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Tardive dyskinesia
Classification and external resources
ICD-10 G24.0
ICD-9 333.85
OMIM 272620
DiseasesDB 12909
eMedicine neuro/362 

Tardive dyskinesia refers to a variety of involuntary, repetitive movements manifesting as a side effect of long-term or high-dose use of dopamine antagonists, usually antipsychotics. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings G00-G99 - Diseases of the Nervous system (G00-G09 Inflammatory diseases of the Central nervous system ( Bacterial meningitis The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors A dopamine antagonist is a drug which blocks Dopamine receptors by Receptor antagonism. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Other dopamine antagonists that can cause tardive dyskinesia are drugs (e. g. metoclopramide) for gastrointestinal disorders and neurological disorders. Metoclopramide ( INN) (ˌmɛtəˈkloʊprəmaɪd or /ˌmɛtəˈklɒprəmaɪd is a potent Dopamine receptor antagonist used for its Antiemetic and Prokinetic While newer atypical antipsychotics such as olanzapine and risperidone appear to have less dystonic effects, only clozapine has been shown to have a lower risk of tardive dyskinesia than older antipsychotics. The atypical antipsychotics (also known as second generation antipsychotics) are a group of Antipsychotic drugs used to treat psychiatric conditions Olanzapine ( Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, or in combination with Fluoxetine Symbyax) is Risperidone (pronounced Ris-PER-ǐ-dōn and sold under the trade name Risperdal in the Netherlands, United States, Canada, the Clozapine (sold as Clozaril, Leponex, Fazaclo, Froidir; Gen-Clozapine in Canada Clozaril, Denzapine, [1]

The term tardive dyskinesia was introduced in 1964. Year 1964 ( MCMLXIV) was a Leap year starting on Wednesday (link will display full calendar of the 1964 Gregorian calendar. Dyskinesia refers to an involuntary movement. Dyskinesia refers to involuntary movements similar to a Tic or Chorea. The effect of these drugs can be tardive, meaning the dyskinesia continues or appears even after the drugs are no longer taken.

Contents

Features

Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano. For comparison, patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficulty not moving. Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's

Other closely related neurological disorders have been recognized as variants of tardive dyskinesia. Tardive akathisia involves painful feelings of inner tension and anxiety and a compulsive drive to move the body. Akathisia, or acathisia, is a syndrome characterized by unpleasant sensations of "inner" restlessness that manifests itself with an inability to sit still or remain In the extreme, the individual undergoes internal torture and can no longer sit still. Tardive tourettism is a tic disorder that can closely mimic Tourette Syndrome, sometimes to the point where the two can only be distinguished by the details of their onsets. Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome, as the result of other diseases or conditions known as "secondary causes" A tic is a sudden repetitive nonrhythmic stereotyped motor movement or vocalization involving discrete muscle groups Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or more commonly simply Tourette's

Cause

Despite the fact that tardive dyskinesia has existed for over 50 years, its etiology is poorly understood due to the limited research conducted on psychiatric drug side effects. The cause of tardive dyskinesia appears to be related to damage to the system that uses and processes the neurotransmitter dopamine. See Chemical synapse for an introduction to concepts and terminology used in this article Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates The most compelling line of evidence suggests that tardive dyskinesia may result primarily from neuroleptic-induced dopamine supersensitivity in the nigrostrial pathway, with the D2 dopamine receptor being most affected. Neuroleptics act primarily on this dopamine system, and older neuroleptics, which have greater affinity for the D2 binding site, are associated with high risk for tardive dyskinesia. [2] The D2 hypersensitivity hypothesis is also supported by evidence of a dose-response relationship, withdrawal effects, studies on D2 agonists and antagonists, animal studies, and genetic polymorphism research. [2]

Given similar doses of the same neuroleptic individual differences still exist in the likelihood of developing tardive dyskinesia. Such individual differences may be due to genetic polymorphosms, which code for D2 receptor binding site affinity, or prior exposure to environmental toxins. Decreased functional reserve or cognitive dysfunction, associated with aging, mental retardation, alcohol and drug abuse, or traumatic head injuries, has also been shown to increase risk of developing the disorder among those treated with neuroleptics. [2]

The available research seems to suggest that the concurrent prophylactic use of a neuroleptic and an antiparkinsonian drug is useless to avoid early extrapyramidal side-effects and may render the patient more sensitive to tardive dyskinesia. In Human anatomy, the extrapyramidal system is a Neural network located in the brain that is part of the Motor system involved in the coordination Since 1973 the use of these drugs have been found to be associated with the development of tardive dyskinesia (Crane, 1973). Since some of the symptoms of tardive dyskinesia can be interpreted as schizophrenia by doctors, they may prescribe additional neuroleptic drugs to treat it, leading to increased risk of more prevalent tardive dyskinesia. Several studies have indicated that long-term neuroleptic use is associated with both cognitive deterioration and atrophy of the brain. [3][4]

Treatment

Primary prevention of tardive dyskinesia is achieved by using the lowest effective dose of a neuroleptic for the shortest time. If tardive dyskinesia is diagnosed, the causative drug should be reduced or discontinued if possible. Tardive dyskinesia may persist after withdrawal of the drug for months, years, or even permanently. Improvements are also seen in some cases, if the high potency benzodiazepines - lorazepam (Ativan), diazepam (Valium), or clonazepam (Klonopin)--are used. The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Lorazepam (also known by its brand name Ativan or Temesta) is a Benzodiazepine drug with short to medium duration of action Diazepam (daɪˈæzɨpæm first marketed as Valium by Hoffmann-La Roche, is a Benzodiazepine derivative Drug. Clonazepam (marketed by Roche under the trade-names Klonopin in the United States and Rivotril, Ravotril or Rivatril in Europe South The findings about the effects of natural substances, such as vitamin E (Alpha-Tocopherol) or melatonin, are inconclusive. See also Tocopherol, Tocotrienol Vitamin E is the collective name for a set of 8 related Tocopherols and Tocotrienols which are fat-soluble Melatonin is a naturally occurring Hormone found in most animals including humans and some other living organisms including Algae.

The dopamine-depleting drug tetrabenazine has been used to treat tardive dyskinesia and other movement disorders. Cannabis can be useful as well in treating the symptoms of Tardive dyskinesia

Natural remedies are unproven, since they are seldom tested in a controlled setting such as a drug trial. Preliminary research indicates that alternating rest, and regular exercise also negate the symptoms of tardive dyskinesia, necessary for all mental health outpatients who maintain anti-psychotic neuroleptic drug regimes, for on-going 'wellness'. Switching to a newer drug with fewer side effects might be an option for a patient in a controlled or monitored environment.

Epidemiology

Tardive dyskinesia most commonly occurs in patients with psychiatric conditions who are treated with antipsychotic medications for many years. Antipsychotics are a group of Psychoactive drugs commonly but not exclusively used to treat Psychosis, which is typified by Schizophrenia. Some estimates suggest that it occurs in 15-30% of patients receiving treatment with antipsychotic neuroleptic medications for 3 months or longer. “A study being conducted at the Yale University School of Medicine has estimated that 32% of patients develop persistent tics after 5 years on major tranquilizers, 57% by 15 years, and 68% by 25 years. ”[5] Other estimates suggest that with each year of neuroleptic use, 5% of the patients will show signs of tardive dyskinesia, i. e. , 5% after one year, 10% after two years, 15% after three years with no clear upper limit. [6] Eventually, according to these estimates, if on the drugs long enough, the majority of patients will develop the disorder. [7] The incidence of tardive dyskinesia varies with the type of neuroleptic (e. g. , haloperidol (Haldol) more often than perphenazine (Trilafon)), daily dose and duration of treatment (the higher the daily dose and the longer the duration of treatment, the higher the risk). Haloperidol is a Typical antipsychotic. It is in the Butyrophenone class of Antipsychotic medications and has pharmacological effects similar Perphenazine is a Typical antipsychotic drug. Chemically it is classified as a piperazinyl Phenothiazine.

The elderly and female patients are more prone to develop tardive dyskinesia. Cigarette smokers also have a higher prevalence of tardive dyskinesia. Children and adolescents are much more sensitive to the early and late extrapyramidal side-effects of neuroleptics than adults. Because of this, treatment of youngsters with neuroleptics may be contraindicated, and many authorities believe that they should be initiated only as a last resort, using the lowest dose regime possible and the shortest duration of treatment in accordance with good patient management.

Tardive dyskinesia can become a social handicap. Patients and/or their families (guardians and/or caregivers/nurses) should receive full information about the neuroleptic before starting treatment (informed consent). Informed consent is a legal condition whereby a person can be said to have given Consent based upon an appreciation and understanding of the facts implications The benefits need to be weighed by the individual patient/guardian and their physician.

Controversy

Peter Breggin has discussed tardive dyskinesia in the context of his criticism of biological psychiatry. Peter Roger Breggin (born May 11, 1936) is an American Psychiatrist, best known as an advocate of Anti-psychiatry and as a critic Biological psychiatry, or biopsychiatry is an approach to Psychiatry that aims to understand Mental disorder in terms of the biological function [8][9][10][11]

See also

References

  1. ^ Craig & Stitzel; Modern Pharmacology (6th ed) pp. Primary ciliary dyskinesia ( PCD) also known as immotile ciliary syndrome or Kartagener Syndrome (KS, is a rare Autosomal recessive Athetosis is a continuous stream of slow sinuous writhing movements typically of the Hands and feet. Asterixis (also called the flapping tremor) is a Tremor of the wrist when the wrist is extended (dorsiflexion sometimes said to resemble a bird flapping its wings 401.
  2. ^ a b c Hoerger, M. (2007). The primacy of neuroleptic-induced D2 receptor hypersensitivity in tardive dyskinesia. Psychiatry Online, 13(12), 18-26.
  3. ^ Breggin, P. R. (1990) Brain damage, dementia and persistent cognitive dysfunction associated with neuroleptic drugs. Evidence, etiology, implications. Journal of Mind and Behavior, 11, 425 64
  4. ^ Gualtieri, C. T. and Barnhill, L. J. (1988) Tardive dyskinesia in special populations. In M. E. Wolf and A. D. Mosnaim (eds) Tardive dyskinesia. Washington DC: American Psychiatric Press.
  5. ^ Glenmullen, Joseph. Prozac Backlash. ©2000 by Joseph Glenmullen. Simon & Schuster, Inc. New York. page 38. [1]
    Referring to W. M. Glazer, H. Morgenstern, and J. T. Doucette, "Predicting the Long-Term Risk of Tardive Dykinesia [tics] in Outpatients Maintained on Neuroleptic [major tranquilizer] Medications," Journal of Clinical Psychiatry 54 (1993): 133-139. [2]
  6. ^ Jeste D, Caligiuri M. (1993) Tardive dyskinesia. Schizophr Bull. Schizophrenia Bulletin is a Peer reviewed Scientific journal which publishes articles of Original research, Systematic reviews etc 1993;19:303-316. PMID 8100643
  7. ^ Whitaker , Robert - Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, Perseus Pub. , c2002
  8. ^ Breggin, P. R. (1983) Psychiatric drugs. New York: Springer
  9. ^ Breggin, P. R. (1991) Toxic psychiatry. New York: St. Martin's Press
  10. ^ Psychiatrist and Psychiatry Critic, Peter Breggin, On Tardive Dyskinesia
  11. ^ Psychiatrist and Psychiatry Critic, Peter Breggin, On Neuroleptics

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