The prevalence of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia The Curaçao extrapyramidal syndromes study: I

doi:10.1016/0920-9964(95)00096-8

Schizophrenia Research

Volume 19, Issues 2–3, May 1996, Pages 195-203

https://doi.org/10.1016/0920-9964(95)00096-8 Get rights and content

Abstract

A prevalence study of extrapyramidal syndromes was conducted among all psychiatric inpatients of the Netherlands Antilles (n =194; mean age 53.1). The Netherlands Antilles are very suitable for epidemiological research as it is a well-defined catchment area with only one psychiatric hospital and a health care system based on western principles. In this mainly chronic population, the prevalence was measured of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia using respectively the Fahn-Marsden rating scale, the Abnormal Involuntary Movement Scale, the Unified Parkinson Disease Rating Scale and the Barnes Akathisia Rating Scale. The prevalence numbers were for tardive dystonia 13.4%, tardive dyskinesia 39.7%, parkinsonism 36.1%, akathisia 9.3% and pseudoakathisia 12.9%. The most important conclusions were: (1) The prevalence of tardive dystonia was higher than reported in most other studies and (2) extrapyramidal syndromes are very common in this predominantly Negroid population, with three out of four patients suffering of one or more extrapyramidal syndromes.

References (39)

R.S. Kern et al.
Patterns of manual dominance in patients with neuroleptic-induced movement disorders
Biol. Psychiatry
(1991)
R.A. Sweet et al.
Phenomenology and prevalence of neuroleptic induced akathisia in late life
Am. J. Geriatr. Psychiatry
(1993)
D.G. Altman
Practical statistics for medical research
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorders
(1987)
T.R.E. Barnes
A rating scale for drug-induced akathisia
Br. J. Psychiatry
(1989)
R.E. Burke
Neuroleptic-induced tardive dyskinesia variants
R.E. Burke et al.
Validity and reliability of a rating scale for the primary torsion dystonias
Neurology
(1985)
CBS (1993). Central Bureau of Statistics, The Netherlands Antilles, Statistical Orientation...
H. Chiu et al.
Prevalence of tardive dyskinesia, tardive dystonia, and respiratory dyskinesia among Chinese psychiatric patients in Hong Kong
Am. J. Psychiatry
(1992)
J.M. Davis
Comparative doses and costs of antipsychotic medication
Arch. Gen. Psychiatry
(1976)

S. Fahn et al.

Classification and investigation of dystonia

J.H. Friedman

Drug-induced parkinsonism

J.H. Friedman et al.

Tardive dystonia in a psychiatric hospital

J. Neurol. Neurosurg. Psychiatry

(1987)

G. Gardos et al.

Drug-induced parkinsonism and concomitant tardive dyskinesia

W.M. Glazer et al.

Race and Tardive dyskinesia among outpatients at a CMHC

Hospital Community Psychiatry

(1994)

S.M. Halstead et al.

Akathisia: Prevalence and associated dysphoria in an in-patient population with chronic schizophrenia

Br. J. Psychiatry

(1994)

W.E. Hoffman et al.

Prevalence of tardive dystonia in a chronically mentally ill population

Neuropsychopharmacology

(1994)

T. Inada et al.

Clinical variants of tardive dyskinesia in Japan

Jap. J. Psychiatr. Neurol.

(1991)

Cited by (108)

Motor abnormalities are associated with poor social and functional outcomes in schizophrenia
2022, Comprehensive Psychiatry
Up to 50% of patients with schizophrenia are suffering from motor abnormalities, which may contribute to decreased quality of life, impaired work capacity, and a reduced life expectancy by 10–20 years. However, the effect of motor abnormalities on social and global functioning, as well as, functional capacity is not clear. We hypothesized, that the presence of motor abnormalities is associated with poorer functional outcomes in patients with schizophrenia.
We collected data on 5 different motor abnormalities in 156 patients suffering from schizophrenia spectrum disorders: parkinsonism, catatonia, dyskinesia, neurological soft signs and psychomotor slowing (PS). Additionally, we used three different scales to evaluate the functional outcomes in these patients: the Global Assessment of Functioning (GAF) and the Social and Occupational Functioning Assessment Scale (SOFAS) which use clinicians' judgment; and one using a performance-based measure of functional capacity, the brief version of the UCSD Performance-based Skills Assessment (UPSA-B).
Our analysis demonstrated that patients with catatonia (all F > 4.5; p < 0.035) and parkinsonism (all F > 4.9; p < 0.027) scored lower on GAF and SOFAS compared to patients without catatonia and parkinsonism. In contrast, no significant difference on functional outcomes between patients with dyskinesia versus without dyskinesia exist in our study. Furthermore, there are statistically significant negative correlations for parkinsonism and PS with GAF, SOFAS and UPSA-B (all tau are at least −0.152, p-value <0.036). We also found significant negative correlations between catatonia and both GAF & SOFAS (all tau are at least −0.203, p-value<0.001) and between NES and SOFAS (tau = −0.137, p-value = 0.033).
Here, we showed that four of the most common motor abnormalities observed in schizophrenia were associated with at least one of the patients' functional outcomes. The stronger the motor impairment was the worse the global and social functioning. Future studies need to test, whether amelioration of motor abnormalities is linked to improved community functioning.
The psychopharmacology of catatonia, neuroleptic malignant syndrome, akathisia, tardive dyskinesia, and dystonia
2019, Handbook of Clinical Neurology
Citation Excerpt :
Eighty percent of cases present with the orofacial type characterized by the bucco–linguo–masticatory triad (Slotema et al., 2008). Limb–truncal dyskinesia consists of purposeless choreiform movements of trunk and/or limbs (van Harten et al., 1996b; Bakker et al., 2011). The often misdiagnosed respiratory dyskinesia is characterized by a fast and irregular breathing pattern, sometimes accompanied by gasping, sighing, grunting, forceful breathing, shortness of breath, and dyspnea (Muzyk et al., 2012).
Although highly prevalent, motor syndromes in psychiatry and motor side effects of psychopharmacologic agents remain understudied. Catatonia is a syndrome with specific motor abnormalities that can be seen in the context of a variety of psychiatric and somatic conditions. The neuroleptic malignant syndrome is a lethal variant, induced by antipsychotic drugs. Therefore, antipsychotics should be used with caution in the presence of catatonic signs. Antipsychotics and other dopamine-antagonist drugs can also cause motor side effects such as akathisia, (tardive) dyskinesia, and dystonia. These syndromes share a debilitating impact on the functioning and well-being of patients. To reduce the risk of inducing these side effects, a balanced and well-advised prescription of antipsychotics is of utmost importance. Clinicians should be able to recognize motor side effects and be knowledgeable of the different treatment modalities.
Neurostimulation in tardive dystonia/dyskinesia: A delayed start, sham stimulation-controlled randomized trial
2018, Brain Stimulation
Growing evidence suggests that pallidal deep brain stimulation represents a potential new therapeutic avenue in tardive dystonia/dyskinesia, but controlled and blinded randomized studies (RCT) are missing. The present RCT compares dystonia/dyskinesia severity of pallidal neurostimulation in patients with tardive dystonia using a delayed-start design paradigm.
Dystonia/dyskinesia severity was assessed via blinded videos following pallidal neurostimulation at 3 (blinded phase) and 6 months (open extension phase). Primary endpoint was the percentage change of dystonia severity (Burke-Fahn-Marsden-Dystonia-Rating-Scale, BFMDRS) at 3 months between active vs. sham neurostimulation using blinded-video assessment. Secondary endpoints comprised clinical rating scores for movement disorders. Clinicaltrials.gov NCT00331669.
Twenty-five patients were randomized (1:1) to active (n = 12) or sham neurostimulation (n = 13). In the intention-to-treat analyses the between group difference of dystonia severity (BFMDRS) between active vs. sham stimulation was not significant at 3 months. Three months post-randomisation dystonia severity improved significantly within the neurostimulation by 22.8% and non-significantly within the sham group (12.0%) compared to their respective baseline severity. During the open-label extension with both groups being actively treated, significant and pronounced improvements of 41.5% were observed via blinded evaluation. Adverse events (n = 10) occurred in 10/25 of patients during the 6 months, mostly related to surgical implantation of the device; all resolved without sequelae.
The primary endpoint of this randomized trial was not significant, most likely due to incomplete recruitment. However, pronounced improvements of most secondary endpoints at 3 and 6 months provide evidence for efficacy and safety of pallidal neurostimulation in tardive dystonia.
A new era in the diagnosis and treatment of tardive dyskinesia
2023, CNS Spectrums
Extrapyramidal Effects of First and Second Generation Antipsychotics: A Review
2023, International Journal of Drug Delivery Technology
The Outcome of Antipsychotics-induced Tardive Syndromes: A Ten-year Follow-up Study
2023, Clinical Psychopharmacology and Neuroscience

View all citing articles on Scopus

View full text

The prevalence of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia The Curaçao extrapyramidal syndromes study: I

Abstract

Biol. Psychiatry

Am. J. Geriatr. Psychiatry

Practical statistics for medical research

Diagnostic and Statistical Manual of Mental Disorders

A rating scale for drug-induced akathisia

Br. J. Psychiatry

Neuroleptic-induced tardive dyskinesia variants

Validity and reliability of a rating scale for the primary torsion dystonias

Neurology

Prevalence of tardive dyskinesia, tardive dystonia, and respiratory dyskinesia among Chinese psychiatric patients in Hong Kong

Am. J. Psychiatry

Comparative doses and costs of antipsychotic medication

Arch. Gen. Psychiatry

Classification and investigation of dystonia

Drug-induced parkinsonism

Tardive dystonia in a psychiatric hospital

J. Neurol. Neurosurg. Psychiatry

Drug-induced parkinsonism and concomitant tardive dyskinesia

Race and Tardive dyskinesia among outpatients at a CMHC

Hospital Community Psychiatry

Akathisia: Prevalence and associated dysphoria in an in-patient population with chronic schizophrenia

Br. J. Psychiatry

Prevalence of tardive dystonia in a chronically mentally ill population

Neuropsychopharmacology

Clinical variants of tardive dyskinesia in Japan

Jap. J. Psychiatr. Neurol.