DRUG-INDUCED MOVEMENT DISORDERS
|
|
- Brenda Hutchinson
- 8 years ago
- Views:
Transcription
1 142 KEY POINTS: A A A Drug-induced parkinsonism is clinically indistinguishable from idiopathic Parkinson s disease and may occur as a symmetric or asymmetric phenomenon. The most effective treatment for drug-induced parkinsonism is elimination of the offending medication. If symptoms persist, the patient most likely has subclinical parkinsonism that was unmasked. Tardive dyskinesia is associated with chronic use, greater than 3 months, of dopaminergic blocking medications including typical and atypical neuroleptic medications, except quetiapine and clozapine and the antiemetic agents of prochlorperazine and metoclopramide. DRUG-INDUCED MOVEMENT DISORDERS Stacy Horn ABSTRACT Drug-induced movement disorders are varied and can be caused by a number of medications that alter central nervous system neurochemistry. Drug-induced movement disorders include parkinsonism, tardive phenomena, chorea, dystonia, tremor, akathisia, myoclonus, tics, and neuroleptic malignant syndrome. The movements can be acute or chronic phenomena and may be focal, hemi-, or generalized in nature. The drug-induced movement disorders, with the exception of the tardive phenomenon, can usually be treated by elimination of the offending medication. INTRODUCTION Drug-induced movement disorders are commonly seen in neurologic practice and may be caused by medications that alter neurotransmitter levels. The majority of drug-induced movement disorders can be improved with the elimination of the offending medication, and this remains the preferred method of treatment. Drug-induced movement disorders can be acute, subacute, or chronic phenomena and may occur with prescription or illicit drug use. Each drug-induced movement disorder will be discussed in the following sections. DRUG-INDUCED PARKINSONISM Drug-induced parkinsonism is a hypokinetic movement disorder that includes tremor, rigidity, bradykinesia, and less commonly postural instability. It is clinically indistinguishable from idiopathic Parkinson s disease and may occur as a symmetric or asymmetric phenomenon. Drug-induced parkinsonism is due to medications that affect presynaptic, synaptic, or postsynaptic dopamine levels. It can be either a subacute or chronic condition that can occur with both prescription and illicit drug use. Medications that deplete presynaptic dopamine in the central nervous system include tetrabenazine and reserpine. Methyldopa causes drug-induced parkinsonism by acting as a false neurotransmitter. The most common mechanism of drug-induced parkinsonism is through in the nigrostriatal system. This has been associated with the use of both typical and atypical neuroleptic agents or with antiemetic agents such as metoclopramide and prochlorperazine (Adler, 1999; Armon et al, 1996; Indo and Ando, 1982). Reports of drug-induced parkinsonism from dopamine blocking agents vary widely from 5% to 90% of patients treated depending upon the agent used and the population studied. Older adult patients and females are at higher risk of developing this syndrome. In patients at risk, 50% to 70% will develop symptoms within 1 month of starting therapy and 90% within 3 months (Ayd, 1961). Other medications less commonly associated with drug-induced parkinsonism include some of the calcium channel blockers, especially flunarizine and cinnarizine. These medications are thought to cause drug-induced parkinsonism by causing and mitochondrial chain dysfunction. Table 8-1
2 lists medications and drugs associated with drug-induced parkinsonism and their primary mechanism of action (Diederich and Goetz, 1998). A recent study in Olmstead County, Minnesota, to determine the incidence of parkinsonism found that 20% of patients were drug induced (Rocca et al, 2001). The most effective treatment for drug-induced parkinsonism is elimination of the offending medication. If symptoms persist, the patient most likely has subclinical parkinsonism that was unmasked. Neuroimaging with [18F] fluorodopa positron emission tomography suggests that patients with pure druginduced parkinsonism will have normalization of their radioactive dopa uptake in the basal ganglia after elimination of precipitating drugs while patients with unmasking of an underlying parkinsonism will have persistent diminished uptake after elimination of the precipitating medication (Burn and Brook, 1993) (Case 8-1). TARDIVE DYSKINESIA Tardive dyskinesia is a hyperkinetic movement disorder that causes choreic movements. Chorea is characterized by involuntary, rapid, nonrepetitive, random, small-amplitude movements that may be symmetric or asymmetric. Tardive dyskinesia is associated with chronic use, greater than 3 months, of dopaminergic blocking medications including typical and atypical neuroleptic medications except quetiapine and clozapine and the antiemetic agents of prochlorperazine and metoclopramide. Table 8-2 lists medications associated with tardive dyskinesia. The typical location is orobuccolingual, but chorea may be generalized. The exact pathophysiology for the development of the involuntary movements has not been completely elucidated, but one leading hypothesis is that chronic blockade of dopamine receptors may lead to supersensitivity of the receptors. This receptor supersensitivity causes normal amounts of available dopamine to create involuntary movements (Klawans, 1973). This syndrome is most prevalent in older females, and TABLE 8-1 Medication Chlorpromazine Fluphenazine Haloperidol Loxapine Thioridazine Molindone Pimozide Perphenazine Mesoridazine Trifluoperazine Risperidone Olanzapine Prochlorperazine Metoclopramide Methyldopa Reserpine Tetrabenazine Valproic acid Lithium Substances Associated With Drug-Induced Parkinsonism 1-Methyl-4-phenyl-1,2,3, 6-tetrahydropyridine Flunarizine Cinnarizine Verapamil Mechanism False neurotransmitter Presynaptic dopamine depletion Presynaptic dopamine depletion Mitochondrial respiratory chain dysfunction Unclear Selective dopamine cell death Mitochondrial respiratory chain dysfunction Mitochondrial respiratory chain dysfunction Mitochondrial respiratory chain dysfunction Reprinted with permission from Diederich NJ, Goetz CG. Drug-induced movement disorders. Neurol Clin 1998;16: Copyright # 1998, Elsevier. 143
3 "DRUG-INDUCED MOVEMENT DISORDERS Case 8-1 A 42-year-old male presents with the complaint of hand shaking for the past 6 months, which is causing him some social disability. He denies any interference with eating or activities of daily living. He has a past history significant for bipolar disorder with psychotic features. He has been treated for years with carbemazepine for mood stabilization and within the past year was started on risperidone for psychotic features. On neurologic examination, the patient has a resting tremor of both upper extremities, bradykinesia of rapid alternating movements in the upper and lower extremities, and cogwheel rigidity of all extremities. With gait testing, he has a diminished arm swing and mild retropulsion with the pull test. He is diagnosed with drug-induced parkinsonism, and risperidone is eliminated by his psychiatrist. Two months later the patient no longer has any tremor, bradykinesia, rigidity, or gait abnormalities. He currently has some paranoid ideations that will require treatment. Comment. This case illustrates parkinsonism in the clinical setting of a medication that blocks dopamine D2 receptor activity. The first treatment approach is to attempt to eliminate the risperidone, which was successful in this patient and eliminated his drug-induced syndrome; however, his psychiatric disease was exacerbated by the elimination of the precipitating medication. This patient may need long-term neuroleptic medications to control his psychosis. Two choices for therapy to control his psychosis without causing a drug-induced parkinsonism are quetiapine or clozapine. 144 prevalence increases with time treated. A meta-analysis calculated an incidence of 20% in patients treated with dopamine blocking agents (Kane and Smith, 1982) (Case 8-2). Choreic movements do not always extinguish with elimination of the offending medication. In fact, reports indicate that only 2% of patients have complete and persistent resolution of their involuntary movements (Glazer et al, 1990). Because these movements are often both socially and functionally disabling, pharmacologic treatment is often necessary if the choreic movements do not improve after the elimination of the offending agent. Pharmacologic treatments include dopamine-depleting agents such as reserpine or tetrabenazine, dopamine blocking agents such as quetiapine or clozapine, benzodiazepines, beta-blockers, and clonidine (Diederich and Goetz, 1998; Ondo et al, 1999). An alternative therapy includes vitamin E, which was shown to be effective in a small open-label study at a dose of 1600 mg a day (Sajjad 1998). Lastly, a controversial treatment that may be effective in selected patients includes TABLE 8-2 " Chlorpromazine " Fluphenazine " Haloperidol " Loxapine " Thioridazine " Molindone " Pimozide " Perphenazine " Mesoridazine " Trifluoperazine " Risperidone " Olanzapine " Prochlorperazine " Ziprasidone " Aripiprazole " Metoclopramide Medications Associated With Tardive Dyskinesia Adapted from Klawans HL Jr. The pharmacology of tardivedyskinesias.amjpsychiatry1973;130:82 86.
4 Case 8-2 A 70-year-old woman presents with a 3-month history of involuntary movements of her mouth and tongue. The patient has also noticed some gasping sounds. She states that these movements interfere with eating because they push food out of her mouth, and she has experienced a 10-pound weight loss. The patient also describes significant social disability due to the mouth movements. She has been taking olanzepine for the past year for insomnia and depression. On neurologic examination, the patient has respiratory dyskinesias and choreic movements of the tongue and lower face with tongue hypertrophy. The patient was felt to have tardive dyskinesia due to chronic dopaminergic blocking agents. Olanzapine was discontinued, and on follow-up at 3 months, the patient had a significant reduction in the involuntary movements with no current functional or social impairment. Comment. This case illustrates the patient population at risk for developing tardive dyskinesia and highlights some of the more serious complications, including respiratory dyskinesias, weight loss, and social disability. This patient s symptoms resolved with elimination of the offending medication. Had they persisted, she would have required symptomatic therapy guided by coexistent medical problems and concurrent medications. KEY POINT: A Tardive dyskinesia is most prevalent in older females, and prevalence increases with time treated. A meta-analysis calculated an incidence of 20% in patients treated with dopamine blocking agents. botulinum toxin type A injections into the affected musculature. This treatment has only been reported in case studies and should be used with caution in the anterior cervical musculature and oral regions because of the risk of weakness and dysphagia. Table 8-3 lists medications used in the treatment of tardive dyskinesia. TABLE 8-3 Medications Used in Treatment of Tardive Dyskinesia " Reserpine " Tetrabenazine " Clozapine " Quetiapine " Amantadine " Vitamin E " Botulinum toxin type A " Clonazepam DRUG-INDUCED CHOREA Drug-induced chorea is a hyperkinetic movement disorder that occurs as an acute or subacute phenomenon. The movements are again random, rapid, and of low amplitude. They are typically generalized or hemichoreic and can interfere with voluntary movement and gait. Patients with drug-induced chorea can be divided into two groups: parkinsonian patients and others. Acute and subacute drug-induced chorea are often associated with dopaminergic agents such as levodopa and, less commonly, dopamine agonists in parkinsonian patients. Dopaminergic-induced dyskinesias in parkinsonism are predominantly choreic in nature, but may also be dystonic. These movements typically occur with peak serum levels of levodopa and may be asymmetric. In the deprenyl and tocopherol antioxidative therapy of parkinsonism (DATATOP) study, 9% of patients taking levodopa developed dyskinesias after 6 months of therapy, 17% after 12 months of therapy, and 145
5 "DRUG-INDUCED MOVEMENT DISORDERS 146 KEY POINTS: A Acute dystonic reaction is typically caused by medications that block dopamine D2 receptors in the central nervous system. A It is estimated that 2% to 3% of patients exposed to dopamine blocking medications develop an acute dystonic reaction. The movements are typically abrupt in onset and are more frequently seen in a younger population, with 90% of patients developing the abnormal movements in the first 5 days of treatment. 26% after 18 months of therapy. (Fahn, 2000) Drug-induced chorea can also be seen with other medications including stimulants such as amphetamines, oral contraceptives, antiepileptics, and some antidepressants. Illicit drugs, particularly cocaine, may also cause chorea. Patients with a prior history of basal ganglia dysfunction from such entities as Sydenham s chorea or cyanotic heart disease are at increased risk of developing drug-induced chorea. The exact incidence of drug-induced chorea in the general population is not clear. However, large numbers of patients are treated each year with the offending medications without problems. The proposed pathophysiology of drug-induced chorea is through dopaminergic augmentation, but this is incompletely understood. In parkinsonian patients with druginduced chorea, treatment strategies can include decreasing dopaminergic medications, increasing dosage frequency, and adding amantadine. If these fail, surgical therapies such as pallidotomy or deep brain stimulation of the globus pallidus interna or subthalamic nucleus may be helpful. The best treatment option in the general population is elimination of the underlying medication. With discontinuation of the offending agent, the abnormal movements should resolve over time. ACUTE DYSTONIC REACTION Dystonia is a central nervous system disorder that results in repetitive movements of agonist and antagonist musculature. Acute dystonic reaction is typically caused by medications that block dopamine D2 receptors in the central nervous system. Table 8-4 lists medications associated with acute dystonic reactions. The movements predominantly affect the cranial and cervical musculature and can be associated with oculogyric crisis. It is estimated that 2% to 3% of patients TABLE 8-4 " Metoclopramide " Prochlorperazine " Olanzapine " Risperidone " Trifluoperazine " Mesoridazine " Perphenazine " Pimozide " Molindone " Thioridazine " Loxapine " Haloperidol " Fluphenazine " Chlorpromazine " Cocaine Medications Commonly Associated With Acute Dystonic Reaction exposed to dopamine blocking medications develop an acute dystonic reaction (Ayd, 1961). The movements are typically abrupt in onset and are more frequently seen in a younger population, with 90% of patients developing the abnormal movements in the first 5 days of treatment. The acute dystonic reaction can be treated effectively with either intravenous anticholinergic medications or benzodiazepines. Patients may require a few additional days of oral therapy with the effective medication (Diederich and Goetz, 1998). TARDIVE DYSTONIA These movements are involuntary, repetitive, and twisting. They may be intermittent or sustained and are often painful. The dystonic movements are described by location as focal, segmental, hemi-, or generalized.
6 Tardive dystonia is a syndrome that occurs after prolonged use (ie, greater than 3 months) of dopamine blocking agents including typical and atypical neuroleptic medications and antiemetic medications. These medications are the same medications implicated in tardive dyskinesia. The typical types of tardive dystonia include cranial and cervical disorders such as blepharospasm, opisthotonos, retrocollis, and torticollis, but the dystonia may affect any body part or be generalized in nature. The incidence of tardive dystonia appears to be 1.5% to 2% of patients treated with central nervous system dopaminergic blocking agents (Friedman et al, 1987; Yassa et al, 1986). Spontaneous remissions are rare, and this disorder can often be disabling and painful, requiring treatment (Wojcik et al, 1991). Treatment options include elimination of the offending agent and monitoring for remission over several months. If this is ineffective and patients continue to have disability or pain, then other pharmacologic agents can be useful. For generalized forms of dystonia, a trial of oral medication such as anticholinergics, baclofen, benzodiazepines, tetrabenazine, quetiapine, or, in medically refractory cases, clozapine. In each case, the medications should be started at low dosage and titrated slowly to efficacy or side effects. For focal forms of tardive dystonia, botulinum toxin injections into the affected musculature may be useful for alleviating the spasms and pain. Table 8-5 contains a list of medications that may be effective in treating tardive dystonia. DRUG-INDUCED TREMOR Tremor is a rhythmic, involuntary, oscillatory movement of any body part and is named for the position of greatest prominence. Drug-induced tremor disorders typically begin shortly after institution of the offending medication. Drug-induced tremors may be postural, rest, or intention. The most common form is the enhanced physiologic tremor (Deuschl et al, 1998). Drug-induced tremors are associated with multiple medications, including stimulants, antidepressants, theophylline, lithium, valproic acid, amiodarone, cyclosporine, neuroleptics, and immunomodulators. Table 8-6 contains a more complete list of medications associated with drug-induced tremor (Deuschl et al, 1998). Elimination of the offending medication often ameliorates drug-induced tremor. If the offending agent cannot be discontinued, then medications commonly used to treat tremor can be effective, including beta-blockers such as propanolol up to 240 mg a day and primidone up to KEY POINT: A The incidence of tardive dystonia appears to be 1.5% to 2% of patients treated with central nervous system dopaminergic blocking agents. 147 TABLE 8-5 Pharmacological Therapy of Dystonia Medication Trihexyphenidyl Baclofen Clonazepam Tetrabenazine Clozapine Botulinum toxin type A Typical Therapeutic Dosage Up to 120 mg/d 25 mg/d to 80 mg/d 1.5 mg/d to 12 mg/d 12.5 mg/d to 400 mg/d Up to 400 mg/d Multiple dosages depending upon injection location
7 "DRUG-INDUCED MOVEMENT DISORDERS 148 KEY POINT: A Akathisia is a hyperkinetic movement disorder characterized by restlessness and the irresistible urge to move. Akathisia may be an acute, subacute, or tardive phenomenon. TABLE 8-6 Substances Associated With Drug-Induced Tremor " Nicotine " Atypical neuroleptics Risperidone Olanzapine " Typical neuroleptics Chlorpromazine Fluphenazine Haloperidol Loxapine Thioridazine Molindone Thiothixene Pimozide Perphenazine Mesoridazine Trifluoperazine " Antiemetics Metoclopramide Prochlorperazine Reserpine Tetra " Reserpine " Tetrabenazine " Antidepressants Tricyclic antidepressants Selective serotonin reuptake inhibitors Other depressants such as trazodone and mirtazapine TABLE 8-6 " Caffeine " Dopamine " Steroids Continued Progesterone Tamoxifen Adrenocorticosteroids " Valproic acid " Antiarrhythmics Amiodarone Mexiletine Procainamide " Calcitonin " Levothyroxine " Chemotherapeutics Vincristine Adriablastine Cytosinarabinoside Ifosfamide " Immunosuppressants Cyclosporin Mycophenolate mofetil Muromonab Basiliximab Daclizumab " Amphetamine From Deuschl G, Bain P, Brin. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord 1998;13(suppl 3):2 23. Copyright # 1998, Movement Disorder Society. Reprinted by permission of Wiley-Liss, Inc, a subsidiary of John Wiley & Sons, Inc. " Lithium " Cocaine " Alcohol " Beta-agonists " Theophylline 250 mg a day, and benzodiazepines such as clonazepam. AKATHISIA Akathisia is a hyperkinetic movement disorder characterized by restlessness
8 and the irresistible urge to move. Akathisia may be an acute, subacute, or tardive phenomenon. Akathisia occurs with medications that alter central nervous system dopamine levels, including typical and atypical neuroleptic medications, antiemetic agents, reserpine, and tetrabenazine. Akathisia is estimated to occur in 20% to 30% of patients exposed to these medications (Sachdev, 1995) (Case 8-3). The exact pathophysiologic basis for the development of akathisia is unknown. It can be improved by diminishing the dosage of the precipitating agent or eliminating this agent. If the akathisia persists or is a tardive phenomenon, then medical therapy may be necessary to help control symptoms. The most consistently effective treatment is propanolol. If propanolol is ineffective or cannot be tolerated, other agents that have been used, including benzodiazepines, amantadine, or clonidine, can be tried (Miller and Fleischhacker, 2000). DRUG-INDUCED MYOCLONUS Myoclonus is an involuntary hyperkinetic movement disorder that is classified as either positive or negative. Positive myoclonus features sudden brief muscular contractions, while negative myoclonus involves pauses in muscular activity (Fahn et al, 1986). Medication-induced myoclonus is typically generalized in nature and can be very debilitating. The underlying pathophysiologic mechanism of myoclonus appears to be mediated through enhancement of serotonin and g-aminobutyric acid (Marsden et al, 1982; Matsumoto et al, 2000). Multiple medications and illicit substances have been implicated in the etiology of drug-induced myoclonus. These medications are listed in Table 8-7 (Blindauer, 2001). The best therapy for drug-induced myoclonus is identification and elimination of the offending agent. DRUG-INDUCED TICS Tics are a hyperkinetic movement disorder consisting of repetitive, stereotyped motor or vocal movements that may be simple or complex in nature. Often patients can describe an urge to perform the movement, relief after performing the movement, and some ability to suppress the movement for Case 8-3 A 33-year-old pregnant woman presents with generalized involuntary movements. She has been taking metoclopramide 10 mg 4 times a day for the past month because of intractable nausea and vomiting. The patient describes the inability to sit still for long periods of time. She feels good when active. Her inability to sit still has been interfering with many daily activities. On examination, the patient is constantly moving. When asked to sit still, she can do this for several minutes but then becomes uncomfortable and begins to pace. The patient is diagnosed with akathisia due to dopamine blocking medications. The patient is asked to limit the amount of metoclopramide and to take this medication on an as-needed basis instead of around the clock. Two weeks later her symptoms have moderately improved. Comment. This case illustrates typical drug-induced akathisia. Abnormal movements, primarily chorea, can be seen in pregnancy. Akathisia may occur with the institution of any medication that blocks D2 receptors. Clinical improvement may be seen with reduction or elimination of the precipitating medication. 149
9 "DRUG-INDUCED MOVEMENT DISORDERS 150 KEY POINT: A Neuroleptic malignant syndrome is a syndrome of hyperthermia and autonomic dysfunction, altered mental status, and muscular rigidity. TABLE 8-7 Substances Associated With Myoclonus " Morphine " Meperidine " Hydromorphone " Fentanyl " Sufentanil " Diamorphine " Diltiazem " Nifedipine " Verapamil " Tricyclic antidepressants " Selective serotonin reuptake inhibitors " Monoamine oxidase inhibitors " Lithium " Buspirone " Neuroleptic medications " Phenytoin " Valproic acid " Carbamazepine " Gabapentin " Lamotrigine " Vigabatrin " Chlorambucil " Flecainide " Propafenone " Carvedilol " Levodopa " Bromocriptine " Metoclopramide " Pseudoephedrine " Tryptophan " Albuterol " Physostigmine " Alcohol Reprinted with permission from Blindauer K. Myoclonus and its disorders. Neurol Clin 2001; 19: Copyright # 2001, Elsevier. short amounts of time. Tics have a predilection for cranial and cervical musculature but may occur in any body location. They are caused by enhanced dopamine levels and have been associated with multiple substances, including stimulants such as methylphenidate, dextroamphetamine, pemoline, cocaine, and, lastly, lamotrigine (Kumar and Lang, 1997). A recent double-blind randomized study performed with methylphenidate to determine if stimulants exacerbate tics in Tourette s syndrome found no significant change in tic severity between the active drugs and the placebo groups (Tourette s Syndrome Study Group, 2002). This recent study suggests that stimulants may not exacerbate tics, although multiple case reports exist in the literature describing this phenomenon. The best therapy is again to eliminate any medication that may have been associated with the onset or worsening of tics. NEUROLEPTIC MALIGNANT SYNDROME Neuroleptic malignant syndrome (NMS) is a serious complication of medications that block D2 receptors. NMS is a syndrome of hyperthermia and autonomic dysfunction, altered mental status, and muscular rigidity. Diagnostic criteria for NMS, according to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) include increased temperature and muscle rigidity accompanied by two or more of the following: diaphoresis, tremor, dysphagia, altered mental status, tachycardia, incontinence, dysregulation of blood pressure, leukocytosis, and elevated creatine kinase. Patients may develop the syndrome at any time during treatment with medications that block D2 receptors; it is seen most commonly with typical or atypical neuroleptic medications. Risk may be
10 slightly increased with depot forms of neuroleptic medications. NMS may occur at any time during therapy but is most commonly seen within the first 3 to 9 days of therapy. The incidence of NMS is between 0.5% and 2.4% of patients exposed to these medications, and mortality rates have been reported as low as 4% and as high as 20% (Bertorini, 1997). NMS has also been described with lithium and the rapid elimination of dopaminergic medications in idiopathic Parkinson s disease. The pathophysiologic basis is felt to be through dopaminergic dysregulation and blockade of dopamine in the basal ganglia and hypothalamus (Henderson and Wooten, 1981). Abnormal laboratory findings include leukocytosis and increased creatine kinase levels. The most important therapy is identification and elimination of the offending medication. Treatment includes supportive care such as aggressive intravenous fluid replacement and diuresis, blood pressure support, and temperature control. Medications that have been used to treat NMS include bromocriptine 5 mg 4 times a day and dantrolene 3mg/kg to 5 mg/kg intravenously in divideddoses3timesor4timesaday. Other modalities that have been described to be effective in the treatment of NMS include benzodiazepines, amantadine, and electroconvulsive therapy (Carbone, 2000). CONCLUSION Drug-induced movement disorders can be commonly seen in outpatient and inpatient clinical practice. When evaluating a patient with a movement disorder, it is important to take a thorough past and present medication history, including any recently added medications or changes in dosages. The best therapy for treating a drug-induced movement disorder is elimination of the offending agent. If elimination is not possible due to underlying illness, then attempting to decrease the dosage or change to a less-offensive agent would be the next line of therapy. If all of the above measures are impossible or a tardive syndrome exists, then medical therapy can be considered to help decrease disability. The choice of therapeutic agent is guided by the type of movement disorder and coexistent medical problems and medications. REFERENCES " Adler CH. Differential diagnosis of Parkinson s disease. Med Clin North Am 1999;83: Review article with an excellent differential diagnosis of parkinsonism. 151 " Armon C, Shin C, Miller P, et al. Reversible parkinsonism and cognitive impairment with chronic valproate use. Neurology 1996;47: Early description of valproate-induced parkinsonism. " Ayd FJ Jr. A survey of drug-induced extrapyramidal reactions. JAMA 1961; 175: One of the earliest articles describing drug-induced movement disorders. " Bertorini TE. Myoglobinuria, malignant hyperthermia, neuroleptic malignant syndrome and serotonin syndrome. Neurol Clin 1997;15: Review article describing the above phenomenon and how to differentiate among the disorders.
11 "DRUG-INDUCED MOVEMENT DISORDERS " Blindauer K. Myoclonus and its disorders. Neurol Clin 2001;19: Review article describing the types of myoclonus and differential diagnosis. " Burn DJ, Brook DJ. Nigral dysfunction in drug-induced parkinsonism: an 18F-dopa PET study. Neurology 1993;43: Interesting study comparing drug-induced parkinsonism with parkinsonism following elimination of dopamine blocking drugs. " Carbone JR. The neuroleptic malignant and serotonin syndromes. Emerg Med Clin North Am 2000;18: Review article on neuroleptic malignant syndrome and serotonin syndrome with their causes and treatments. " Deuschl G, Bain P, Brin M, et al. Consensus statement of the Movement Disorder Society on Tremor. Ad Hoc Scientific Committee. Mov Disord 1998;13(suppl 3):2 23. Consensus statement describing the various tremor disorders and causes for tremor. " Diederich NJ, Goetz CG. Drug-induced movement disorders. Neurol Clin 1998;16: Excellent review article on all drug-induced movement disorders. " Fahn S. The spectrum of levodopa-induced dyskinesias. Ann Neurol 2000;47(suppl 1):S2 S9. Description of dyskinesias associated with levodopa in Parkinson s disease (PD). " Fahn S. High dosage anticholinergic therapy in dystonia. Neurology 1983; 33: One of the original treatment articles in dystonia. " Fahn S, Marsden CD, Van Woert MH. Definition and classification of myoclonus. Adv Neurol 1986;43:1 5. Description of various forms of myoclonus and their phenomenology. 152 " Friedman JH, Kucharski LT, Wagner RL. Tardive dystonia in a psychiatric hospital. J Neurol Neurosurg Psychiatry 1987;50: Article describing the incidence of tardive dystonia in psychiatric patients. " Glazer WM, Morgenstern H, Schooler N, et al. Predictors of improvement in tardive dyskinesia following discontinuation of neuroleptic medication. Br J Psychiatry 1990;157: Article describing features to help predict resolution of tardive dyskinesia (TD). " Henderson VW, Wooten GF. Neuroleptic malignant syndrome (NMS): a pathogenic role for dopamine receptor blockade? Neurology 1981;31: Article describing the possible pathophysiologic role of dopamine in neuroleptic malignant syndrome. " Indo T, Ando K. Metoclopramide-induced parkinsonism. Arch Neurol 1982;39: Early article describing parkinsonism caused by antiemetics.
12 " Kane JM, Smith JM. Tardive dyskinesia: prevalence and risk factors, 1959 to Arch Gen Psychiatry 1982;39: Early article describing TD and its prevalence in a select psychiatric population. " Klawans HL Jr. The pharmacology of tardive dyskinesias. Am J Psychiatry 1973;130: Article outlines an early model for the development of TD. " Kumar R, Lang AE. Tourette syndrome. Secondary tic disorders. Neurol Clin 1997;15: Review article on causes of secondary tic disorders. " Marsden CD, Hallet M, Fahn S. The nosology and pathophysiology of myoclonus. In: Marsden CD, Fahn S, eds, Movement disorders. London: Butterworths, 1982; Textbook chapter describing the phenomenology and pathophysiology of various myoclonic disorders. " Matsumoto RR, Truong DD, Nguyen KD, et al. Involvement of GABA (A) receptors in myoclonus. Mov Disord 2000;15(suppl 1): Basic pathophysiology of myoclonus. " Miller CH, Fleischhacker WW. Managing antipsychotic-induced acute and chronic akathisia. Drug Saf 2000;22: Treatment options of acute and tardive akathisia. " Ondo WG, Hanna PA, Jankovic J. Tetrabenazine treatment for tardive dyskinesia: assessment by randomized videotape protocol. Am J Psychiatry 1999;156: Good double-blind study of tetrabenazine for TD. " Rocca WA, Bower JH, McDonnell SK, et al. Time trends in the incidence of parkinsonism in Olmstead County, Minnesota. Neurology 2001;57: Incidence study for the prevalence of PD and parkinsonism. " Sachdev P. The epidemiology of drug-induced akathisia: Part 1. Acute akathisia. Schizophr Bull 1995;21: Incidence of tardive akathisia. 153 " Sajjad SH. Vitamin E in the treatment of tardive dyskinesia: a preliminary study over 7 months at different doses. Int Clin Psychopharmacol 1998;13: Short-term trial evaluating the use of Vitamin E in TD. " Tourette s Syndrome Study Group. The treatment of ADHD in children with tics. Neurology 2002;58: Good article showing no enhancement of tics with stimulant use in patients with Gilles de la Tourette syndrome. " Wojcik JD, Falk WE, Fink JS, et al. A review of 32 cases of tardive dystonia. Am J Psychiatry 1991;148: " Yassa R, Nair V, Dimitry R. Prevalence of tardive dystonia. Acta Psychiatr Scand 1986;73: Prevalence study of tardive dystonia.
Drug-induced movement
FEATURE Recognizing and managing drug-induced movement disorders Reprint from DUE Quarterly, July 2003 RICHARD CAMICIOLI, MD, Department of Medicine, University of Alberta, Edmonton, AB NOREEN VANDERBURGH,
More informationChapter 28. Drug Treatment of Parkinson s Disease
Chapter 28 Drug Treatment of Parkinson s Disease 1. Introduction Parkinsonism Tremors hands and head develop involuntary movements when at rest; pin rolling sign (finger and thumb) Muscle rigidity arthritis
More informationDrug-induced movement disorders in the elderly
Clinical practice 609 Drug-induced movement disorders in the elderly Drug-induced movement disorders are common in the elderly and responsible for significant morbidity and reduction in quality of life.
More informationChapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of
Chapter 18 Drugs Used for Psychoses Learning Objectives Identify signs and symptoms of psychotic behavior Describe major indications for the use of antipsychotic agents Identify common adverse effects
More informationUnderstanding Antipsychotic Medications
Understanding Antipsychotic Medications NARSAD RESEARCH National Alliance for Research on Schizophrenia and Depression 60 Cutter Mill Road, Suite 404 Great Neck, NY 11021 516-829-0091 1-800-829-8289 516-487-6930
More informationDementia & Movement Disorders
Dementia & Movement Disorders A/Prof Michael Davis Geriatrician ACT Health & GSAHS ANU Medical School Eastern Dementia Network Aged and Dementia Care Symposium Bateman s Bay, 22 October 2010 Types of Dementia
More informationMovement Disorder Emergencies. Anne E. A. Constantino, MD Attending Neurologist Holy Cross Hospital Silver Spring, MD June 28, 2014
Movement Disorder Emergencies Anne E. A. Constantino, MD Attending Neurologist Holy Cross Hospital Silver Spring, MD June 28, 2014 Objectives Provide a working definition of movement disorder emergencies
More informationA Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood.
Bipolar disorder Bipolar (manic-depressive illness) is a recurrent mode disorder. The patient may feel stable at baseline level but experience recurrent shifts to an emotional high (mania or hypomania)
More informationClinical characteristics of neuroleptic-induced parkinsonism
J Neural Transm (2001) 108: 1299 1308 Clinical characteristics of neuroleptic-induced parkinsonism S. Hassin-Baer 1,*, P. Sirota 2, A. D. Korczyn 1,3, T. A. Treves 1,**, B. Epstein 2, H. Shabtai 1, T.
More informationTreatments for Major Depression. Drug Treatments The two (2) classes of drugs that are typical antidepressants are:
Treatments for Major Depression Drug Treatments The two (2) classes of drugs that are typical antidepressants are: 1. 2. These 2 classes of drugs increase the amount of monoamine neurotransmitters through
More informationSummary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole)
EMA/303592/2015 Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole) This is a summary of the risk management plan (RMP) for Aripiprazole Pharmathen, which details the measures
More informationEmergency Room Treatment of Psychosis
OVERVIEW The term Lewy body dementias (LBD) represents two clinical entities dementia with Lewy bodies (DLB) and Parkinson s disease dementia (PDD). While the temporal sequence of symptoms is different
More informationUnderstanding Parkinson s Disease
Understanding Parkinson s Disease Irene Oh, MD Neurologist, Movement Disorders Specialist The Neurology Center of Southern California, Encinitas & Escondido Introduction PD was first described in 1817
More informationJournal Club. Parkinsonismo iatrogeno
PROGETTO UNIVA 2013 Journal Club Parkinsonismo iatrogeno Pietro Gareri, MD, PhD Geriatra ASP Catanzaro Lamezia Terme 3 Luglio 2013 Drug-induced parkinsonism (DIP) was recognized in the early 1950s as a
More informationPSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS. Juanaelena Garcia, MD Psychiatry Director Institute for Family Health
PSYCHOPHARMACOLOGY AND WORKING WITH PSYCHIATRY PROVIDERS Juanaelena Garcia, MD Psychiatry Director Institute for Family Health Learning Objectives Learn basics about the various types of medications that
More informationPsychopharmacotherapy for Children and Adolescents
TREATMENT GUIDELINES Psychopharmacotherapy for Children and Adolescents Guideline 7 Psychopharmacotherapy for Children and Adolescents Description There are few controlled trials to guide practitioners
More informationDrug-induced Parkinsonism
Drug-induced Parkinsonism Terms highlighted in bold italic are defined in the glossary at the end of this information sheet. What is drug-induced parkinsonism? About 7% of people with parkinsonism have
More informationUnderstanding tardive dyskinesia
Understanding tardive dyskinesia 1 Contents What is tardive dyskinesia? 3 What does TD look like? 3 What might affect the risk of me getting TD? 4 Will TD disappear if I stop my medication? 5 What else
More informationConjoint Professor Brian Draper
Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course
More informationThe Road to Rehabilitation, Part 6: Mapping the Way: Drug Therapy & Brain Injury Written by Gregory O Shanick, MD
The Road to Rehabilitation, Part 6: Mapping the Way: Drug Therapy & Brain Injury Written by Gregory O Shanick, MD Introduction The basic unit of the nervous system is the neuron or nerve cell. Billions
More information9/20/2010. Disclaimer. Movement Disorders in Psychiatry. Overview of Key Points: Learning Objectives:
Movement Disorders in Psychiatry Badari Birur,MD PGY4 Psychiatry Resident ETSU James H. Quillen College of Medicine Disclaimer NEITHER THE PUBLISHER NOR THE AUTHORS ASSUME ANY LIABILITY FOR ANY INJURY
More informationWhat You Need to Know About Xenazine
Note to Healthcare Professionals: Please provide this guide to your patient or your patient s caregiver. What You Need to Know About Xenazine (tetrabenazine) Patient/Caregiver Counseling Guide This guide
More informationBelow, this letter outlines [patient name] s medical history, prognosis, and treatment rationale.
[Date] [Name of Contact] [Title] [Name of Health Insurance Company] [Address] [City, State, Zip Code] Insured: [Patient Name] Policy Number: [Number] Group Number: [Number] Diagnosis: [Diagnosis and ICD-9-CM
More informationHow To Treat Aphasic Depression
Antipsychotic Use in Patients with Parkinson s Disease 단국의대 정신과 이석범 Difficulties in Parkinson's disease Motor symptoms Neuropsychiatric syndromes Severe Disability Cognitive impairment 2 Neuropsychiatric
More informationCENTRAL NERVOUS SYSTEM MANAGEMENT OF PARKINSON S DISEASE
MANAGEMENT CENTRAL NERVOUS SYSTEM MANAGEMENT OF PARKINSON S DISEASE Parkinson s Disease is classically determined by the triad or rest tremor (usually starting in one arm) with bradykinesia (slowing of
More informationParkinson Disease Levodopa-Induced Dyskinesia. Christopher Kenney, MD Novartis Pharmaceuticals
Parkinson Disease Levodopa-Induced Dyskinesia Christopher Kenney, MD Novartis Pharmaceuticals Disclosures Dr. Kenney is a full-time employee of Novartis Pharmaceuticals Corporation The opinions expressed
More informationWe re all aware that neuroleptics
Subscribe today! Call 866-348-9279 The carlat report psychiatry an UNBIASED MONTHLY COVERING all things psychiatric A CME Publication Steve Balt, MD Editor-in-Chief Volume 12, Number 4 April 2014 www.thecarlatreport.com
More informationMedications for Huntington s Disease Vicki Wheelock, M.D.
Medications for Huntington s Disease Vicki Wheelock, M.D. Director, HDSA Center of Excellence at UC Davis June 4, 2013 Outline Introduction and disclaimers Medications for cognitive symptoms Medications
More informationBackground. Population/Intervention(s)/Comparator/Outcome(s) (PICO)
updated 2012 Role of anticholinergic medications in patients requiring long-term antipsychotic treatment for psychotic disorders Q6: In individuals with psychotic disorders (including schizophrenia) who
More informationThe majority of parkinsonism (approx. 80%) is due to idiopathic PD other causes include drug therapy (Table 1),toxins and trauma.
THE TREATMENT OF PARKINSON S DISEASE SUMMARY Levodopa (L-dopa) administered in conjunction with a dopa decarboxylase inhibitor (DDCI) remains the mainstay of therapy for Parkinson s disease. New drugs
More informationPsychotic Disorder. Psychosis. Psychoses may be caused by: Examples of Hallucinations and Delusions 12/12/2012
Psychosis Psychotic Disorder Dr Lim Boon Leng Psychiatrist and Medical Director Dr BL Lim Centre For Psychological Wellness Tel: 64796456 Email: info@psywellness.com.sg Web: www.psywellness.com.sg A condition
More informationParkinson s Disease and Tremors
Parkinson s Disease and Tremors Current Strategies Leah Karliner, MD, MAS Division of General Internal Medicine Disclosures I have no conflicts of interest Parkinsonism neurological syndrome: Bradykinesia:
More informationDepression is a common biological brain disorder and occurs in 7-12% of all individuals over
Depression is a common biological brain disorder and occurs in 7-12% of all individuals over the age of 65. Specific groups have a much higher rate of depression including the seriously medically ill (20-40%),
More informationNursing Care of Patients with Movement Disorders. Catholic Health 2 nd Annual Neurorehab Symposium November 1, 2014
Nursing Care of Patients with Movement Disorders Catholic Health 2 nd Annual Neurorehab Symposium November 1, 2014 Types of Movement Disorders Parkinson s disease Huntington s disease Dystonia Tremors
More informationNeuropharmacology I Parkinson s Disease and Movement Disorders
Harvard-MIT Division of Health Sciences and Technology HST.151: Principles of Pharmocology Instructor: Dr. David Standaert Standaert 1 Neuropharmacology I Parkinson s Disease and Movement Disorders What
More informationComorbid Conditions in Autism Spectrum Illness. David Ermer MD June 13, 2014
Comorbid Conditions in Autism Spectrum Illness David Ermer MD June 13, 2014 Overview Diagnosing comorbidities in autism spectrum illnesses Treatment issues specific to autism spectrum illnesses Treatment
More informationThe Road to Rehabilitation
The Road to Rehabilitation Part 6 Mapping the Way: Drug Therapy & Brain Injury Written by Gregory O Shanick, MD Brain Injury Association of America Brain Injury Association of America Creating a better
More informationThorazine (chlorpromazine)
Generic name: Chlorpromazine Available strengths: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg tablets; 100 mg/ml oral concentrate; 25 mg/ml injection Available in generic: Yes Drug class: First-generation (conventional)
More informationChapter 20 USE OF DRUGS FOR NEUROLOGICAL DISORDER
Chapter 20 USE OF DRUGS FOR NEUROLOGICAL DISORDER Sapiah S. 1, Mohd. Sufian A. 1, Norsima Nazifah S. 2, Nurul Faezah M.Y. 2, Khutrun Nada Z. 1, Md. Hanip M.R. 1 1. Kuala Lumpur Hospital, Kuala Lumpur,
More informationDEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE
1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff
More informationClinical Psychopharmacology
Clinical Psychopharmacology Antiparkinsonian drugs Department of Pharmacy, GGZ WNB Chair on Pharmacotherapy in Psychiatric Patients/Anton Loonen May 2015 2 Basal ganglia diseases Parkinson s disease and
More information1. According to recent US national estimates, which of the following substances is associated
1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates
More informationContemporary Psychiatric-Mental Health Nursing. Assessing the Effectiveness of Medications. Administering Medications
Contemporary Psychiatric-Mental Health Nursing Chapter 32 Psychopharmacologic Nursing Interventions Assessing the Effectiveness of Medications Include how well the medications are helping the client to
More informationPARKINSON S DISEASE AND PARKINSONISM. Dr Phil Wood Geriatrician, Waitemata DHB Clinical Unit Leader, Waikato DHB
PARKINSON S DISEASE AND PARKINSONISM Dr Phil Wood Geriatrician, Waitemata DHB Clinical Unit Leader, Waikato DHB OUTLINE Covering:- Why this is an important area of Medical and Psychiatric care The variety
More informationBipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:
Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic
More informationWhat is PD? Dr Catherine Dotchin MD MRCP Consultant Geriatrician
What is PD? Dr Catherine Dotchin MD MRCP Consultant Geriatrician Overview of presentation Case history Video example pre and post treatment Historical review PD in the UK Epidemiology and aetiology Making
More informationDoncaster & Bassetlaw Medicines Formulary
Doncaster & Bassetlaw Medicines Formulary Section 4.9: Drugs Used in Parkinsonism and related Disorders Co-Beneldopa 12.5/50, 25/100 and 50/200 (Madopar) Capsules Co-Beneldopa 12.5/50 and 25/100 Dispersible
More informationParkinson's s disease - a
Parkinson's Disease Parkinson's s disease - a progressive disorder of the nervous system that affects movement. The most common perception of Parkinson s is the patient having tremors. Hands shaking, inability
More informationTREATING MAJOR DEPRESSIVE DISORDER
TREATING MAJOR DEPRESSIVE DISORDER A Quick Reference Guide Based on Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Second Edition, originally published in April 2000.
More informationBRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS
BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems
More informationI. The Positive Symptoms...Page 2. The Negative Symptoms...Page 2. Primary Psychiatric Conditions...Page 2
SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Assessment & Treatment of Psychosis Developed March 1, 2003 Revised September 21,
More informationplacebo-controlledcontrolled double-blind, blind,
Clinical Potential of Minocycline for Depression with Psychotic Features Tsuyoshi Miyaoka Department of Psychiatry Shimane University School of Medicine Minocycline 1. Second-generation tetracycline which
More informationParkinson s Disease - A Junior Doctor s Survival Guide
Parkinson s Disease - A Junior Doctor s Survival Guide Professor Richard Walker Consultant Geriatrician Hon. Professor of Ageing & Interna
More informationAlcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol
Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission
More informationAnti-Parkinsonism Drugs
Anti-Parkinsonism Drugs Pharma Team 429 Fahad Alrumaih Ibrahim Alshiddi Sultan Alsalem Ismail Raslan Suhail Asiri Parkinsonism - Could be: primary [idiopathic] or secondary [viral infection or drug induced
More informationTremor in the Elderly
UNDERSTANDING Tremor in the Elderly Tremor is an important and frequent symptom/sign in older patients requiring a logical approach to diagnosis. The clinician should know the different types of common
More informationAn Introduction to Lewy Body Dementia
An Introduction to Lewy Body Dementia A special publication for people newly diagnosed with Lewy body dementia and those still seeking answers. You don t have to face LBD alone. Increasing Knowledge Sharing
More informationAlgorithm for Initiating Antidepressant Therapy in Depression
Algorithm for Initiating Antidepressant Therapy in Depression Refer for psychotherapy if patient preference or add cognitive behavioural office skills to antidepressant medication Moderate to Severe depression
More informationCOMPREHENSIVE MANAGEMENT OF THE ELDERLY PATIENT WITH MANIA
COMPREHENSIVE MANAGEMENT OF THE ELDERLY PATIENT WITH MANIA Manic depressive illness is a biological brain disorder that produces significant alterations of mood and psychosis. Mania in the elderly occurs
More informationXenazine (tetrabenazine) Treatment Form
Xenazine (tetrabenazine) Treatment Form Step 1: Patient Information Name: (First) (Middle) (Last) Sex: Male Female DOB: Address: City: State: Zip Code: Phone: Cell Phone: Best Time to Call: E-mail: Preferred
More informationUpdate on guidelines on biological treatment of depressive disorder. Dr. Henry CHEUNG Psychiatrist in private practice
Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological
More informationAntipsychotic-Induced Movement Disorders: Evaluation and Treatment
[REVIEW] by MAJU MATHEWS, MD, MRCPsych, DIP PSYCH; SYLVIA GRATZ, DO; BABATUNDE ADETUNJI, MD, FASAM; VINU GEORGE, MD; MANU MATHEWS, MD; and BIJU BASIL, MD Dr. Maju Mathews is Assistant Professor of Psychiatry,
More informationParkinson s Disease: General Information
Parkinson s Disease: General Information Does PD come in stages? If so, how many stages? Hubert Fernandez, MD: Staging provides an artificial classification of a patient's illness severity but, in reality,
More informationA BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES
INTRODUCTION A BRIEF OVERVIEW OF PSYCHOTROPIC MEDICATION USE FOR PERSONS WITH INTELLECTUAL DISABILITIES Individuals with intellectual disabilities are not uncommonly prescribed psychotropic medications.
More informationPARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT
PARTNERSHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT X.J. Mental Health Services 1. For claims with dates of service on or before January 1, 2014: Mental Health Services are
More informationPreferred Practice Guidelines Bipolar Disorder in Children and Adolescents
These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,
More informationAntidepressant treatment in adults
Antidepressant treatment in adults A NICE pathway brings together all NICE guidance, quality standards and materials to support implementation on a specific topic area. The pathways are interactive and
More informationSUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]
SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual
More information1. Which of the following SSRIs requires up to a 5-week washout period because of the
1 Chapter 38. Major Depressive Disorders, Self-Assessment Questions 1. Which of the following SSRIs requires up to a 5-week washout period because of the long half-life of its potent active metabolite?
More informationMedications for bipolar disorder
Medications for bipolar disorder Findings from Australian National Survey of Mental Health and Wellbeing (Mitchell et al, 2004) In 12 months, only one-third saw a mental health professional 40% received
More informationCLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia
CLINICAL PRACTICE GUIDELINES Treatment of Schizophrenia III. Pharmacotherapy Medications These guidelines only refer to medications available in Canada at the time of writing. They refer to clozapine,
More informationMOH CLINICAL PRACTICE GUIDELINES 2/2008 Prescribing of Benzodiazepines
MOH CLINICL PRCTICE GUIELINES 2/2008 Prescribing of Benzodiazepines College of Family Physicians, Singapore cademy of Medicine, Singapore Executive summary of recommendations etails of recommendations
More informationAmphetamines Addiction
Introduction Amphetamines, which are classified as stimulants, work by using the dopamine reward system of the brain. When these drugs are used, the user s central nervous system is simulated which causes
More informationLocal Clinical Trials
Local Clinical Trials The Alzheimer s Association, Connecticut Chapter does not officially endorse any specific research study. The following information regarding clinical trials is provided as a service
More informationOverview of Mental Health Medication Trends
America s State of Mind Report is a Medco Health Solutions, Inc. analysis examining trends in the utilization of mental health related medications among the insured population. The research reviewed prescription
More informationPOST-TEST Pain Resource Professional Training Program University of Wisconsin Hospital & Clinics
POST-TEST University of Wisconsin Hospital & Clinics True/False/Don't Know - Circle the correct answer T F D 1. Changes in vital signs are reliable indicators of pain severity. T F D 2. Because of an underdeveloped
More informationMEDICATIONS AND TOURETTE S DISORDER: COMBINED PHARMACOTHERAPY AND DRUG INTERACTIONS. Barbara Coffey, M.D., Cheston Berlin, M.D., Alan Naarden, M.D.
MEDICATIONS AND TOURETTE S DISORDER: COMBINED PHARMACOTHERAPY AND DRUG INTERACTIONS Barbara Coffey, M.D., Cheston Berlin, M.D., Alan Naarden, M.D. Introduction Tourette Syndrome (TS) or Tourette s Disorder
More informationMOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION
MOH CLINICAL PRACTICE GUIDELINES 6/2011 DEPRESSION Executive summary of recommendations Details of recommendations can be found in the main text at the pages indicated. Clinical evaluation D The basic
More informationMedications Used in the Management of Disruptive Behavior Disorders
The following medication chart is provided as a brief guide to some of the medications used in the management of various behavior disorders, along with their potential benefits and possible side effects.
More informationDonepezil as a precipitating factor of mania: a case report
Donepezil as a precipitating factor of mania: a case report Jonathan G Leung, PharmD, BCPS, BCPP Psychiatric Clinical Pharmacist Western Psychiatric Institute and Clinic University of Pittsburgh Medical
More informationNow Antidepressant-Induced Chronic Depression Has a Name: Tardive...
1 of 5 Published on Psychology Today (http://www.psychologytoday.com) Now Antidepressant-Induced Chronic Depression Has a Name: Tardive Dysphoria By Robert Whitaker Created Jun 30 2011-9:35am Three recently
More informationHow To Safely Use Aripiprazole
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Bipolar I Disorder Reported prevalence rates for bipolar I disorder differ due to local variations in psychiatric practice, variations
More informationPsychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
More information4 Clinical Particulars
SUMMARY OF PRODUCT CHARACTERISTICS 1 Name of the Medicinal Product Procyclidine Syrup 5mg/5ml 2. Qualitative and Quantitative Composition Each 5ml dose contains 5mg Procyclidine Hydrochloride BP. 3. Pharmaceutical
More informationPhilip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth
Philip Moore DO, Toxicology Fellow, PinnacleHealth Toxicology Center Joanne Konick-McMahan RN MSRN, Staff RN, PinnacleHealth I. II. Background A. AWS can occur in anyone who consumes alcohol B. Risk correlates
More informationDepression Flow Chart
Depression Flow Chart SCREEN FOR DEPRESSION ANNUALLY Assess for depression annually with the PHQ-9. Maintain a high index of suspicion in high risk older adults. Consider suicide risk and contributing
More informationATYPICALS ANTIPSYCHOTIC MEDICATIONS
The atypical antipsychotics are a class of drugs that are used to treat a number of behavioral health disorders, including schizophrenia, other psychotic disorders, mood disorders, and behavioral agitation
More informationNICE Clinical guideline 23
NICE Clinical guideline 23 Depression Management of depression in primary and secondary care Consultation on amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised
More informationSLEEP AND PARKINSON S DISEASE
A Practical Guide on SLEEP AND PARKINSON S DISEASE MICHAELJFOX.ORG Introduction Many people with Parkinson s disease (PD) have trouble falling asleep or staying asleep at night. Some sleep problems are
More informationDepre r s e sio i n o i n i a dults Yousuf Al Farsi
Depression in adults Yousuf Al Farsi Objectives 1. Aetiology 2. Classification 3. Major depression 4. Screening 5. Differential diagnosis 6. Treatment approach 7. When to refer 8. Complication 9. Prognosis
More informationObsessive Compulsive Disorder: a pharmacological treatment approach
Obsessive Compulsive Disorder: a pharmacological treatment approach Professor Alasdair Vance Head, Academic Child Psychiatry Department of Paediatrics University of Melbourne Royal Children s Hospital
More informationABC s of Parkinson s Disease 4/29/15 Karen Parenti, MS, PsyD
ABC s of Parkinson s Disease 4/29/15 Karen Parenti, MS, PsyD What is Parkinson s Disease? Parkinson's disease is a progressive disorder of the nervous system that affects movement. It develops gradually,
More informationBest Practices Treatment Guideline for Major Depression
Best Practices Treatment Guideline for Major Depression Special Report on New Depression Treatment Technology Based on 2010 APA Practice Guidelines Best Practices Guideline for the Treatment of Patients
More informationParkinson s Disease Symptoms Guide
Parkinson s Disease Symptoms Guide Some symptoms of Parkinson s disease (PD) are hard for even specialists to detect. Others are obvious even to an untrained eye. Parkinson s symptoms are different for
More informationDRUGS OF ABUSE CLASSIFICATION AND EFFECTS
Drug and Drug use DRUGS OF ABUSE CLASSIFICATION AND EFFECTS A pharmaceutical preparation or a naturally occurring substance used primarily to bring about a change in the existing process or state (physiological,
More informationSocial phobia following maprotiline: The first case report. Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
Social phobia following maprotiline: The first case report Seyed Hamzeh Hosseini (MD) 1*, Ebraheim Salehifar (PharmD) 2 1* Associate professor of Psychiatry, Department of Psychiatry, Faculty of Medicine,
More informationPARKINSON S DISEASE IN LONG-TERM-CARE SETTINGS
PARKINSON S DISEASE IN LONG-TERM-CARE SETTINGS De Anna Looper, RN CHPN Corporate Clinical Consultant / Legal Nurse Consultant Carrefour Associates L.L.C. PARKINSON S DISEASE IN LONG-TERM-CARE SETTINGS
More informationGLOSSARY OF TERMS. This glossary explains the terms and words often used in association with Parkinson s.
Antagonist This glossary explains the terms and words often used in association with Parkinson s. Medications which have a negative effect on particular cells in the body. In Parkinson s dopamine antagonists
More informationManagement of Parkinson s Disease in Primary Care
Management of Parkinson s Disease in Primary Care Dr June Tan National University Hospital System (NUHS) Division of Neurology Senior Consultant Topics: Diagnosing PD Choice of medication in the de novo
More informationSummary of the risk management plan (RMP) for Rasagiline ratiopharm (rasagiline)
EMA/744222/2014 Summary of the risk management plan (RMP) for Rasagiline ratiopharm (rasagiline) This is a summary of the risk management plan (RMP) for Rasagiline ratiopharm, which details the measures
More information