Pub Date : 2022-01-01DOI: 10.4103/jopsys.jopsys_24_22
S. Suhas, H. Vijayakumar, G. Venkatasubramanian, S. Varambally
Tardive dyskinesia (TD) syndromes are clinical conditions characterized by abnormal involuntary movements of the body and can range from occasional annoying involuntary movements to debilitating dystonia and are associated with increased mortality rates in schizophrenia. The annual incidence of TDs 5.5% for first-generation antipsychotics and 3.9% for second-generation antipsychotics. The prevalence of TD in long-term use of antipsychotics ranges from 15% to 30%. Tardive syndromes include TD, dystonia, akathisia, tremor, and variants of other movement disorders. Tardive syndromes are poorly understood and often inadequately treated. Although there are diverse groups of drugs that are helpful in this condition, no single agent is proven to be consistently effective. The incidence of tardive syndromes has not significantly decreased with the increased use of second-generation antipsychotics. Conventionally, olanzapine, quetiapine, and clozapine are considered safe alternatives as they are most atypical among antipsychotics. There is reasonable evidence to suggest that adjunct quetiapine and clozapine are associated with a decrease in the severity of TDs. In this case, we report a patient with schizophrenia who has had long-standing tardive dystonia and dyskinesia, which did not improve with baclofen, tetrabenazine, benzodiazepines, diphenhydramine, and Vitamin E. He was given a trial of quetiapine as an inpatient, with subsequent worsening of dystonia and dyskinesia. The administration of clozapine was associated with significant improvement in symptoms. Through this case, we highlight the presence of long-term TD in a person suffering from bipolar affective disorder, examine the role of antipsychotics in its exacerbation of TD, and discuss treatment strategies. Subsequently, we highlight the essential facts about TD through clinical grand rounds discussion.
{"title":"Tardive dyskinesia and dystonia – Clinical case review and grand rounds","authors":"S. Suhas, H. Vijayakumar, G. Venkatasubramanian, S. Varambally","doi":"10.4103/jopsys.jopsys_24_22","DOIUrl":"https://doi.org/10.4103/jopsys.jopsys_24_22","url":null,"abstract":"Tardive dyskinesia (TD) syndromes are clinical conditions characterized by abnormal involuntary movements of the body and can range from occasional annoying involuntary movements to debilitating dystonia and are associated with increased mortality rates in schizophrenia. The annual incidence of TDs 5.5% for first-generation antipsychotics and 3.9% for second-generation antipsychotics. The prevalence of TD in long-term use of antipsychotics ranges from 15% to 30%. Tardive syndromes include TD, dystonia, akathisia, tremor, and variants of other movement disorders. Tardive syndromes are poorly understood and often inadequately treated. Although there are diverse groups of drugs that are helpful in this condition, no single agent is proven to be consistently effective. The incidence of tardive syndromes has not significantly decreased with the increased use of second-generation antipsychotics. Conventionally, olanzapine, quetiapine, and clozapine are considered safe alternatives as they are most atypical among antipsychotics. There is reasonable evidence to suggest that adjunct quetiapine and clozapine are associated with a decrease in the severity of TDs. In this case, we report a patient with schizophrenia who has had long-standing tardive dystonia and dyskinesia, which did not improve with baclofen, tetrabenazine, benzodiazepines, diphenhydramine, and Vitamin E. He was given a trial of quetiapine as an inpatient, with subsequent worsening of dystonia and dyskinesia. The administration of clozapine was associated with significant improvement in symptoms. Through this case, we highlight the presence of long-term TD in a person suffering from bipolar affective disorder, examine the role of antipsychotics in its exacerbation of TD, and discuss treatment strategies. Subsequently, we highlight the essential facts about TD through clinical grand rounds discussion.","PeriodicalId":262035,"journal":{"name":"Journal of Psychiatry Spectrum","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121209923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/jopsys.jopsys_5_21
Rishabh Aggarwal, L. Pandit, M. Aswath, Vathsalya Gowda
Baclofen is primarily a gamma-aminobutyric acid-B receptor agonist. It is used in patients with dystonia and to reduce spasticity in neuromuscular disorders. It has dopaminergic antagonist properties that reduce craving in alcohol dependence. Somnolence, dizziness, and fatigue are common side effects. Rarely paresthesia, rigidity, dystonia, dysarthria, or seizures are reported. We hereby report a rare case of baclofen-induced dystonia and tremors in a patient with alcohol dependence. An alcohol-dependent patient was admitted and withdrawal symptoms were managed. Twenty mg baclofen was advised to reduce craving. He developed dystonia and tremors within a few hours of the first dose. On evaluation, magnetic resonance imaging of brain revealed non-specific changes and electroencephalography was normal. To our knowledge, this is one of the first case reports of drug-induced dystonia attributable to baclofen. The underlying pathophysiological processes involved remain unclear. Baclofen decreases pre-synaptic dopamine release in the nigrostriatal pathway, which may be the possible mechanism for dystonia.
{"title":"Baclofen-Induced dystonia and tremors in a patient with alcohol dependence syndrome","authors":"Rishabh Aggarwal, L. Pandit, M. Aswath, Vathsalya Gowda","doi":"10.4103/jopsys.jopsys_5_21","DOIUrl":"https://doi.org/10.4103/jopsys.jopsys_5_21","url":null,"abstract":"Baclofen is primarily a gamma-aminobutyric acid-B receptor agonist. It is used in patients with dystonia and to reduce spasticity in neuromuscular disorders. It has dopaminergic antagonist properties that reduce craving in alcohol dependence. Somnolence, dizziness, and fatigue are common side effects. Rarely paresthesia, rigidity, dystonia, dysarthria, or seizures are reported. We hereby report a rare case of baclofen-induced dystonia and tremors in a patient with alcohol dependence. An alcohol-dependent patient was admitted and withdrawal symptoms were managed. Twenty mg baclofen was advised to reduce craving. He developed dystonia and tremors within a few hours of the first dose. On evaluation, magnetic resonance imaging of brain revealed non-specific changes and electroencephalography was normal. To our knowledge, this is one of the first case reports of drug-induced dystonia attributable to baclofen. The underlying pathophysiological processes involved remain unclear. Baclofen decreases pre-synaptic dopamine release in the nigrostriatal pathway, which may be the possible mechanism for dystonia.","PeriodicalId":262035,"journal":{"name":"Journal of Psychiatry Spectrum","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129540145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/jopsys.jopsys_6_21
GuruS Gowda, Prashant Sahu, KG Vijaykumar, S. Ganjekar, P. Murthy, H. Thippeswamy
Accreditation is usually a voluntary program and an essential step in ensuring quality in healthcare settings. Quality in health care and accreditation has gained importance over the last two decades worldwide. Mental health laws, policies, and regulations emphasize on improving the quality to meet the standards of care. Accreditation of mental health care is associated with unique challenges as compared to accreditation of a general medical facility. The information on the scope and challenges in accreditation of mental health care facilities is relatively sparse when compared to the latter. We discuss the development of policies and standard operating procedures that are essential for accreditation of a hospital providing mental health care. Our article provides a framework for accreditation of a hospital providing mental health care facilities in a low-and middle-income (LAMI) country.
{"title":"The scope and challenges for accreditation of quality care in mental health – Perspectives from India","authors":"GuruS Gowda, Prashant Sahu, KG Vijaykumar, S. Ganjekar, P. Murthy, H. Thippeswamy","doi":"10.4103/jopsys.jopsys_6_21","DOIUrl":"https://doi.org/10.4103/jopsys.jopsys_6_21","url":null,"abstract":"Accreditation is usually a voluntary program and an essential step in ensuring quality in healthcare settings. Quality in health care and accreditation has gained importance over the last two decades worldwide. Mental health laws, policies, and regulations emphasize on improving the quality to meet the standards of care. Accreditation of mental health care is associated with unique challenges as compared to accreditation of a general medical facility. The information on the scope and challenges in accreditation of mental health care facilities is relatively sparse when compared to the latter. We discuss the development of policies and standard operating procedures that are essential for accreditation of a hospital providing mental health care. Our article provides a framework for accreditation of a hospital providing mental health care facilities in a low-and middle-income (LAMI) country.","PeriodicalId":262035,"journal":{"name":"Journal of Psychiatry Spectrum","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125165842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/jopsys.jopsys_6_22
Ranganath R. Kulkarni, Swapna A. Pandurangi, R. Patil, R. Pai
Oculogyric crisis (OGC) is an acute paroxysmal sustained dystonia that occurs as an adverse drug event, commonly following first-generation antipsychotics and rarely with second-generation antipsychotics. We report a case of quetiapine (QTP)-induced disabling and stigmatizing tardive OGC developing after a month of its initiation, at a substantive low-dose (100 mg/day) in an ectomorphic young adult female during concomitant QTP, fluoxetine, and lithium therapy. It responded well to anticholinergic medications alone, without the need for dose-reduction or discontinuation of medications. We review literature on OGC due to QTP, fluoxetine and lithium; and discuss putative mechanisms leading to OGC in our case.
{"title":"Tardive Oculogyric Dystonia during Concomitant Quetiapine, Fluoxetine and Lithium Therapy: Case Report and Literature Review","authors":"Ranganath R. Kulkarni, Swapna A. Pandurangi, R. Patil, R. Pai","doi":"10.4103/jopsys.jopsys_6_22","DOIUrl":"https://doi.org/10.4103/jopsys.jopsys_6_22","url":null,"abstract":"Oculogyric crisis (OGC) is an acute paroxysmal sustained dystonia that occurs as an adverse drug event, commonly following first-generation antipsychotics and rarely with second-generation antipsychotics. We report a case of quetiapine (QTP)-induced disabling and stigmatizing tardive OGC developing after a month of its initiation, at a substantive low-dose (100 mg/day) in an ectomorphic young adult female during concomitant QTP, fluoxetine, and lithium therapy. It responded well to anticholinergic medications alone, without the need for dose-reduction or discontinuation of medications. We review literature on OGC due to QTP, fluoxetine and lithium; and discuss putative mechanisms leading to OGC in our case.","PeriodicalId":262035,"journal":{"name":"Journal of Psychiatry Spectrum","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125711232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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