Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-22T16:14:13.974Z Has data issue: false hasContentIssue false

Effect of Anticholinergics on Tardive Dyskinesia

A Controlled Discontinuation Study

Published online by Cambridge University Press:  29 January 2018

W. Greil*
Affiliation:
Psychiatric Hospital of the University of Munich, Nussbaumstrasse 7, D-8000 Munich, Federal Republic of Germany
H. Haag
Affiliation:
Psychiatric Hospital of the University of Munich, Nussbaumstrasse 7, D-8000 Munich, Federal Republic of Germany
G. Rossnagl
Affiliation:
Psychiatric Hospital of the University of Munich, Nussbaumstrasse 7, D-8000 Munich, Federal Republic of Germany
E. Rüther
Affiliation:
Psychiatric Hospital of the University of Munich, Nussbaumstrasse 7, D-8000 Munich, Federal Republic of Germany
*
Correspondence

Summary

In a double-blind, placebo-controlled study, ten chronic schizophrenic patients with pronounced symptoms of tardive dyskinesia (TD) were withdrawn from anticholinergic medication. All patients had previously been under long-term treatment with neuroleptics and anticholinergics for at least two years. The rating-scales used were the AIMS, our own TD Scale, and the Simpson-Angus scale for extra-pyramidal side-effects. The severity of TD decreased significantly in nine patients within two weeks; this improvement, most pronounced in the oral region (P <.001), persisted during a six-week placebo period. There was a slight increase in parkinsonian symptoms (P <.05), which was not a prerequisite for improvement in TD. Hence, discontinuation of anticholinergic medication is a possible therapeutic approach in patients with TD.

Type
Research Article
Copyright
Copyright © 1984 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beckmann, H. & Moises, H. W. (1982) The cholinolytic biperiden in depression. Archives of Psychiatry and Neurological Sciences, 231, 213220.Google ScholarPubMed
Burnett, G. B., Prange, A. J., Wilson, I. C., Jolliff, L. A., Creese, J. C. & Snyder, S. H. (1980) Adverse effects of anticholinergic antiparkinsonian drugs in tardive dyskinesia. Neuropsychobiology, 6, 109120.CrossRefGoogle ScholarPubMed
Casey, D. E. & Denney, D. (1977) Pharmacological characterization of tardive dyskinesia. Psychopharmacology, 54, 18.Google Scholar
Casey, D. E. Gerlach, J. & Christensson, E. (1980) Dopamine, acetylcholine, and GABA effects in acute dystonia in primates. Psychopharmacology, 70, 8387.Google Scholar
Chouinard, G., Montigny, C. & Annable, L. (1979) Tardive dyskinesia and antiparkinsonian medication. American Journal of Psychiatry, 136, 228229.Google ScholarPubMed
Fann, W. E. & Lake, C. R. (1974a) On the coexistence of parkinsonism and tardive dyskinesia. Diseases of the Nervous System, 35, 324326.Google ScholarPubMed
Fann, W. E. & Lake, C. R. (1974b) Cholinergic suppression of tardive dyskinesia. Psychopharmacologia, 37, 101107.CrossRefGoogle ScholarPubMed
Forsman, A. & Öhman, R. (1979) Interindividual variation of clinical response to haloperidol. In Biological Psychiatry Today (eds. Obiols, J., Ballús, C., Monclús, E. G. & Pujol, J.). Amsterdam: Elsevier.Google Scholar
Gautier, J., Jus, A., Villeneuve, A., Jus, K., Pires, P. & Villeneuve, R. (1977) Influence of the antiparkinsonian drugs on the plasma level of neuroleptics. Biological Psychiatry, 12, 389399.Google Scholar
Gerlach, J., Reisby, N. & Randrup, A. (1974) Dopaminergic hypersensitivity and cholinergic hypofunction in the pathophysiology of tardive dyskinesia. Psychopharmacologia, 34, 2135.Google Scholar
Gerlach, J. & Thorsen, K. (1976) The movement pattern of oral tardive dyskinesia in relation to anticholinergic and antidopaminergic treatment. International Pharmacopsychiatry, 11, 17.CrossRefGoogle ScholarPubMed
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmacology. Department of Health, Education and Welfare, 534537. Washington D.C. Google Scholar
Heinrich, K., Wegener, J. & Bender, H.-J. (1968) Späte extrapyramidale Hyperkinesen bei neuroleptischer Langzeittherapie. Pharmakopsychiatrie, 1, 169195.Google Scholar
Hippius, H. & Logemann, G. (1970) Zur Wirkung von Dioxyphenylalanin (L-DOPA) auf extrapyramidal-motorische Hyperkinesen nach langfristiger neuroleptischer Therapie. Arzneimittel-Forschung, 20, 894895.Google Scholar
Itoh, H., Yagi, G., Ohtsuka, N., Iwamura, K. & Ichikawa, K. (1980) Serum level of haloperidol and its clinical significance. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 4, 171183.Google Scholar
Jellinek, T., Gardos, G. & Cole, J. O. (1981) Adverse effects of antiparkinson drug withdrawal. American Journal of Psychiatry, 138, 15671571.Google ScholarPubMed
Kiloh, L. G., Smith, J. S. & Williams, S. E. (1973) Antiparkinson drugs as causal agents in tardive dyskinesia. Medical Journal of Australia, 2, 591593.CrossRefGoogle ScholarPubMed
Klawans, H. L. & Rubovits, R. (1974) Effect of cholinergic and anticholinergic agents on tardive dyskinesia. Journal of Neurology, Neurosurgery, and Psychiatry, 27, 941947.CrossRefGoogle Scholar
Kolakowska, T., Wiles, D. H., Gelder, M. G. & McNeilly, A. S. (1976) Clinical significance of plasma chlorpromazine levels: II. Plasma levels of the drug: Some of its metabolites and prolactin in patients receiving long-term phenothiazine treatment. Psychopharmacology, 49, 101107.Google Scholar
Linnoila, M., Viukari, M., Vaisanen, K. & Auvtnen, J. (1980) Effect of anticonvulsants on plasma haloperidol and thioridazine levels. American Journal of Psychiatry, 137, 819821.Google ScholarPubMed
Manos, N., Gkiouzepas, J. & Logothetis, J. (1981) The need for continuous use of antiparkinsonian medication with chronic schizophrenic patients receiving long-term neuroleptic therapy. American Journal of Psychiatry, 138, 184188.Google Scholar
Moore, D. C. & Bowers, M. B. (1980) Identification of a sub-group of tardive dyskinesia patients by pharmacologic probes. American Journal of Psychiatry, 137, 12021205.Google Scholar
Morselli, P. L., Zarifian, E., Cuche, H., Bianchetti, G., Cotterau, M. J. & Deniker, P. (1980) Haloperidol plasma level monitoring in psychiatric patients. In Long-Term Effects of Neuroleptics (ed. Cattabeni, F.). New York: Raven Press.Google Scholar
Reunanen, M., Kaartinen, P. & Väisänen, E. (1982) The influence of anticholinergic treatment on tardive dyskinesia caused by neuroleptic drugs. Acta Neurologica Scandinavica, Supplementum 90, 65, 278279.Google Scholar
Rivera-Calimlim, L., Nasrallah, H., Strauss, J. & Lasagna, L. (1976) Clinical response and plasma levels: Effect of dose, dosage schedules, and drug interactions on plasma chlorpromazine levels. American Journal of Psychiatry, 133, 646652.Google ScholarPubMed
Simpson, G. M. & Angus, J. W. S. (1970) A rating scale for extrapyramidal side effects. Acta Psychiatricia Scandinavica, 212, 1119.CrossRefGoogle ScholarPubMed
Simpson, G. M. Lee, J. H., Zoubok, B. & Gardos, G. (1979) A rating scale for tardive dyskinesia. Psychopharmacology, 64, 171179.Google Scholar
Simpson, G. M. Cooper, T. B., Bark, N., Sud, I. & Lee, J. H. (1980) Effect of antiparkinsonian medication on plasma levels of chlorpromazine. Archives of General Psychiatry, 37, 205208.Google Scholar
Sovner, R. & Dimascio, A. (1977) The effect of benztropine mesylate in the rabbit syndrome and tardive dyskinesia. American Journal of Psychiatry, 134, 13011302 Google Scholar
Weiss, K. J. Ciraulo, D. A. & Shader, R. I. (1980) Physostigmine test in the rabbit syndrome and tardive dyskinesia. American Journal of Psychiatry, 137, 627628.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.