And tardive dyskinesia

The anainoacridines, tacrine (19) and its 1-hydroxy metaboUte, velnacrine (20), are reversible inhibitors of AChE. Tacrine was synthesi2ed in the 1940s and has been used clinically for the treatment of myasthenia gravis and tardive dyskinesia (115). Placebo-controUed studies have indicated modest efficacy of tacrine to treat AD dementia (122,123) and in 1993 the dmg was recommended for approval by the PDA under the trade name Cognex. Tacrine (19) has been shown to interact with sites other than AChE, such as potassium channels (124) and muscarinic receptors. However, these interactions are comparatively weak and are not thought to contribute to the biological activity of the dmg at therapeutic levels (115). 

Immediately report the occurrence of the following adverse reactions restlessness, inability to sit still, muscle spasms, masklike expression, rigidity, tremors, drooling, or involuntary rhythmic movements of the mouth, face, or extremities. Inform all patients about the risks of extrapyramidal symptoms and tardive dyskinesia Avoid exposure to the sun. If exposure is unavoidable, wear sunblock, keep arms and legs covered, and wear a sun hat. 

Metoclopramide crosses the BBB and has centrally-mediated adverse effects. Young children and the elderly are especially susceptible to these effects, which include somnolence, reduced mental acuity, anxiety, depression, and EPS (akathisia, dystonia, and tardive dyskinesia).30 The overall incidence of adverse effects is estimated to be 10% to 20%.1... 

Kapitany, T., Meszaros, K., Lenzinger, E. et al. (1998). Genetic polymorphisms for drug metabolism (CYP2D6) and tardive dyskinesia in schizophr. Schizophr. Res., 32, 101-6. 

Glazer, W. M., Morgenstern, H. Doucette, J. (1994). Race and tardive dyskinesia among outpatients at a CMHC. Hosp. Comm. Psychiatry, 45, 38 42. 

O Callaghan E, Larkin C, Kinsella A, Waddington JL. Obstetric complications, the putative familial-sporadic distinction, and tardive dyskinesia in schizophrenia. Br J Psychiatry 1990 157 578-584. 

Segman R, Neeman T, Heresco-Levy U, Finkel B, Karagichev L, Schlafman M et al. Genotypic association between the dopamine D3 receptor and tardive dyskinesia in chronic schizophrenia. Mol Psychiatry 1999 4(3) 247-253. 

Rietschel M, Krauss H, Muller DJ, Schulze TG, Knapp M, Marwinski K et al. Dopamine D3 receptor variant and tardive dyskinesia. Eur Arch Psychiatry Clin Neurosci 2000 250(l) 31-35. 

Schulze TG, Schumacher J, Muller DJ, Krauss H, Alfter D, Maroldt A, et al. Lack of association between a functional polymorphism of the cytochrome P450 1A2 (CYP1A2) gene and tardive dyskinesia in schizophrenia. Am J Med Genet 2001 105(6) 498-501. 

Ari pi prazole, olanzapine, quetiapine, risperidone, and ziprasidone are effective as monotherapy or as add-on therapy to lithium or valproate for acute mania. Prophylactic use of antipsychotics can be needed for some patients with recurrent mania or mixed states, but the risks versus benefits must be weighed in view of long-term side effects (e.g., obesity, type 2 diabetes, hyperlipidemia, hyperprolactinemia, cardiac disease, and tardive dyskinesia). 

Hori, H., Ohmori, O., Shinkai, T., Kojima, H., and Nakamura, J. (2001) Association between three functional polymorphisms of dopamine D receptor gene and tardive dyskinesia in schizophrenia. Am. J. Med. Genet. 105, llA-11. ... 

When an antipsychotic is needed, we prefer using one of the newer atypical agents olanzapine, ziprasidone, risperidone, quetiapine, or aripiprazole. Each of these medications reliably reduces agitation and is well tolerated. In particular, they decrease the potential for acute dystonic reactions and tardive dyskinesia caused by the typical antipsychotics. Both ziprasidone and olanzapine are now available in an injectable form that is very rapidly acting and effective in this setting. 

Rascol O, Eabre N. Dyskinesia L-dopa-indnced and tardive dyskinesia. Clin Neuropharma-col 2001 24(6) 313-323. 

Cadet JL, Kahler LA (1994) Free radical mechanisms in schizophrenia and tardive dyskinesia. Neurosci Biobehav Rev 18 457-467... 

Eichhammer, P., Albus, M., Borrmann-Hassenbach, M., Schoeler, A., Putzhammer, A., Frick, U., Klein, H.E., and Rohrmeier, T. (2000) Association of dopamine D3-receptor gene variants with neuroleptic induced akathisia in schizophrenic patients a generalization of Steen s study on DRD3 and tardive dyskinesia. Am J Med Genet 96 187-91. 

Rietschel, M., Krauss, H., Muller, D.J., Schulze, T.G., Knapp, M., Marwinski, K., Maroldt, A.O., Pans, S., Grunhage, R, Propping, P., Maier, W, Held, T., and Nothen, M.M. (2000) Dopamine D3 receptor variant and tardive dyskinesia. Eur Arch Psychiatry Clin Neurosci 250 31-35. 

Prior to the availability of atypical antipsychotics, typical antipsychotics were used to diminish the acute agitation of mania. Onset of action is typically observed within 3 to 7 days. In a meta-analysis of chlorpromazine trials, efficacy was 54%, which was substantially less than that of lithium, but comparable to that of other mood stabilizers (range, 12%-70%). Risk of extrapyramidal effects and tardive dyskinesia limits the use of these medications beyond the acute phase. 

Campbell and co-workers conducted several controlled studies of haloperidol in autistic children (Campbell et al., 1978 Cohen et al., 1980 Anderson et al., 1984, 1989). Haloperidol, in doses of 1 to 2 mg/ day, was found to be more effective than placebo for withdrawal, stereotypy, hyperactivity, affective lability, anger, and temper outbursts. Acute dystonic reactions and withdrawal and tardive dyskinesias were not infrequent, however. 

Tourette s syndrome is a well-studied condition, characterized by motor and phonic tics and by behavioral and psychological problems. While many neurotransmitters were implicated in the etiology of this disorder, it is now believed that the dopaminergic system and noradrenergic systems are involved. Two major clinical trials (Shapiro et ah, 1989 Sallee et al, 1997) indicated that haloperidol and pimozide reduced the severity of tics by 65%. However, these medications are associated with side effects (including possible cognitive impairment, sedation, dysphoria, and tardive dyskinesia) that may limit their effectiveness in children with MR. 

Kirch DC, Alho AM, Wyatt RJ Hypothesis a nicotine-dopamine interaction hnking smoking with Parkinson s disease and tardive dyskinesia. Cell Mol Neurobiol 8 285-291, 1988... 

Educate the patient and family about the risks of developing metabolic syndrome, diabetes, obesity, dyslipidemia, and tardive dyskinesia. Document this discussion in the patient s chart. 

Casey DE. Clozapine neuroleptic-induced EPS and tardive dyskinesia. Psychopharmacoiogy 1989 99 S47-S53. 

Adverse effect Pseudo-parkinsonism, dystonia, and tardive dyskinesia... 

Effects, below. Newer antipsychotics such as olanzapine, quetiapine, and aripiprazole cause no or minimal increases of prolactin and reduced risks of extrapyramidal system dysfunction and tardive dyskinesia, reflecting their diminished D2 antagonism. 

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