Clinical assessment of antipsychotic-induced extrapyramidal symptoms in nursing home residents with schizophrenia

• Authors: Karol Woźniak , Iwona Kłoszewska

Title variants

EN

Kliniczna ocena polekowych objawów pozapiramidowych u pensjonariuszy domów pomocy społecznej z rozpoznaniem psychoz schizofrenicznych

• Languages of publication: EN PL

Abstracts

EN

This study assessed the incidence and potential risk factors for extrapyramidal symptoms in a population of nursing home residents with schizophrenia receiving antipsychotic medication. A study sample consisted of 261subjects, recruited in nursing homes in Poland. Extrapyramidal symptoms were evaluated using the Simpson–Angus Scale and each extrapyramidal symptoms domain was determined using the appropriate standard scale. The results of the study indicate that approximately 60–70% of patients did not develop extrapyramidal symptoms following prolonged antipsychotic treatment. The risk of extrapyramidal symptoms increased with age, dose of antipsychotic and the number of antipsychotic drugs used concomitantly, and decreased with the duration of the disease. There was no direct effect of gender or common substances of abuse, such as alcohol or nicotine, on the incidence of extrapyramidal symptoms. Among concomitant diseases, hypertension and epilepsy played the most significant role in modulating the incidence and severity of extrapyramidal adverse events. Patients with high blood pressure were less likely to develop extrapyramidal symptoms. Epilepsy significantly increased the risk of some extrapyramidal antipsychoticinduced motor symptoms, such as akathisia and dystonia. Combined treatment with antipsychotic and antidepressant drugs produced slightly higher risk of parkinsonian syndrome. In conclusion, our data indicate that an incidence, type and severity of drug-induced extrapyramidal adverse effects may strongly depend on individual patient characteristics, such as age, gender or comorbid medical conditions and medication, and thus these factors should be taken into account in the therapeutic process.

PL

W prezentowanym badaniu oceniano czynniki ryzyka oraz częstość występowania objawów pozapiramidowych u pensjonariuszy domów pomocy społecznej z rozpoznaniem psychoz schizofrenicznych, leczonych długotrwale lekami przeciwpsychotycznymi. Badaną populację stanowiło 261 pacjentów domów pomocy społecznej regionu łódzkiego. Nasilenie objawów pozapiramidowych było oceniane za pomocą ogólnej skali Simpsona–Angusa, a poszczególne domeny objawów pozapiramidowych analizowano za pomocą odpowiednich standardowych skal. U większości badanych pacjentów (około 60–70%) nie stwierdzono objawów pozapiramidowych. Ryzyko wystąpienia objawów pozapiramidowych wzrastało wraz z wiekiem, dawką leku oraz liczbą leków przeciwpsychotycznych przyjmowanych jednocześnie, a zmniejszało się wraz z czasem trwania choroby. Częstość występowania objawów pozapiramidowych nie zależała natomiast od płci czy stosowania przez pacjentów popularnych używek, takich jak alkohol czy nikotyna. Wśród współistniejących chorób największy wpływ na wystąpienie i nasilenie objawów pozapiramidowych wykazywały nadciśnienie tętnicze oraz padaczka. Pacjenci z nadciśnieniem tętniczym byli w mniejszym stopniu narażeni na wystąpienie objawów pozapiramidowych, podczas gdy u chorych na padaczkę stwierdzono podwyższone ryzyko wystąpienia niektórych pozapiramidowych objawów ruchowych, takich jak akatyzja i dystonia. Łączne przyjmowanie leków przeciwpsychotycznych i przeciwdepresyjnych zwiększało ryzyko wystąpienia zespołu parkinsonowskiego. Otrzymane wyniki wskazują, że indywidualne cechy pacjenta, takie jak wiek, płeć, współistniejące schorzenia oraz przyjmowane leki, w znaczący sposób mogą wpływać na częstość występowania, rodzaj i nasilenie polekowych objawów pozapiramidowych, a zatem czynniki te powinny być brane pod uwagę w procesie terapeutycznym.

Keywords

EN

antipsychotics; extrapyramidal symptoms; leki przeciwpsychotyczne; nursing home residents; objawy pozapiramidowe; pensjonariusze domów pomocy społecznej; schizofrenia; schizophrenia

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Psychiatria i Psychologia Kliniczna
• Year: 2016
• Volume: 16
• Issue: 1
• Pages: 7–14

Contributors

author

Karol Woźniak

• Department of Psychiatry, Pabianice Medical Centre, Pabianice, Poland

author

Iwona Kłoszewska

• Department of Psychiatry, Central Teaching Hospital, Medical University of Lodz, Lodz, Poland

References

• Adler L, Angrist B, Peselow E et al.: Efficacy of propranolol in neuroleptic-induced akathesia. J Clin Psychopharmacol 1985; 5: 164–166.
• Aichhorn W, Whitworth AB, Weiss EM et al.: Second-generation antipsychotics: is there evidence for sex differences in pharmacokinetic and adverse effect profiles? Drug Saf 2006; 29: 587–598.
• Alexopoulos GS, Streim J, Carpenter D et al.; Expert Consensus Panel for Using Antipsychotic Drugs in Older Patients: Using antipsychotic agents in older patients. J Clin Psychiatry 2004; 65 Suppl 2: 5–99.
• Atkins M, Burgess A, Bottomley C et al.: Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications. Psychiatr Bull 1997; 21: 224–226.
• Avorn J, Monane M, Everitt DE et al.: Clinical assessment of extrapyramidal signs in nursing home patients given antipsychotic medication. Arch Intern Med 1994; 154: 1113–1117.
• Azermai M, Elseviers M, Petrovic M et al.: Assessment of antipsychotic prescribing in Belgian nursing homes. Int Psychogeriatr 2011; 23: 1240–1248.
• Barzilai N, Huffman DM, Muzumdar RH et al.: The critical role of metabolic pathways in aging. Diabetes 2012; 61: 1315–1322.
• Bazire S: Przewodnik lekow psychotropowych. Via Medica, 2010.
• Boecker H, Weindl A, Brooks DJ et al.: GABAergic dysfunction in essential tremor: an 11C-flumazenil PET study. J Nucl Med 2010; 51: 1030–1035.
• Brooks VL: Interactions between angiotensin II and the sympathetic nervous system in the the long-term control of arterial pressure. Clin Exp Pharmacol Physiol 1997; 24: 83–90.
• Browne S, Roe M, Lane A et al.: Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand 1996; 94: 118–124.
• Cho HS, Baek DJ, Baek SS: Effect of exercise on hyperactivity, impulsivity and dopamine D2 receptor expression in the substantia nigra and striatum of spontaneous hypertensive rats. J Exerc Nutrition Biochem 2014; 18: 379–384.
• Darbin O: The aging striatal dopamine function. Parkinsonism Relat Disord 2012; 18: 426–432.
• Divac N, Prostran M, Jakovcevski I et al.: Second-generation antipsychotics and extrapyramidal adverse effects. Biomed Res Int 2014; 2014: 656370.
• Dixon L, Weiden PJ, Haas G et al.: Increased tardive dyskinesia in alcohol-abusing schizophrenic patients. Compr Psychiatry 1992; 33: 121–122.
• Dumon JP, Catteau J, Lanvin F et al.: Randomized, double-blind, crossover, placebo-controlled comparison of propranolol and betaxolol in the treatment of neuroleptic-induced akathisia. Am J Psychiatry 1992; 149: 647–650.
• Essali A, Deirawan H, Soares-Weiser K et al.: Calcium channel blockers for neuroleptic-induced tardive dyskinesia. Cochrane Database Syst Rev 2011; (11): CD000206.
• Fischel T, Hermesh H, Aizenberg D et al.: Cyproheptadine versus propranolol for the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. J Clin Psychopharmacol 2001; 21: 612–615.
• Gareri P, Segura-García C, Manfredi VG et al.: Use of atypical antipsychotics in the elderly: a clinical review. Clin Interv Aging 2014; 9: 1363–1373.
• Gill HS, DeVane CL, Risch SC: Extrapyramidal symptoms associated with cyclic antidepressant treatment: A review of the literature and consolidating hypotheses. J Clin Psychopharmacol 1997; 17: 377–389.
• Govoni S, Racchi M, Masoero E et al.: Extrapyramidal symptoms and antidepressant drugs: neuropharmacological aspects of a frequent interaction in the elderly. Mol Psychiatry 2001; 6: 134–142.
• van Harten PN, Hoek HW, Matroos GE et al.: The inter-relationships of tardive dyskinesia, parkinsonism, akathisia and tardive dystonia: the Curaçao Extrapyramidal Syndromes Study II. Schizophr Res 1997; 26: 235–242.
• Holloman LC, Marder SR: Management of acute extrapyramidal effects induced by antipsychotic drugs. Am J Health Syst Pharm 1997; 54: 2461–2477.
• de Jong W, Linthorst AC, Versteeg HG: The nigrostriatal dopaminę system and the development of hypertension in the spontaneously hypertensive rat. Arch Mal Coeur Vaiss 1995; 88: 1193–1196.
• Kaiser R, Tremblay PB, Klufmöller F et al.: Relationship between adverse effects of antipsychotic treatment and dopamine D2 receptor polymorphisms in patients with schizophrenia. Mol Psychiatry 2002; 7: 695–705.
• Kamble P, Chen H, Sherer JT et al.: Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging 2009; 26: 483–492.
• Lasoń W, Chlebicka M, Rejdak K: Research advances in basic mechanisms of seizures and antiepileptic drug action. Pharmacol Rep 2013; 65: 787–801.
• Lipinski JF Jr, Keck PE Jr, McElroy SL: Beta-adrenergic antagonists in psychosis: is improvement due to treatment of neurolepticinduced akathisia? J Clin Psychopharmacol 1988; 8: 409–416.
• Mangoni AA, Jackson SHD: Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004; 57: 6–14.
• Mann E, Köpke S, Haastert B et al.: Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatr 2009; 9: 18.
• Mao YM, Zhang MD: Augmentation with antidepressants in schizophrenia treatment: benefit or risk. Neuropsychiatr Dis Treat 2015; 11: 701–713.
• Marder SR: Facilitating compliance with antipsychotic medication. J Clin Psychiatry 1998; 59 Suppl 3: 21–25.
• Miller CH, Hummer M, Oberbauer H et al.: Risk factors for the development of neuroleptic induced akathisia. Eur Neuropsychopharmacol 1997; 7: 51–55.
• Newton MR, Berkovic SF, Austin MC et al.: Dystonia, clinical lateralization, and regional blood flow changes in temporal lobe seizures. Neurology 1992; 42: 371–377.
• Novick D, Haro JM, Bertsch J et al.: Incidence of extrapyramidal symptoms and tardive dyskinesia in schizophrenia: thirty-six-month results from the European schizophrenia outpatient health outcomes study. J Clin Psychopharmacol 2010; 30: 531–540.
• Ormerod S, McDowell SE, Coleman JJ et al.: Ethnic differences in the risks of adverse reactions to drugs used in the treatment of psychoses and depression: a systematic review and meta-analysis. Drug Saf 2008; 31: 597–607.
• Perkins DO: Predictors of noncompliance in patients with schizophrenia. J Clin Psychiatry 2002; 63: 1121–1128.
• Probst-Schendzielorz K, Viviani R, Stingl JC: Effect of Cytochrome P450 polymorphism on the action and metabolism of selective serotonin reuptake inhibitors. Expert Opin Drug Metab Toxicol 2015; 11: 1219–1232.
• Puttachary S, Sharma S, Stark S et al.: Seizure-induced oxidative stress in temporal lobe epilepsy. Biomed Res Int 2015; 2015: 745613.
• Russell V, de Villiers A, Sagvolden T et al.: Altered dopaminergic function in the prefrontal cortex, nucleus accumbens and caudateputamen of an animal model of attention-deficit hyperactivity disorder– the spontaneously hypertensive rat. Brain Res 1995; 676: 343–351.
• Rzewuska M (ed.): Leczenie zaburzeń psychicznych. PZWL, Warszawa 2003.
• Scigliano G, Musicco M, Soliveri P et al.: Reduced risk factors for vascular disorders in Parkinson disease patients: a case-control study. Stroke 2006; 37: 1184–1188.
• Snowdon J, Day S, Baker W: Why and how antipsychotic drugs are used in 40 Sydney nursing homes. Int J Geriatr Psychiatry 2005; 20: 1146–1152.
• Spina E, Avenoso A, Scordo MG et al.: Inhibition of risperidone metabolism by fluoxetine in patients with schizophrenia: a clinically relevant pharmacokinetic drug interaction. J Clin Psychopharmacol 2002; 22: 419–423.
• Suzuki T: Which rating scales are regarded as ‘the standard’ in clinical trials for schizophrenia? A critical review. Psychopharmacol Bull 2011; 44: 18–31.
• Targum SD: Treating psychotic symptoms in elderly patients. Prim Care Companion J Clin Psychiatry 2001; 3: 156–163.
• Tatara A, Shimizu S, Shin N et al.: Modulation of antipsychotic-induced extrapyramidal side effects by medications for mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2012; 38: 252–259.
• Thanvi B, Treadwell S: Drug induced parkinsonism: a common cause of parkinsonism in older people. Postgrad Med J 2009; 85: 322–326.
• Wastesson JW, Ringbäck Weitoft G, Johnell K: Educational disparities in antipsychotic drug use among older people with and without dementia in Sweden. Acta Psychiatr Scand 2015; 132: 20–28.
• Watanabe M, Tsuruta S, Inoue Y et al.: Dopamine D1 and D2 receptors in spontaneously hypertensive rat brain striatum. Can J Physiol Pharmacol 1989; 67: 1596–1597.
• Woods SW: Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry 2003; 64: 663–667.
• Xiang YT, Wang CY, Si TM et al.: Sex differences in use of psychotropic drugs and drug-induced side effects in schizophrenia patients: findings of the Research on Asia Psychotropic Prescription (REAP) studies. Aust N Z J Psychiatry 2011; 45: 193–198.
• Zadikoff C, Munhoz RP, Asante AN et al.: Movement disorders in patients taking anticonvulsants. J Neurol Neurosurg Psychiatry 2007; 78: 147–151.
• Zhang XY, Tan YL, Zhou DF et al.: Disrupted antioxidant enzyme activity and elevated lipid peroxidation products in schizophrenic patients with tardive dyskinesia. J Clin Psychiatry 2007; 68: 754–760.
• Zhornitsky S, Stip E, Pampoulova T et al.: Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia. Mov Disord 2010; 25: 2188–2194.
• Ziemssen T, Reichmann H: Cardiovascular autonomic testing in extrapyramidal disorders. J Neurol Sci 2011; 310: 129–132.

• Document Type: article