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Biomedical subjects

P Sachdev

Publications and source records attributed to P Sachdev.

At least 55 records · Page 3Linked to original sources
PubMed1995

The development of the concept of akathisia: a historical overview.

This paper traces the history of 'akathisia' and related syndromes, and examines the important studies that have helped shape our current understanding of the concept. Even though the term has come to be used synonymously with drug-induced akathisia, its origin was in the pre-neuroleptic era, and it is still often used to describe syndromes not related to medication. The literature clearly distinguishes restless legs syndrome (RLS) from akathisia. The complexity of the akathisia syndrome has increasingly become manifest, and a number of sub-types have been described. Recent attempts have been made to operationalize its diagnostic criteria and understand its pathophysiology. Akathisia due to non-neuroleptic drugs, in particular the serotonin-specific reuptake inhibitors (SSRIs), has also received much attention. The development of newer psychopharmacotherapeutic drugs, with different side-effects profiles, has made this focus pertinent and timely.

Akathisia, Drug-Induced↗
PubMed1995

Neuropsychological outcome from psychosurgery for obsessive-compulsive disorder.

Seventeen obsessive-compulsive disorder patients treated with psychosurgery were administered a comprehensive neuropsychological test battery. Their performance on neuropsychological testing was compared with that of an age and severity matched sample of 17 OCD sufferers who had not received psychosurgery. The psychosurgery and control groups did not differ in intellectual or memory functioning, consistent with earlier findings that psychosurgery does not reduce global ability estimates. The psychosurgery group performed more poorly than the control group on an adaptation of the Wisconsin Card Sorting Test, demonstrating the possible impact of frontal lobe lesions on the abilities underpinning the formation and shifting of response sets.

Adult↗
PubMed1995

The epidemiology of drug-induced akathisia: Part I. Acute akathisia.

This article reviews the epidemiological data on drug-induced acute akathisia, examining studies in which akathisia was the primary focus as well as those in which it was one of a number of drug side effects studied. The studies are diverse in methodology and suffer from many limitations. Incidence rates for acute akathisia with conventional neuroleptics vary from 8 to 76 percent, with 20 to 30 percent being a conservative estimate; preliminary evidence suggests that the newer atypical antipsychotic drugs are less likely to produce acute akathisia. A number of nonneuroleptic drugs--in particular the serotonin-specific reuptake inhibitors--have been implicated in the development of akathisia, but the epidemiological data are limited. Risk factors for neuroleptic-induced akathisia are not completely understood. Drug dose, rate of increment of dose, and drug potency seem to be important, but the role of sociodemographic factors and other treatment-related variables is modest. Drug-induced parkinsonism is significantly correlated with akathisia. Evidence for iron deficiency as a risk factor is conflicting, and its contribution is likely to be minor.

Acute Disease↗
PubMed1995

The epidemiology of drug-induced akathisia: Part II. Chronic, tardive, and withdrawal akathisias.

This article examines the epidemiological data on chronic akathisia, tardive akathisia, and withdrawal akathisia. The limitations of the data are discussed--in particular, the lack of consistent definitions of the syndromes. The studies suggest that a significant proportion of patients chronically treated with neuroleptics suffer from akathisia. The prevalence may be as high as 40 percent, although a conservative estimate would be closer to 30 percent. Risk factors for the development of chronic akathisia and tardive akathisia are poorly understood, but old age, female sex, iron deficiency, negative symptoms, cognitive dysfunction, and affective disorder diagnosis need to be studied further for their potential role. While there is convincing evidence that akathisia may develop after neuroleptic cessation or reduction in dose, the prevalence and risk factors for withdrawal akathisia are not known. Reports of akathisia in children and the elderly have been few, and more systematic research is necessary. Akathisia appears to be common in individuals with mental retardation treated chronically with neuroleptics.

Adolescent↗
PubMed1995

Clozapine-induced neuroleptic malignant syndrome: review and report of new cases.

The published case reports of clozapine-induced neuroleptic malignant syndrome (NMS) are reviewed, to which the authors add three, and possibly four, new cases seen in Australia, occurring in and estimated 1,250 patients exposed to the drug. The review suggests that typical NMS does occur with clozapine and that its incidence may be as common as with the classic neuroleptics. The features of clozapine-induced NMS may be somewhat different, with fewer extrapyramidal side effects and a lower rise in creatine kinase levels. The occurrence of NMS with clozapine raises important issues with regard to our understanding of the pathophysiology of the syndrome.

Adolescent↗
PubMed1995

Does neurosurgery for obsessive-compulsive disorder produce personality change?

Seventeen patients suffering from intractable obsessive-compulsive disorder treated with neurosurgery were assessed before surgery and a mean 10 +/- 5.1 years after surgery. Change in personality was assessed using a special 34-item schedule on patients and informants. The majority of subjects had not noted any significant changes in personality. The subjects were rated by themselves and their informants to have improved overall in the following characteristics: they were less obsessional, cried less, demonstrated a greater depth of feelings, laughed more, were more sociable, and were less anxious or dependent. Six subjects were judged by informants to have improved in their degree of obsessionality, which was distinguishable from the impact on obsessive-compulsive symptoms. The traits that showed an overall negative change were initiative/drive and energy level. Four subjects (2/4 open and 2/13 stereotactic surgery) were judged to have a negative personality change. Ratings of neuroticism, anxiety, depression, and capacity for pleasure showed significant improvement. We conclude that while most obsessive-compulsive disorder patients treated with stereotactic surgery do not experience a personality change, a small proportion report a positive or negative impact. Of note is the improvement in obsessionality in some patients, and an adverse personality change of the "frontal lobe type" in a few patients.

Adolescent↗
PubMed1995

Neuroleptic-induced respiratory dyskinesia.

Respiratory dyskinesia is a common but under-recognized side effect of chronic neuroleptic administration. It manifests as irregular respiration, dyspnea, grunting or gasping, and abnormal chest or esophageal movements. It occurs almost exclusively in association with other tardive effects of neuroleptics, such as tardive dyskinesia and tardive akathisia. Complications of the disorder include respiratory alkalosis and aspiration pneumonia. The authors describe 5 patients with respiratory dyskinesia whose cases highlight the important clinical features of neuroleptic-induced respiratory dyskinesia and the manner in which some cases may be misdiagnosed. They also review the literature on this syndrome and discuss the likely pathophysiological mechanisms.

Adult↗
PubMed1994

Slowness of movement in melancholic depression.

We studied 10 subjects each with melancholic depression evidencing significant motor retardation (RM), Parkinson's disease (PD) with bradykinesia, and normal healthy controls (NC), matched closely for age and gender, on measurements of motor function and depression, and their performance of simple and complex ballistic movements. The simple movements involved the execution of 10 degrees, 20 degrees, and 40 degrees angular movements using a methodology adapted from Hallett and Khoshbin (1980). The complex movements involved the performance by the right arm and hand of a squeeze and a flexion movement, both sequentially and simultaneously, using a methodology adopted from Benecke et al (1986, 1987). The RM and PD groups demonstrated a smaller increase in the angular velocity as the angle of the movement increased from 10 degrees to 40 degrees than did the NC group. Many PD and RM subjects showed multiple electromyographic (EMG) bursts during the ballistic movements. The RM and PD subjects tended take longer to perform the simultaneous and sequential movements, but nonsignificantly so. The RM group performed the squeeze movement slower when executed as part of the simultaneous movement than when performed as a simple movement. The pause time between the movements when performed sequentially was longer (nonsignificantly) for the RM subjects. Our study demonstrated a disturbance in the execution of simple and complex movements by RM subjects that resembled the disturbance seen in PD. This argues for a common pathophysiological basis for at least some aspects of motor retardation in the two disorders. Reduced dopamine function is one common abnormality that may partially account for these findings.

Basal Ganglia Diseases↗
PubMed1994

A rating scale for acute drug-induced akathisia: development, reliability, and validity.

This paper describes the process of developing a new rating scale for acute neuroleptic-induced akathisia. Previously reported clinical characteristics of akathisia were used to construct the initial version of the scale. This was administered to 100 consecutively admitted psychiatric patients treated with neuroleptic medication. The scale was then subjected to a reliability analysis, and the number of items reduced. A factor analysis of the ratings supported the decision to rate subjective and objective items separately. The new version of the scale (The Prince Henry Hospital Akathisia Rating Scale) was further standardized in its administration. A preliminary examination of its construct validity was performed by calculating the correlations with the ratings on the analogue and global scales, as well as those of depression, anxiety, and hyperactivity. The new scale was administered to 50 new subjects to examine its interrater reliability and concurrent validity with respect to the Barnes Akathisia Rating Scale.

Acute Disease↗
PubMed1994

Clinical characteristics and predisposing factors in acute drug-induced akathisia.

BACKGROUND: As subtypes of drug-induced akathisia have become accepted and attempts have been made at establishing diagnostic criteria, a prospective study of the clinical features and predisposing factors of acute akathisia is a significant deficiency in the literature. METHODS: One hundred consecutive inpatients with non-organic psychotic disorders, not receiving neuroleptics or other drugs and free of akathisia and related disorders at admission, were assessed for psychiatric status and movement disorders at baseline and daily for 2 weeks, with detailed examinations on days 7 and 14. Multiple operational criteria for akathisia were used. The following risk factors were examined: age, sex, current neuroleptic dose, rate of increment of dose, drug type, duration of illness, past use of neuroleptics, extrapyramidal side effects score, Zung Depression Scale score, Spielberger State Anxiety Inventory score, psychosis score, and smoking. RESULTS: Using a global rating, mild akathisia developed in 41% and moderate-to-severe akathisia in 21%. The symptoms that best discriminated akathisia from non-akathisia were shifting weight from foot to foot or walking on the spot, inability to keep legs still, feelings of inner restlessness, and shifting of body position in the chair. The subjective and objective symptoms loaded on separate factors. Akathisia ratings had low correlations with the anxiety and Zung scores. Receiver operating characteristic analysis suggested a cutoff score of 4 on our 10-item Akathisia Scale as optimal for the diagnosis of akathisia, with a stricter criterion of scores of 2 or more on both the subjective and objective items being more suitable for research diagnosis. The most significant predisposing factors were the extrapyramidal side effects score and current neuroleptic dose and its rate of increment, with lesser contributions from serum iron status and medication type. Predictability was, however, modest. CONCLUSION: Acute akathisia is a common syndrome with well-defined clinical features. Its occurrence can be predicted with only modest accuracy.

Acute Disease↗
PubMed1994

Research diagnostic criteria for drug-induced akathisia: conceptualization, rationale and proposal.

This paper argues for consistency in the conceptualization and definition of drug-induced akathisia (DIA), something found lacking in published research reports. It suggests the adoption of a common set of provisional categories with operationally defined diagnostic criteria. The categories proposed are acute, tardive, withdrawal and chronic DIA, with overlap of chronic DIA with the other three. The prerequisites for diagnosis are drug exposure, the presence of characteristic clinical features and the exclusion of non-drug causes. The frequency of the clinical features, and their nature, determine the level of certainty. A decision regarding severity is made independently of diagnostic certainty. Some ways of testing the usefulness and validity of these definitions are discussed.

Akathisia, Drug-Induced↗
PubMed1994

Effect of prolonged treatment with haloperidol on "emotional" defecation and movement in rats in a well-habituated environment.

Sixteen adult male Wistar rats were administered either haloperidol (n = 8), 0.5 mg/kg, or saline (placebo) (n = 8) by subcutaneous injection three times per week for 6 weeks, and were again injected after a 6-week drug-free period. The study was conducted in a well-habituated, distinctive environment to which the rats were introduced 1 hour before the injection on each occasion. The fecal bolus counts 1 hour before and 2 hours after drug injection were obtained, as well as movement counts repeatedly in epochs of 90 seconds upon introduction to the cages and after the injections. Haloperidol produced an overall increase in defecation in the 2 hours after drug injection compared with placebo. The post-drug bolus counts for haloperidol-treated rats were lower in week 2 compared with week 1, but the difference from placebo for this reduction was not significant, and it did not persist beyond week 4. The haloperidol-treated group showed a significant increase in the predrug bolus counts from week 5, suggesting a conditioned response to the cage environment. The haloperidol-treated rats were markedly less mobile than the placebo-treated rats, and with repeated exposure to haloperidol, they tended to develop hypomotility earlier. No tolerance to the movement effect was observed. The defecation and movement effects of haloperidol at 12 weeks were no different from those at week 1. This study supports earlier work indicating that haloperidol produces a dysphoric effect in rats, and it suggests that this effect does not habituate over 6 weeks of repeated administration. It does not replicate the motor aspect of akathisia seen in humans.

Akathisia, Drug-Induced↗
PubMed1994

The clinical features of Tourette's disorder: an Australian study using a structured interview schedule.

The clinical features of an Australian series of patients fulfilling DSM-III-R criteria for Tourette's Syndrome (TS) were examined. Fifty patients, recruited from a hospital-based outpatient clinic and a self-help group, were interviewed using a structured schedule. TS is a complex disorder with wide ranging manifestations. Forty male and ten female TS patients with a mean age of 20.8 years (SD 11.2) were assessed. The mean age of onset of tics was 8.3 years (SD 3.3). Simple motor tics occurring in the rostral body regions were more common (eye 86%, face and head 80%) when compared both to simple tics occurring caudally (leg 52%) and complex motor tics (58%). Simple vocal tics were more common (94%) than complex ones (44%). There was a rostrocaudal pattern in the age of onset and severity of simple motor tics. Rates of comorbidity were 32%, 18% and 30% for Attention-Deficit Hyperactivity Disorder, Major Depression and Generalised Anxiety Disorder respectively and this was reflected in the considerable proportion (32%) of the sample who first presented for reasons other than their tics. There were substantial delays between the age of first presentation and diagnosis of TS owing to the insidious onset of the disorder, misdiagnosis and delays in presentation for help. A comparison of the features of the present patients with those of other published studies revealed similarities with some differences. Better clinical recognition of the symptoms and modes of presentation of TS may improve existing delays in diagnosis and treatment.

Adult↗
PubMed1994

The abortion battle: the Canadian scene.

In January 1988 the Supreme Court of Canada struck down the country's archaic abortion law on the ground that it imposed arbitrary delays and unfair disparities in access to abortion across the country. Since then, the conservative government of Canada has made a few attempts to introduce a new abortion policy, but it did not get passed in the parliament because the revised bills failed to protect women's right to 'life, liberty, and security of the person' within the meaning of the Canadian Charter. Canada has been without an abortion law for over four years and there has been a wide range of provincial policies and confusion in the country. Despite the legal vacuum, Canadian women are not frenziedly having abortions. However, the militancy of the anti-abortion groups has steadily intensified with continued assault on a woman's right to make reproductive choices. Since no law, short of banning abortions altogether, is going to satisfy abortion opponents, the abortion battle will rage on in Canada.

Abortion, Legal↗