Biomedical subjects
Publications and source records attributed to R Yassa.
The authors present two patients suffering from tardive akathisia. They also review the available literature on the subject. Propranolol was found to be an effective treatment of tardive akathisia in both patients. The implications of this finding are discussed.
The prevalent theory of tardive dyskinesia indicates that this condition may result from an imbalance of the cholinergic-dopaminergic system. Thus, claims have been made that anticholinergic drugs may increase the incidence of tardive dyskinesia and the severity of the established form of this syndrome. The author reviews the literature with these two claims in mind. While the studies published do not indicate that the incidence of tardive dyskinesia is increased by the addition of anticholinergic medication, there is ample evidence to indicate that anticholinergic drugs may increase the severity of established tardive dyskinesia. Thus, it is recommended that anticholinergic drugs should be discontinued when a patient develops tardive dyskinesia.
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A group of 116 lithium-treated patients (53 men, 63 women) with predominant diagnoses of affective disorders were systematically examined for the presence of thyroid disorders. Nine (7.8%) patients (2 men, 7 women) were found to suffer from hypothyroidism after a mean of 3.4 years of lithium therapy. An increase in thyroid-stimulating hormone without clinical hypothyroidism was noted in 2 (1.7%) patients (both men). Hyperthyroidism with a full-blown picture of thyrotoxic nodular goiter was noted in 1 woman, and temporary increases in thyroxine and triiodothyronine were noted in another woman. These findings are discussed in light of other studies.
One hundred thirty-five outpatients were evaluated for tardive dyskinesia (TD). Of the fluphenazine-treated patients (N = 63), 32 were found to have TD as compared with 29 of 72 non-fluphenazine-treated patients. This difference was not statistically significant. There was no difference in duration and total dose of fluphenazine injections between TD and non-TD patients. However, patients receiving fluphenazine injections were found to require fewer hospitalizations after fluphenazine therapy was started.
Mania in old age is not as rare as it was once thought to be. It may constitute up to 5 per cent of admissions in the psychogeriatric department. The clinical picture, for the most part, seems to correspond with mania in younger patients, although some patients may have atypical presentations. Secondary mania should be excluded first, before a firm diagnosis of primary affective disorder is made. The prognosis and treatment of late onset mania do not seem to differ appreciably from those in younger patients.
The authors compared clinical characteristics of 36 late-onset schizophrenic patients from four centers (hospitals in San Diego, Baltimore, Los Angeles, and Montreal). There was a preponderance of the paranoid type with bizarre delusions and auditory hallucinations, chronic course of illness, and response to relatively low doses of neuroleptics. A comparison of late-onset and younger schizophrenic patients revealed both similarities and differences between the two groups. The authors reviewed the relevant literature and discussed the implications for assessing the validity of the concept of late-onset schizophrenia. They believe that, although less common, late-onset schizophrenia is probably as valid an entity (or group of entities) as schizophrenia with onset before age 45.
The prevalence of tardive dyskinesia (TD) in chronic psychiatric outpatients was significantly higher in smokers (46/85) than in nonsmokers (18/69) (p less than 0.001). This increased prevalence was associated with a significantly greater prescribed dose of neuroleptics in women, but not in men. Nicotine increases the synthesis and release of dopamine in the nigrostriatal pathway of animals. Such a mechanism may contribute to the higher prevalence of TD in smokers. The present findings suggest that smoking is a risk factor for the development of TD. A statistically significant association between smoking and TD, however, does not necessarily imply a cause-effect relationship. Treatment of TD with mecamylamine or other central nicotine antagonists merits investigation.
The effect of tardive dyskinesia (TD) on body weight has been studied longitudinally in 14 subjects suffering from severe TD, as rated by the Smith Rating Scale. Patients with trunk and extremity movements showed no reduction in their body weight. However, three of four patients who exhibited respiratory TD, with or without oesophageal involvement, were found to have a significant reduction in their body weight after the appearance of TD, as compared to their condition before.
Although carbamazepine is known to cause hyponatremia, no previous reports have indicated an interaction between carbamazepine and a diuretic. Two patients are described who were treated with this combination and developed symptomatic hyponatremia, which cleared when both drugs were discontinued in one patient and when the diuretic was discontinued in the second patient. The possible mechanisms of action of carbamazepine-induced hyponatremia are discussed.
The authors present a prevalence study of tardive dyskinesia (TD) in the course of antidepressant therapy. Of the 50 patients evaluated, three developed TD. TD developed rapidly and in a short period of time. Withdrawal of antidepressant improved TD in two patients. The literature on TD developing in the course of antidepressant therapy is reviewed, and the different etiological theories are examined.
Patients with late-onset psychosis (defined as psychosis requiring hospitalization at age 45 or more, n = 20) were compared with early-onset psychosis patients (defined as psychosis requiring hospitalization at age 25 or less, n = 56) for the prevalence of tardive dyskinesia (TD). Late-onset psychosis patients were found to have significantly more TD (p less than 0.01), which was more severe (p less than 0.05) and developed in a relatively shorter period of neuroleptic treatment (p less than 0.001), than patients with early-onset psychosis. In addition, TD patients (irrespective of early or late onset of neuroleptic treatment) were found to show a preponderance of drug-free periods (p less than 0.01) in their past neuroleptic history, more so than non-TD patients. Our findings indicate that late-onset psychosis should be considered to be a risk factor for the development of TD.
In a survey of 351 chronically hospitalized adult psychiatric patients, clinical evidence of irregular respiration compatible with respiratory tardive dyskinesia was present in eight subjects (2.3%). In four, audible involuntary respiratory noises were present. All patients with respiratory irregularities had a facio-bucco-lingual dyskinesia and in four the dyskinesia also involved extremities and/or other regions of the body. The prevalence of respiratory irregularities amongst patients with tardive dyskinesia was eight out of 108 (7.4%); none of the patients without tardive dyskinesia had respiratory irregularities. The prevalence of respiratory irregularities was significantly greater in patients with an organic mental disorder (11.1%) compared with those without (1.3%) (P less than 0.005). None of the patients complained of their respiratory symptoms and none had been diagnosed as having a respiratory dyskinesia prior to the survey. In two patients the symptoms were severe, leading in one case to prominent gasping, dysphagia, severe choking when eating, and episodes of aspiration pneumonia. In a second patient the noisy respiration was interpreted as attention-seeking and intimidating behaviour which led to rejection by the staff. In the remaining six patients respiratory symptoms were relatively minor.
Tardive dystonia is a rare late-onset side effect of neuroleptics. This paper presents a prevalence study of 351 inpatients conducted in our hospital. Seven patients (2%) were found to suffer from this condition. The majority were found to be young and had received neuroleptics for a variable number of years before the onset of the dystonia. In general, treatment of this condition is disappointing.
Among 266 chronic inpatients receiving neuroleptics, six of the 137 (4.4%) receiving neuroleptics alone and none of the 129 receiving concomitant anticholinergics manifested the rabbit syndrome. Procyclidine resolved the signs of all affected patients. The syndrome's potential prevalence remains unknown.
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