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Probable neuroleptic induced tardive dyskinesia in association with combined SSRI and risperidone treatment
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menopausal women have a rate similar to men, (b) the present study TD prevalence was significantly greater in men than in women the literature shows TD prevalence to be lower in older men than in older women, (c) the present study men showed higher basal phenylalanine levels than the women-higher levels have been reported for young men versus elderly men while higher levels are seen in elderly women than in young women.
VII. Movement Disorder VII.A. Tardive Dyskinesia VII.A. 1 PROBABLE
NEUROLEPTIC
INDUCED
TARDIVE DYSKINESIA IN ASSOCIATION WITH COMBINED SSRI AND RISPERIDONE
TREATMENT
VII.A. 3
D.G. Daniel, M. Egan, a n d T. H y d e
Washington Clinical Research Center, 6404 P, 7 Corners Place, Falls Church, VA, 22044, U.S.A. Increased risk of tardive dyskinesia has been linked to cumulative neuroleptic exposure and early development of extrapyramidal side effects. Risperidone is a putatively 'atypical' antipsychotic with a relatively low incidence of extrapyramidal side effects at therapeutic dosages. Fluoxetine and other agents that selectively inhibit presynaptic reuptake of serotonin may exacerbate motor symptoms when given in combination with antipsychotic medication. We describe an 18 year old caucasian male who developed extrapyramidal side effects followed by persistent, dyskinetic tongue movements in association with combined fluoxetine and risperidone treatment.
VII.A. 2 TD AND PHENYLALANINE SEX AND AGE ISSUES
METABOLISM:
M.A. R i c h a r d s o n , C. Flynn, M. ReiUy, L. Read, R. Suckow, T. M a h e r , S. Lin a n d I. Sziraki
N. S. Kline Institute for Psychiatric Research, N Y State Office of Mental Health, N Y University Medical Center, 140 Old Orangeburg Road, Orangeburg, NY10962, U.S.A. The metabolic response to a challenge of phenylalanine was studied in psychotic patients with and without TD (men, n = 209; women, n = 103). The mean age for men was 33 (95% under 50) and for women, 39 (85% under 50). Men showed a highly significant positive association (controlling for age) between the presence of TD and postchallenge plasma phenylalanine indices. The women, however, showed no such association. There was a significant interaction between sex, TD, and the plasma phenylalanine indices. Sex thus was a defining variable in the relationship between TD and a precursor of neurotransmitter metabolism. Relevant literature suggests that the young age of the sample may be related to the sex interactions found; (a) premenopausal women show a slower gastric emptying rate than men--post-
SCHIZOPHRENIC SYMPTOMS, TARDIVE DYSKINESIA AND ITS ASSOCIATION WITH COGNITIVE FUNCTIONING C.L. Shriqui 1, L. A n n a b l e 2 a n d C. D o u c e t 1
1Centre hospitalier Robert-Giffard & Le Centre de recherche universitk Laval Robert-Giffard, Department of Psychiatry, Laval University, Beauport, Quebec, Canada, 2Allan Memorial Institute, Department of Psychiatry, McGill University, Montreal Quebec, Canada The aim of this study was to examine for differences in the severity of psychopathology and cognitive functioning in a group of 71 neuroleptic-treated schizophrenic patients (58 men, 13 women) with and without tardive dyskinesia (TD). 53 patients met RDC criteria for TD (43 men, 10 women) and 18 patients (15 men, 3 women) were without such a diagnosis. TD was assessed using the Extrapyramidal Symptom Rating Scale (ESRS). The age of the patients ranged from 28 to 64 years (mean=46 years), duration of neuroleptic treatment ranged from 3 to 40 years (mean = 23 years), and the current neuroleptic dose (in CPZ equivalents) ranged from 50 to 3 450mg/day (median=500mg/day). There was a trend for patients with TD to be older and to have been treated with neuroleptic medication for a longer period than patients without TD. There was no significant difference between patients with and without TD with respect to mean neuroleptic dosage in CPZ equivalents at the time of the examination. Psychopathology was evaluated on the Positive and Negative Syndrome Scale (PANSS) and cognitive performance on the Wisconsin Card-Sorting test, Stroop Color-Word test, and Random Number Generation test. Schizophrenic patients with TD were compared to those without TD with respect to the results of each test by means of multivariate analysis of covariance controlling for gender and age. No significant differences were observed between patients with and without TD with respect to mean scores on the PANSS Positive, Negative or General Psychopathology subscales, Wisconsin Card-Sorting test, Stoop Color-Word test, or Random Number Generation test. In conclusion, our results lend support to a lack of a consistent association between positive and negative schizophrenic symptoms, and cognitive functioning in schizophrenic patients with tardive dyskinesia.
menopausal women have a rate similar to men, (b) the present study TD prevalence was significantly greater in men than in women the literature shows TD prevalence to be lower in older men than in older women, (c) the present study men showed higher basal phenylalanine levels than the women-higher levels have been reported for young men versus elderly men while higher levels are seen in elderly women than in young women.
VII. Movement Disorder VII.A. Tardive Dyskinesia VII.A. 1 PROBABLE
NEUROLEPTIC
INDUCED
TARDIVE DYSKINESIA IN ASSOCIATION WITH COMBINED SSRI AND RISPERIDONE
TREATMENT
VII.A. 3
D.G. Daniel, M. Egan, a n d T. H y d e
Washington Clinical Research Center, 6404 P, 7 Corners Place, Falls Church, VA, 22044, U.S.A. Increased risk of tardive dyskinesia has been linked to cumulative neuroleptic exposure and early development of extrapyramidal side effects. Risperidone is a putatively 'atypical' antipsychotic with a relatively low incidence of extrapyramidal side effects at therapeutic dosages. Fluoxetine and other agents that selectively inhibit presynaptic reuptake of serotonin may exacerbate motor symptoms when given in combination with antipsychotic medication. We describe an 18 year old caucasian male who developed extrapyramidal side effects followed by persistent, dyskinetic tongue movements in association with combined fluoxetine and risperidone treatment.
VII.A. 2 TD AND PHENYLALANINE SEX AND AGE ISSUES
METABOLISM:
M.A. R i c h a r d s o n , C. Flynn, M. ReiUy, L. Read, R. Suckow, T. M a h e r , S. Lin a n d I. Sziraki
N. S. Kline Institute for Psychiatric Research, N Y State Office of Mental Health, N Y University Medical Center, 140 Old Orangeburg Road, Orangeburg, NY10962, U.S.A. The metabolic response to a challenge of phenylalanine was studied in psychotic patients with and without TD (men, n = 209; women, n = 103). The mean age for men was 33 (95% under 50) and for women, 39 (85% under 50). Men showed a highly significant positive association (controlling for age) between the presence of TD and postchallenge plasma phenylalanine indices. The women, however, showed no such association. There was a significant interaction between sex, TD, and the plasma phenylalanine indices. Sex thus was a defining variable in the relationship between TD and a precursor of neurotransmitter metabolism. Relevant literature suggests that the young age of the sample may be related to the sex interactions found; (a) premenopausal women show a slower gastric emptying rate than men--post-
SCHIZOPHRENIC SYMPTOMS, TARDIVE DYSKINESIA AND ITS ASSOCIATION WITH COGNITIVE FUNCTIONING C.L. Shriqui 1, L. A n n a b l e 2 a n d C. D o u c e t 1
1Centre hospitalier Robert-Giffard & Le Centre de recherche universitk Laval Robert-Giffard, Department of Psychiatry, Laval University, Beauport, Quebec, Canada, 2Allan Memorial Institute, Department of Psychiatry, McGill University, Montreal Quebec, Canada The aim of this study was to examine for differences in the severity of psychopathology and cognitive functioning in a group of 71 neuroleptic-treated schizophrenic patients (58 men, 13 women) with and without tardive dyskinesia (TD). 53 patients met RDC criteria for TD (43 men, 10 women) and 18 patients (15 men, 3 women) were without such a diagnosis. TD was assessed using the Extrapyramidal Symptom Rating Scale (ESRS). The age of the patients ranged from 28 to 64 years (mean=46 years), duration of neuroleptic treatment ranged from 3 to 40 years (mean = 23 years), and the current neuroleptic dose (in CPZ equivalents) ranged from 50 to 3 450mg/day (median=500mg/day). There was a trend for patients with TD to be older and to have been treated with neuroleptic medication for a longer period than patients without TD. There was no significant difference between patients with and without TD with respect to mean neuroleptic dosage in CPZ equivalents at the time of the examination. Psychopathology was evaluated on the Positive and Negative Syndrome Scale (PANSS) and cognitive performance on the Wisconsin Card-Sorting test, Stroop Color-Word test, and Random Number Generation test. Schizophrenic patients with TD were compared to those without TD with respect to the results of each test by means of multivariate analysis of covariance controlling for gender and age. No significant differences were observed between patients with and without TD with respect to mean scores on the PANSS Positive, Negative or General Psychopathology subscales, Wisconsin Card-Sorting test, Stoop Color-Word test, or Random Number Generation test. In conclusion, our results lend support to a lack of a consistent association between positive and negative schizophrenic symptoms, and cognitive functioning in schizophrenic patients with tardive dyskinesia.