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Abstract
Neuroleptic-induced neurological side effects have usually been classified as acute dystonia, Parkinsonism, akathisia and tardive dyskinesia (TD). Recent observations in monkeys and man have revealed that classification in this way is over-simplified because nearly identical extrapyramidal syndromes may appear as a result of 1) neuroleptic treatment, 2) withdrawal of neuroleptic treatment and initiation of anticholinergic treatment, or 3) age and/or the psychotic process. The aim of the present study was to determine the prevalence of the these first two syndromes.
Two hundred and two long-term neuroleptically treated psychiatric inpatients were evaluated 1) during treatment with their usual neuroleptic medication, but without anticholinergics for 2 days, and 2) after treatment with anticholinergics for 14 days, the last two of which the neuroleptic treatment was stopped. Patients with extrapyramidal symptoms were divided into subgroups depending on response to this pharmacological manipulation: those who improved during anticholinergic treatment (acute-initial syndromes such as traditional Parkinsonism, akathisia and paradoxical TD) and those who aggravated (tardive syndromes such as tardive akathisia and TD). The prevalence of traditional TD was 42%, ranging from 27% among younger patients (< 40 years) to 50% among older patients (> 60 years) (P < 0.05). «No change» TD was found in 22% of the patients (10% in the youngest, 26% in patients older than 60 years). Paradoxical TD had a prevalence of 8%; this syndrome was more often seen in young patients (18%) than in older patients (6%) (P < 0.05). Patients with paradoxical TD more often had involvement of neck and trunk, and akathisia (50%) than TD patients from the other groups (P < 0.05).
Akathisia was seen in 22% without age differences, «no change» akathisia appeared in 5%, and tardive akathisia in 10%, with a trend towards higher prevalence in the younger patients.
Forty-eight percent had Parkinsonism (26% in patients younger than 40 years increasing to 60% in patients over 60 years (P < 0.05)), and 20% had «no change» Parkinsonism. Paradoxical Parkinsonism was not registered.
The prevalence figures presented are very high, reflecting that the patients included were relatively old (mean: 55.2 years) and that they had been receiving neuroleptics in high doses for several years (mean: 16.4 years). It is further concluded that the number of patients with atypical, paradoxical syndromes is not negligible, but must be taken into account in the treatment and research of movement disorders.