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Spontaneous dyskinesia in first-episode schizophrenia
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23. Tardive Dyskinesia 76~ SPONTANEOUS DYSKINESIA IN FIRSTEPISODE SCHIZOPHRENIA T .R.E. Barnes , B.K. Puri, M .J . Chapman, S.B. Hutton, Eileen Joyce Department of Psychiatry. Charing Cross and Westminster Medical School. St Dunstan 's Road. London W68RF, UK
One hypothesis regarding the role of antipsychotic drugs in the development of tardive dyskinesia is that they provoke a tendency to spontaneous movements inherent in some forms of schizophrenia . More specifically, the pathological processes integral to schizophrenia as wellas age-related cerebral dysfunction may be predisposing factors for the emergence of tardive dyskinesia during chronic antipsychotic administration. If this not ion were true, one prediction might be that the illnessrelated dysfunction could lead to abnormal involuntary movements even without antipsychotic exposure . This is supported by recent reports of dyskinesia in a proportion of drug-nalve pat ients with schizophrenia . We examined the prevalence and nature of abnormal movements in drug-na ive patients and their antipsychotic-treated peers in the context of a first-episode schizophrenia study in West London. In the 23 untreated patients (mean age 29 years), the modified Rogers scale rated 6 (26%) as manifesting abnormal movements (particularly increased tone and postural abnormalities) . According to AIMS ratings, 2 (9%) exhibited dyskinesia (I oro facial and I both orofacial and trunk and limb). For the 34 treated patients (mean age 26 years), the figures were similar: 9 (26%) manifesting abnormal movements and 3 (9%) with dyskinesia (I orofacial and 2 both orofacial and trunk and limb).
fbi.. TREATMENT OF SEVERE TARDIVE DYSKINESIA (TO) IN REFRACTORY SCHIZOPHRENICS WITH CLOZAPINE Debora P. Bassitt, Mario R. Louza Neto PROJESQ-Psychiatry Institute. HC-FMUSP. R. Dr. Ovidio Pires de Campos, sln, 05403-fJ1OBrazil
In most cases TO is mild but some patients develop a persistent, severe and disabling form. When TD is mild it may not require any specific treatment apart from antipsychotic withdrawal or dosage reduction . Associated drug therapy should be considered only to treat moderate to severe TD. Besides this, antipsychotic carries the risk of worsening of psychotic symptoms . Clozapine is an option since it is an antipsychotic associated with almost no extrapyramidal symptoms . In order to evaluate clozapine's effect on TD we have done an open prospective study. Patients were admitted to the inpatient service and were wit~draWD fr~m all antipsychotic medication for one week. Basehne evaluations were performed
utilizing PANSS, AIMS and Chouinard scales. Treatment with clozapine was initiated and lasted for 24 weeks and the dose was gradually titrated to a maximum of 500mg/day. Preliminary result shows reduction of 26.3% in PANSS's scores, 37.18% in AIMS's scores and 48.7% in Chouinard', scores, Scores for tardive dystonia had a greater reduction (66%; overall mean felt from 9 to 3 points at Chouinard's scale). From this we conclude that clozapine is efficacious in the control of severe TO in patients with refractory schizophrenia.
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SPONTANEOUS DYSKINESIA IN SCHIZOPHRENIA SPECTRUM PERSONALITY Shawn L. Cassady, Helene Adami, Marianne Moran, Rick Kunkel, Gunvant Thaker Mary/and Psychiatric Research Center. P.O. Box 21147, Baltimore. AID 21228. USA
The nature and prevalence of spontaneous dyskinesia in schizophrenia remains unclear. We studied dyskinetic movements in 34 subjects with schizophrenia spectrum personal ity (paranoid, schizoid, schizotypal ) who had never received neuroleptics and 22 normals . Standardized videotapes were rated blindly using the Maryland Psychiatric Research Center Involuntary Movement Scale. The spectrum personality group showed greater global dyskinesia (Wilcoxon. p- .026). Dyskinesia at the Mild to Moderate level of severity occurred in 12% of spectrum personality subjects and no controls. At a lower threshold, 35% of spectrum personality subjects showed some dyskinesia compared with 14% of normals . There was no association with age, gender or family history of schizophrenia . Parkinsonism ratings were not significantly different from normals. Dyskinesia was related to the number of positive symptoms (Structured Interview for DSM-III-R Personal ity Disorders; Kruskal-Wallis, p ... .04S). The number of positive symptoms was correlated with total dyskinesia score (r - .53), p=.OOI). These findings suggest more spontaneous dyskinesia in schizophrenia spectrum personality subjects and supports the finding of spontaneous dyskinesia in schizophrenia .
7U THE PREVALENCE OF SPONTANEOUS DYSKINESIA IN NEVER-MEDICATED PATIENTS WITH SCHIZOPHRENIA AND OTHER PSYCHIATRIC DISORDERS
Wayne S. Fenton,Crystal R. Blyler, Richard J. Wyatt. Thomas H. McGlashan Chestnut Lodge Research Institute. 500 ~v. Montgomery Ave. Rockville MD 20850 Objective: To examine the specificity of spontaneous dyskinesia, we compare the prevalence of abnormal movements in
23. Tardive Dyskinesia 76~ SPONTANEOUS DYSKINESIA IN FIRSTEPISODE SCHIZOPHRENIA T .R.E. Barnes , B.K. Puri, M .J . Chapman, S.B. Hutton, Eileen Joyce Department of Psychiatry. Charing Cross and Westminster Medical School. St Dunstan 's Road. London W68RF, UK
One hypothesis regarding the role of antipsychotic drugs in the development of tardive dyskinesia is that they provoke a tendency to spontaneous movements inherent in some forms of schizophrenia . More specifically, the pathological processes integral to schizophrenia as wellas age-related cerebral dysfunction may be predisposing factors for the emergence of tardive dyskinesia during chronic antipsychotic administration. If this not ion were true, one prediction might be that the illnessrelated dysfunction could lead to abnormal involuntary movements even without antipsychotic exposure . This is supported by recent reports of dyskinesia in a proportion of drug-nalve pat ients with schizophrenia . We examined the prevalence and nature of abnormal movements in drug-na ive patients and their antipsychotic-treated peers in the context of a first-episode schizophrenia study in West London. In the 23 untreated patients (mean age 29 years), the modified Rogers scale rated 6 (26%) as manifesting abnormal movements (particularly increased tone and postural abnormalities) . According to AIMS ratings, 2 (9%) exhibited dyskinesia (I oro facial and I both orofacial and trunk and limb). For the 34 treated patients (mean age 26 years), the figures were similar: 9 (26%) manifesting abnormal movements and 3 (9%) with dyskinesia (I orofacial and 2 both orofacial and trunk and limb).
fbi.. TREATMENT OF SEVERE TARDIVE DYSKINESIA (TO) IN REFRACTORY SCHIZOPHRENICS WITH CLOZAPINE Debora P. Bassitt, Mario R. Louza Neto PROJESQ-Psychiatry Institute. HC-FMUSP. R. Dr. Ovidio Pires de Campos, sln, 05403-fJ1OBrazil
In most cases TO is mild but some patients develop a persistent, severe and disabling form. When TD is mild it may not require any specific treatment apart from antipsychotic withdrawal or dosage reduction . Associated drug therapy should be considered only to treat moderate to severe TD. Besides this, antipsychotic carries the risk of worsening of psychotic symptoms . Clozapine is an option since it is an antipsychotic associated with almost no extrapyramidal symptoms . In order to evaluate clozapine's effect on TD we have done an open prospective study. Patients were admitted to the inpatient service and were wit~draWD fr~m all antipsychotic medication for one week. Basehne evaluations were performed
utilizing PANSS, AIMS and Chouinard scales. Treatment with clozapine was initiated and lasted for 24 weeks and the dose was gradually titrated to a maximum of 500mg/day. Preliminary result shows reduction of 26.3% in PANSS's scores, 37.18% in AIMS's scores and 48.7% in Chouinard', scores, Scores for tardive dystonia had a greater reduction (66%; overall mean felt from 9 to 3 points at Chouinard's scale). From this we conclude that clozapine is efficacious in the control of severe TO in patients with refractory schizophrenia.
~~1
SPONTANEOUS DYSKINESIA IN SCHIZOPHRENIA SPECTRUM PERSONALITY Shawn L. Cassady, Helene Adami, Marianne Moran, Rick Kunkel, Gunvant Thaker Mary/and Psychiatric Research Center. P.O. Box 21147, Baltimore. AID 21228. USA
The nature and prevalence of spontaneous dyskinesia in schizophrenia remains unclear. We studied dyskinetic movements in 34 subjects with schizophrenia spectrum personal ity (paranoid, schizoid, schizotypal ) who had never received neuroleptics and 22 normals . Standardized videotapes were rated blindly using the Maryland Psychiatric Research Center Involuntary Movement Scale. The spectrum personality group showed greater global dyskinesia (Wilcoxon. p- .026). Dyskinesia at the Mild to Moderate level of severity occurred in 12% of spectrum personality subjects and no controls. At a lower threshold, 35% of spectrum personality subjects showed some dyskinesia compared with 14% of normals . There was no association with age, gender or family history of schizophrenia . Parkinsonism ratings were not significantly different from normals. Dyskinesia was related to the number of positive symptoms (Structured Interview for DSM-III-R Personal ity Disorders; Kruskal-Wallis, p ... .04S). The number of positive symptoms was correlated with total dyskinesia score (r - .53), p=.OOI). These findings suggest more spontaneous dyskinesia in schizophrenia spectrum personality subjects and supports the finding of spontaneous dyskinesia in schizophrenia .
7U THE PREVALENCE OF SPONTANEOUS DYSKINESIA IN NEVER-MEDICATED PATIENTS WITH SCHIZOPHRENIA AND OTHER PSYCHIATRIC DISORDERS
Wayne S. Fenton,Crystal R. Blyler, Richard J. Wyatt. Thomas H. McGlashan Chestnut Lodge Research Institute. 500 ~v. Montgomery Ave. Rockville MD 20850 Objective: To examine the specificity of spontaneous dyskinesia, we compare the prevalence of abnormal movements in