Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013421 (dystonia)
 8,418 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clozapine, an atypical neuroleptic, does not cause extrapyramidal symptoms of Parkinsonism and dystonia and appears to have a reduced or absent capacity to produce tardive dyskinesia. 37 subjects, most with chronic schizophrenia, were treated with clozapine and TD outcome was analyzed. A subset of these subjects underwent plasma and CSF studies. TD response was heterogenous, but a proportion of patients improved with clozapine treatment. Neurochemical data differed from published reports of classical neuroleptics with the most robust effect produced by clozapine seen in CSF norepinephrine levels. Other neurochemical data and implications for the mechanism of clozapine in TD are reviewed.
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PMID:Clozapine pharmacology and tardive dyskinesia. 247 47

The authors present a basic review on clozapine (Leponex, Clozaril) which is one of the atypical antipsychotic drugs. It is a derivative of dibenzodiazepine, which contrary to classical neuroleptic drugs, does not exert a marked effect on the extrapyramidal system and its long-term use is not associated with the risk of development of irreversible tardive dyskinesia or dystonia. It is effective also in patients who are resistant to treatment with other neuroleptics and it has a more favourable effect on the negative symptoms of schizophrenia than classical neuroleptics. Its disadvantage is the increased risk of granulocytopenia and agranulocytosis (2%) and therefore its use is justified only in patients where there is evidence that they are resistant to other treatment. The mentioned risk can be controlled effectively by regular checks of the haemogram in patients taking clozapine, along with recording in the central data bank which has a consulting and control function and guaranteeing the method of correct administration of this drug and early therapeutic provisions in case of granulocytopenia. Despite the cost of treatment and checks of the haemogram, clozapine reduces the sum total of expenditure associated with the treatment of chronic schizophrenia by reducing the number of re-admissions to hospital, by shortening the period of hospitalization and by cutting indirect costs, which are influenced by a greater sociability of the patient and a greater probability of successful comprehensive therapeutic procedures.
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PMID:[Clozapine--an atypical antipsychotic agents, its advantages and risks]. 785 23

The objective of this study was to determine the putative risk factors for the development of tardive dystonia (TDt) in contrast with tardive dyskinesia (TD). Fifteen TDt patients seen in the Movement Disorders Clinic were compared with 2 groups of 15 TD controls each. The first control group was drawn from the Clinic and matched with the TDt cases for severity, using degree of dysfunction as the matching variable. The second control group comprised mild TD cases drawn from a separate study of drug-induced movement disorders in chronic schizophrenia and were matched for age and sex with the TDt cases. A number of demographic, treatment-related, diagnosis-related and historical variables suggested in the literature were examined. Most risk factors for TDt that have been suggested by previous studies were not supported. The first control group was significantly older than the TDt cases. The TDt patients had a more frequent past history of acute drug-induced dystonia and of postural tremor prior to the onset of the mental illness, although only the former reached statistical significance. The results suggested that TDt and TD do not differ in most putative risk factors, although the small sample size increases the likelihood of a type II error. It is inconclusive on the role of young age and male sex as risk factors. TDt cases may, however, be individuals vulnerable to the development of dystonia, with neuroleptics probably bringing out such a vulnerability. This finding needs to be examined in larger studies.
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PMID:Risk factors for tardive dystonia: a case-control comparison with tardive dyskinesia. 810 38

Data on extrapyramidal symptoms (EPS) from both arms of the North American multicenter comparative study of risperidone, placebo, and haloperidol were analyzed. The subjects were 523 patients with chronic schizophrenia who, after a 1-week washout period, received placebo, risperidone (2, 6, 10, or 16 mg/day), or haloperidol (20 mg/day) for 8 weeks; the trial was completed by 253 patients. Severity of EPS was assessed by means of the Extrapyramidal Symptom Rating Scale (ESRS). Mean changes (increases) in ESRS scores from baseline to worst score were significantly lower in each risperidone group than the haloperidol group on the total ESRS (parkinsonism + dystonia + dyskinesia), total parkinsonism, hypokinetic symptoms, and on the questionnaire (p < 0.001). On several of the subscales (dyskinesia, buccolinguomasticatory, and Clinical Global Impression severity of dyskinesia), mean change scores were significantly lower in some of the risperidone groups than in the placebo group (p < 0.05). At the clinically most effective risperidone dose (6 mg/day), the mean ESRS change score was not significantly different from that of the placebo group. A significant linear relationship was noted between mean change scores and increasing risperidone dose on 4 of the 12 ESRS subscales; nevertheless, even at 16 mg/day of risperidone, mean change scores were lower than in the haloperidol group. A linear relationship between increasing risperidone dose and use of antiparkinsonian medications was also apparent. Acute dystonic reactions occurred both in patients receiving risperidone and haloperidol. Patients with severe baseline EPS were at higher risk of EPS during the study than patients with low or moderate baseline EPS. It is concluded that low doses of risperidone cause few or no EPS and recommendations for initiation of risperidone treatment are made.
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PMID:Extrapyramidal symptoms in patients treated with risperidone. 916 65

Many psychiatric illnesses, including chronic schizophrenia, bipolar disorder, and dementia, are characterized by episodes of acute agitation, making administration of oral agents difficult or impossible. Ziprasidone, the first atypical antipsychotic available in both intramuscular (IM) and oral formulations, has demonstrated significant control of acute agitation within 15 minutes, as seen in two 24-hour studies in patients with schizophrenia. Improvement was maintained for > or = 4 hours, and a low incidence of extrapyramidal symptoms, akathisia, and dystonia as well as no excessive sedation were observed Also, two 7-day studies (n = 132 and n = 306) and one 6-week study (n = 567) of sequential IM/oral ziprasidone versus IM/oral haloperidol in patients with psychotic disorders found IM ziprasidone more effective than IM haloperidol within 3 days of IM treatment; both drugs produced further comparable improvements in efficacy parameters after transition to oral therapy. IM ziprasidone was associated with a lower incidence of movement disorders than was haloperidol in all of these studies. Overall, discontinuations were similar for IM ziprasidone and haloperidol in the comparative trials, including the sequential IM/oral studies. However, in the 6-week sequential IM/oral trial, the rate of discontinuation due to adverse events was twice as high among haloperidol vs ziprasidone patients. This report focuses on the pharmacology, clinical efficacy, and tolerability of IM ziprasidone, and provides an overview of the utility of other commonly used antipsychotics in the management of acute psychotic agitation.
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PMID:The utility of intramuscular ziprasidone in the management of acute psychotic agitation. 1551 47

Atypical antipsychotics can alleviate the severity of tardive dyskinesia, but few studies have monitored their long-term effects. The present study investigated the effect of risperidone on pre-existing severe tardive dyskinesia among 40 patients with chronic schizophrenia over 48 weeks. The total Abnormal Involuntary Movement Scale (AIMS) score decreased in 35 patients (87.5%) and increased in three patients (7.5%). At the end of the 48-week trial, the mean total AIMS score decreased significantly, from 15.7+/-4.7 (baseline) to 10.6+/-4.4 (P<0.001), with a mean risperidone dosage of 3.6+/-1.5 mg/day. Twenty-three patients (57.5%) were responders with an average total AIMS score decrease of 8.0+/-2.7. Multiple logistic regression analysis controlling for age, gender, duration of illness, index hospitalization duration, risperidone dose, anticholinergic concomitant use and dystonia score change revealed that a change in the parkinsonism score was the most significant factor related to responders (odds ratio 3.476, 95% confidence interval 1.173-10.298). A significant improvement observed in tardive dyskinesia was noted at week 8, and this improvement persisted until week 48. The results show that the effect of risperidone on pre-existing tardive dyskinesia may be beneficial.
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PMID:Risperidone for pre-existing severe tardive dyskinesia: a 48-week prospective follow-up study. 1572 82

Recently, patients receiving the long-term administration of typical antipsychotics have been recognized to be at risk of developing intractable tardive dystonia. A 44-year-old man was referred to our hospital because of progressive dysphagia for about 5 years. He had received several typical antipsychotic medications since at age of 24 years for the treatment of chronic schizophrenia. The patient had been suffering from an abnormal sensation in his throat and progressive dysphagia for five years, and nasal escape on deglutition for one year. A videotape recorder esophago pharyngography revealed that his larynx was positioned low, at the level of the 6th cervical vertebra, before swallowing, and was not elevated but rather descended to the level of the 7th vertebra upon swallowing. When the larynx was in this lower position, a small amount of swallowed material was transported to the esophagus. The remaining material in the pyriform sinus overflowed into the laryngeal cavity and lower airway after swallowing. However, the patient was able to eat with ease when he was with a girl friend, eating in a restaurant, and was hungry. The peculiar downward movement of the larynx was not observed during speech production, only during deglutition. Based on these findings, we suspected that his peculiar swallowing disorder might have been induced by tardive dystonia arising from the long-term administration of typical antipsychotics.
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PMID:[Progressive dysphagia with peculiar laryngeal movement induced by tardive dystonia]. 1716 93