quetiapine-fumarate and Movement-Disorders

The most frequent problems associated with the older generation of antipsychotic agents are extrapyramidal side effects (EPS) and tardive dyskinesia. Neuroleptic-induced EPS are thought to be caused by blockade of nigrostriatal dopamine tracts resulting in a relative increase in cholinergic activity; tardive dyskinesia is less well understood but is thought to be a supersensitivity response to chronic dopamine blockade. The leading hypothesis for the mechanism of action of the newer generation of atypical antipsychotics is the presence of a high serotonin-to-dopamine receptor blockade ratio in the brain. When serotonergic activity is blocked-as is the case with atypical antipsychotics-dopamine release increases and balances out the dopamine blockade effect at postsynaptic receptor sites, which results in few or no EPS. Prospective data indicate that the risk of tardive dyskinesia in patients taking atypical antipsychotics is less than that for those taking typical antipsychotics. This article reviews the mechanisms of neuroleptic-induced EPS and tardive dyskinesia and discusses the relationship between these movement disorders and atypical antipsychotic agents.

Topics: Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Brain; Clozapine; Dibenzothiazepines; Humans; Movement Disorders; Olanzapine; Pirenzepine; Quetiapine Fumarate; Receptors, Dopamine; Receptors, Serotonin; Risk Factors; Risperidone

Antipsychotic agents remain the most effective treatment for both acute and chronic schizophrenia. However, conventional antipsychotic agents are frequently associated with significant side effects including, perhaps most notably, extrapyramidal symptoms (EPS). The emergence of EPS can significantly compromise patient compliance with treatment and can have profound effects on long-term treatment outcomes. Providing effective symptom relief with minimal side effects and without inducing EPS is, therefore, a primary goal in the treatment of schizophrenia. Atypical antipsychotic agents are now regarded as first-line therapies for the treatment of schizophrenia because of their lower propensity to induce EPS compared with conventional antipsychotics, and evidence exists that these agents are associated with a lower relapse rate, which perhaps reflects an improvement in patient compliance.

Topics: Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Dibenzothiazepines; Dystonia; Female; Humans; Male; Movement Disorders; Parkinsonian Disorders; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

We compared the response to antipsychotic treatment between patients with and without tardive dyskinesia (TD) and examined the course of TD.. This analysis compared 200 patients with DSM-IV-defined schizophrenia and TD and 997 patients without TD, all of whom were randomly assigned to receive one of 4 second-generation antipsychotics. The primary clinical outcome measure was time to all-cause treatment discontinuation, and the primary measure for evaluating the course of TD was change from baseline in Abnormal Involuntary Movement Scale (AIMS) score. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to compare treatment discontinuation between groups. Changes in Positive and Negative Syndrome Scale (PANSS) and neurocognitive scores were compared using mixed models and analysis of variance. Treatment differences between drugs in AIMS scores and all-cause discontinuation were examined for those with TD at baseline. Percentages of patients meeting criteria for TD postbaseline or showing changes in AIMS scores were evaluated with χ(2) tests. Data were collected from January 2001 to December 2004.. Time to treatment discontinuation for any cause was not significantly different between the TD and non-TD groups (χ(2)(1) = 0.11, P = .743). Changes in PANSS scores were not significantly different (F(1,974) = 0.82, P = .366), but patients with TD showed less improvement in neurocognitive scores (F(1,359) = 6.53, P = .011). Among patients with TD, there were no significant differences between drugs in the decline in AIMS scores (F(3,151) = 0.32, P = .811); 55% met criteria for TD at 2 consecutive visits postbaseline, 76% met criteria for TD at some or all postbaseline visits, 24% did not meet criteria for TD at any subsequent visit, 32% showed a ≥ 50% decrease in AIMS score, and 7% showed a ≥ 50% increase in AIMS score.. Schizophrenia patients with and without TD were similar in time to discontinuation of treatment for any cause and improvement in psychopathology, but differed in neurocognitive response. There were no significant differences between treatments in the course of TD, with most patients showing either persistence of or fluctuation in observable symptoms.. clinicaltrials.gov Identifier: NCT00014001.

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Chi-Square Distribution; Dibenzothiazepines; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Movement Disorders; Olanzapine; Perphenazine; Piperazines; Proportional Hazards Models; Psychiatric Status Rating Scales; Quetiapine Fumarate; Risperidone; Schizophrenia; Severity of Illness Index; Thiazoles; Treatment Outcome

This study aims to identify neuropsychiatric manifestations in neurological Wilson disease (NWD), and their correlation with MRI changes and glutamate excitotoxicity. Forty-three consecutive patients with NWD from a tertiary care teaching hospital were evaluated prospectively who fulfilled the inclusion criteria. The neuropsychiatric evaluation was done using Neuropsychiatric Inventory (NPI) battery that assesses 12 domains including delusion, hallucination, agitation/aggression, dysphoria/depression, anxiety, euphoria, apathy, disinhibition, irritability, aberrant motor activity, appetite change, and abnormal nighttime behavior. Cranial MRI was done using a 3 T machine, and locations of signal changes were noted including the total number of MRI lesions. Serum glutamate level was measured by a fluorescence microplate reader. Abnormal NPI in various domains and total NPI scores were correlated with MRI lesions, serum and urinary copper, and glutamate level. The median age of the patients was 16 years. Forty-one (48.8%) patients had cognitive impairment and 37 (86%) had movement disorder. Neurobehavioral abnormality was detected in all-commonest being agitation (90.7%) followed by appetite change (81.4%), elation (74.4%), irritability (69.8%), anxiety (67.4%), depression (65.1%), apathy (44.2%), night time abnormal behavior (32.6%), aberrant motor behavior (20.9%), delusions (16.3%), and hallucination (18.6%). The thalamic lesion was associated with depression, globus pallidus with depression and anxiety, caudate with anxiety and agitation, brainstem with irritability, and frontal cortex with apathy. Serum glutamate level was higher in NWD. NPI sum score correlated with MRI load and glutamate level. Varying severity of neurobehavioral abnormalities are common in the patients with NWD and correlate with the location of MRI lesion and glutamate level.

Topics: Adolescent; Adult; Behavioral Symptoms; Brain Mapping; Cognition Disorders; Copper; Feeding and Eating Disorders; Female; Glutamic Acid; Hallucinations; Hepatolenticular Degeneration; Humans; Liver; Magnetic Resonance Imaging; Male; Mood Disorders; Movement Disorders; Neuroimaging; Neurotransmitter Agents; Quetiapine Fumarate; Severity of Illness Index; Young Adult

To describe a cohort of young users of risperidone and quetiapine in the province of Manitoba (Canada) and assess the risk for movement disorders in the two treatments.. This was a population-based study conducted on all residents of the province of 19 years of age and younger who received prescriptions for risperidone or quetiapine between April 1, 1996, and March 31, 2011. Incident rates of antipsychotic use were reported. The risk for movement disorders in patients treated with quetiapine compared with those treated with risperidone was assessed by time-to-event analysis using Cox proportional hazards models.. Between April 1, 1996, and March 31, 2011, 23,888 youth (age ≤19 years) were prescribed an antipsychotic agent. Among them, 8756 were identified as new incident users. After applying exclusion criteria, 2594 individuals comprised the cohort of users of risperidone and quetiapine. The use of quetiapine was associated with a lower risk of extrapyramidal symptoms (EPSs) adverse events. The unadjusted and adjusted hazard ratios (95% confidence interval [CI]) for quetiapine versus risperidone were 0.83 (0.56-1.25) and 0.53 (0.34-0.83), respectively.. EPS diagnoses have been detected in children treated with quetiapine; however, the risk of movement disorders appears to be higher with treatment with risperidone. Clinicians should always take into consideration the risk-benefit before treating children with antipsychotic medications and should be vigilant of the onset of drug-induced adverse events.

Topics: Adolescent; Antipsychotic Agents; Basal Ganglia Diseases; Child; Cohort Studies; Female; Humans; Male; Manitoba; Movement Disorders; Population Surveillance; Quetiapine Fumarate; Retrospective Studies; Risk Factors; Risperidone

Topics: Alcoholism; Benzodiazepines; Clonazepam; Depressive Disorder; Dibenzothiazepines; Disulfiram; Female; Fluoxetine; Foreign Bodies; Hallucinations; Humans; Middle Aged; Movement Disorders; Olanzapine; Pharynx; Quetiapine Fumarate; Tetrabenazine; Tongue Habits

We report upon a case of a 55 year old patient with a bipolar affective disorder, presenting herself with a depressive symptomatology in addition to a severe motor perturbation. The main emphasis upon admittance was perfecting and improving her latest medication. Four weeks prior to her stay at our clinic a thorough neurological examination had taken place in terms of an invalidity pension trial which did not result in any diagnostic findings. Therefore a neurological disease seemed at first highly unlikely. Even though the prior testing was negative, the ensuing neurological examination at our clinic resulted in movement disorders very much indicative of Huntington's Disease. A detailed investigation in regards to the particular family history of the patient was positive for Huntington's Disease. However, whether the patient's mother had also been a genetic carrier of Huntington's Disease was still unknown at the time the patient was admitted to our clinic. It was nevertheless discovered that her mother had also suffered from a bipolar affective disorder. A genetic testing that followed the neurological examination of the patient proved positive for Huntington's Disease. Neuro-imaging resulted in a bicaudate-index of 2.4 (the critical value is 1.8). In a clinical psychological test battery the ensuing results were highly uncommon for patients with solely a bipolar affective disorder people. Under the medical regimen of Quetiapine, Citalopram and Tiaprid the patient's mood could be stabilized and there was some improvement of her motor pertubation.

Topics: Antidepressive Agents; Antipsychotic Agents; Bipolar Disorder; Citalopram; Dibenzothiazepines; Female; Genetic Testing; Heterozygote; Humans; Huntington Disease; Magnetic Resonance Imaging; Middle Aged; Movement Disorders; Neurologic Examination; Neuropsychological Tests; Pedigree; Positron-Emission Tomography; Quetiapine Fumarate; Tiapride Hydrochloride

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Dibenzothiazepines; Female; Humans; Movement Disorders; Olanzapine; Quetiapine Fumarate

Topics: Aged; Antipsychotic Agents; Comorbidity; Dibenzothiazepines; Hashimoto Disease; Humans; Male; Movement Disorders; Quetiapine Fumarate

Topics: Basal Ganglia; Dibenzothiazepines; Dopamine Plasma Membrane Transport Proteins; Humans; Male; Middle Aged; Movement Disorders; Quetiapine Fumarate; Tomography, Emission-Computed, Single-Photon

Topics: Antipsychotic Agents; Depression; Dibenzothiazepines; Female; Humans; Middle Aged; Movement Disorders; Quetiapine Fumarate

Dystonia is a syndrome of involuntary, repetitive (or sustained) muscle contractions of opposing muscles, which may result in torsions and abnormal postures. Tardive dystonia is a form of the disorder that starts after longer term use of dopamine antagonists. It occurs in approximately 3% of patients receiving ongoing antipsychotic treatment and is often difficult to reverse. Dystonia can also be induced by compounds other than antipsychotics, such as antidepressants, levodopa, carbamazepine, dextroamphetamine, and diphenylhydantoin. In these cases, it is transient, generally disappearing after the dose is reduced or the causative drug is stopped. Dystonia induced by injury can also be transient. We report a case of transient oromandibular dystonia following a dental filling in a woman receiving quetiapine, a second-generation antipsychotic. The timing, localization, and transience of the dystonia suggested that the dental procedure may have played a triggering role. The dystonia symptoms responded within 8 weeks to benztropine and a dose reduction of quetiapine, and they did not return when benztropine was discontinued. This case benefited from prompt attention and has led to practical recommendations for psychiatric clinicians.

Topics: Dibenzothiazepines; Dystonia; Female; Humans; Middle Aged; Movement Disorders; Quetiapine Fumarate

Topics: Antipsychotic Agents; Dibenzothiazepines; Facial Muscles; Female; Humans; Medication Adherence; Middle Aged; Movement Disorders; Pharyngeal Muscles; Quetiapine Fumarate

Topics: Aged; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Leg; Movement Disorders; Quetiapine Fumarate; Toes; Treatment Outcome

Side effects of antipsychotic medications are particularly problematic in elderly patients, who experience many age-related changes that may exacerbate medication side effects. Side effects of particular concern in the elderly include anticholinergic reactions, parkinsonian events, tardive dyskinesia, orthostatic hypotension, cardiac conduction disturbances, reduced bone mineral density, sedation, and cognitive slowing. In addition, elderly patients with schizophrenia often have comorbid medical illnesses-such as cardiovascular disease and dementia of the Alzheimer's type-and are thus likely to be taking multiple medications. The effects of polypharmacy must be carefully considered. Patients, caregivers, and family often have different perspectives on side effects. This article addresses the side effects of the currently available antipsychotic medications in light of these concerns.

Topics: Age Factors; Aged; Antipsychotic Agents; Basal Ganglia Diseases; Clinical Trials as Topic; Clozapine; Comorbidity; Dementia; Dibenzothiazepines; Humans; Movement Disorders; Neuroleptic Malignant Syndrome; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia

Topics: Aged; Antipsychotic Agents; Basal Ganglia Diseases; Clinical Trials as Topic; Dibenzothiazepines; Dose-Response Relationship, Drug; Humans; Imidazoles; Indoles; Movement Disorders; Psychotic Disorders; Quetiapine Fumarate; Receptor, Serotonin, 5-HT2A; Receptors, Dopamine; Receptors, Serotonin; Schizophrenia; Treatment Outcome