Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness
| Autor: | Hans W. Hoek, P. Roberto Bakker, Peter N. van Harten, Glenn E. Matroos, Jim van Os, Marina A. J. Tijssen, Marjan Drukker, Charlotte L. Mentzel |
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| Přispěvatelé: | Movement Disorder (MD), Promovendi MHN, Psychiatrie & Neuropsychologie, RS: MHeNs - R2 - Mental Health, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Psychiatrie (3), RS: CAPHRI other |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Movement disorders medicine.medical_treatment Dopamine Agents Tardive dyskinesia 03 medical and health sciences 0302 clinical medicine QUALITY-OF-LIFE Internal medicine CATIE SCHIZOPHRENIA TRIAL medicine Humans Tardive Dyskinesia OUTPATIENT HEALTH OUTCOMES DRUGS Parkinson Disease Secondary Netherlands Antilles Psychiatry Prospective cohort study Antipsychotic METAANALYSIS Neurologic Examination Polypharmacy Drug Substitution ATYPICAL ANTIPSYCHOTICS business.industry Mental Disorders Parkinsonism Middle Aged INDUCED MOVEMENT-DISORDERS medicine.disease PREVALENCE 030227 psychiatry Psychiatry and Mental health Cross-Sectional Studies Treatment Outcome Tolerability TOLERABILITY Female Guideline Adherence POLYPHARMACY Abnormal Involuntary Movement Scale medicine.symptom business 030217 neurology & neurosurgery Antipsychotic Agents |
| Zdroj: | Journal of Clinical Psychiatry, 78(3), E279-E285. Physicians Postgraduate Press Inc. |
| ISSN: | 0160-6689 |
| DOI: | 10.4088/jcp.16m11049 |
| Popis: | OBJECTIVE To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). METHODS We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D₂) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. RESULTS There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D₂ affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D₂ affinity switch model), while starting a high D₂ affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D₂ affinity switch model). CONCLUSIONS The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D₂ affinity antipsychotic may reduce the severity of TD. |
| Databáze: | OpenAIRE |
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