of whom have had less than 1 month of total lifetime neuroleptic exposure. Patients are treated with the lowest effective dose of either haloperidol (usually 1-3 mg daily) or thioridazine (usually 25-75 mg daily). Patients are reexamined 1 month and 3 months after initial assessment and then at 3-month intervals. To date, a total of 68 patients (mean age 69.5 years) have been evaluated. Survival analysis showed a 27 percent cumulative incidence of TD (the 95% confidence interval being 14% to 40%) with 6 months of neuroleptic treatment in the study. The TD and non-TD patients did not differ on demographic and baseline clinical measures. Instrumental assessment showed that a greater proportion of TD patients had subclinical evidence of dyskinesia prior to the institution of neuroleptics, compared with non-TD patients.

Age Factors↗
PubMed1991

Clinical and instrumental assessment of neuroleptic-induced parkinsonism in patients with tardive dyskinesia.

We evaluated 21 right-handed psychiatric patients with tardive dyskinesia (TD) for the presence and laterality of neuroleptic-induced tremor and rigidity. The goals of the study were to assess the frequency and coexistence of TD and neuroleptic-induced parkinsonism (NIP) using instrumental and clinical measurements and to evaluate the hypothesis that when TD and NIP coexisted in the same patient, they were more likely to appear in opposite limbs. Results indicated that a high percentage of TD patients had coexisting rigidity and tremor on the basis of both clinical ratings and instrumental procedures; however, only instrumental procedures were useful in identifying tremor and rigidity asymmetries. We found that TD and tremor or rigidity did not lateralize to opposite limbs, thus weakening the hypothesis that TD and NIP stemmed from reciprocal pathophysiological mechanisms.

Antipsychotic Agents↗
PubMed1991

Deficit syndrome in older schizophrenic patients.

Previous studies have reported that a proportion of younger schizophrenic patients have the "deficit syndrome," with persistent "negative" symptoms not secondary to factors other than the disease process (e.g., depression). Yet, there is scant information on the deficit syndrome in older schizophrenic patients. We studied 46 schizophrenic patients over age 45. Seventeen met the criteria for the deficit syndrome as described by Carpenter et al. (1988), 20 were considered definite nondeficit patients, and 9 could not be classified. The deficit schizophrenic patients had a significantly higher total score on the Scale for the Assessment of Negative Symptoms but similar scores on scales for positive symptoms, depressive symptoms, and overall psychopathology as compared with nondeficit patients. The deficit patients also had a nonsignificantly greater impairment on the Halstead-Reitan Battery. One notable difference between our results and those of Carpenter et al. was in the prevalence of deficit syndrome. We found the prevalence (37%) to be significantly higher than that reported in younger patients (15%). Pending confirmation using larger sample sizes, the increased frequency of the deficit syndrome in our study could possibly be attributed to aging or a longer duration of illness in our subjects.

Aged↗
PubMed1991

Instrumental evidence that age increases motor instability in neuroleptic-treated patients.

Fine control of isometric finger flexion force was measured to evaluate motor instability in 40 schizophrenic/schizoaffective patients exposed to neuroleptics and 43 age-comparable normal controls without prior neuroleptic exposure. All the subjects were free of idiopathic or neuroleptic-induced movement disorders. Older neuroleptic-treated patients exhibited significantly greater instability of isometric force compared with older controls, younger patients, or younger controls. Our study indicated that advanced age and neuroleptic exposure contributed to significantly greater motor instability than would be expected by advanced age or neuroleptic exposure alone. These findings are discussed as they pertain to potential mechanisms underlying neuroleptic-induced extrapyramidal side effects.

Adult↗
PubMed1991

New-onset psychosis in HIV-infected patients.

BACKGROUND: Psychiatric symptoms and disorders are becoming increasingly evident in human immunodeficiency virus (HIV)-infected patients. As psychotic symptoms may be severe and require immediate behavioral management, the authors sought to determine the frequency and clinical characteristics of new-onset psychosis not obviously attributable to substance abuse or delirium in these patients. METHOD: The authors reviewed the English-language literature since 1981 by means of the Index Medicus and MEDLINE for reports of new-onset psychosis in HIV-infected patients and also examined the charts of 124 HIV-infected patients who had been followed up at the San Diego Veterans Affairs Medical Center since 1984. Cases of substance-induced psychosis and delirium were excluded. RESULTS: Results reflect a combination of cases from the authors' study and cases of new-onset HIV-associated psychosis reported in the literature (N = 31). Results of the initial neurologic evaluation, including computed tomography (CT) scan and examination of the CSF, were normal in a majority of patients (CT = 12 of 23 patients; CSF = 10 of 14 patients). Psychotic symptoms improved with neuroleptic treatment although side effects were frequently seen. In some patients (N = 12) psychosis was the presenting manifestation of HIV infection or acquired immunodeficiency syndrome. A proportion of patients (N = 7 [23%]), especially those with an abnormal CT and EEG at the time of presentation with psychosis, tended to have a relatively rapid deterioration in cognitive and medical status. Differences between studies in population and method made it impossible to determine the frequency of new-onset psychosis in the general HIV-infected population. CONCLUSIONS: A common clinical feature noted in new-onset psychosis in HIV-infected patients was acute or subacute onset of symptoms, which included delusions, hallucinations, bizarre behavior, mood or affective disturbances, and mild memory or cognitive impairment. The etiological association of the HIV infection to the psychosis is yet to be established.

AIDS Dementia Complex↗
PubMed1991

Behavioral problems associated with dementia: diagnosis and treatment.

The more common behavioral disturbances associated with dementia in elderly patients include depression, psychosis, and agitation. Diagnosis of the underlying cause of these behavioral disturbances begins with a careful investigation of possible medical or toxic disturbances, followed by a careful diagnostic assessment for co-morbid psychiatric syndromes. Treatment of the psychiatric syndromes is often beneficial to the demented patient, improving functional status and reducing the potential for additional morbidity. Patients receiving psychoactive drugs require close monitoring for side effects.

Aged↗
PubMed1990

Antipsychotics.

The multiple medical problems in the geriatric population complicate the issues of diagnosis and management of behavioral symptoms. Systematic evaluation of the etiology, course, and prognosis of behavioral and psychotic symptoms associated with dementia may clarify the indications for treatment. Further research is needed to evaluate effective adjuncts and alternatives to neuroleptic treatment in the demented elderly and to minimize medication side effects.

Age Factors↗