Prescription of Anticholinergics in Tardive Syndromes: A "Dual Center" Survey Among Psychiatrists

Overview

Journal Parkinsons Dis

Publisher Wiley

Date 2020 Dec 10

PMID 33299541

Authors

Anna Cutino

Roongroj Bhidayasiri

Carlo Colosimo

Affiliations

Soon will be listed here.

Abstract

Methods: We assessed the attitude of two groups of psychiatrists (practicing in Italy and Thailand) towards the prescription of anticholinergics by a short online survey consisting of four questions. A total of one hundred questionnaires were sent out (50 in Italy and 50 in Thailand), and 42 psychiatrists responded to the survey.

Results: When comparing the two cohorts, the difference, both for age and years of practice, was statistically significant ( < 0.00001 and < 0.0001, respectively), with Thai psychiatrists being younger and with less time in practice as specialists. The results from the survey showed that the prescription of anticholinergic drugs at the beginning of the antipsychotic treatment was used by 5 psychiatrists (20.0%) of the Italian cohort and by 1 (5.9%) of the Thai cohort. Regarding the Italian psychiatrists who did not prescribe anticholinergics concomitantly with neuroleptics, we found that 5 (25.0%) of them had prescribed anticholinergics in the past but had abandoned this practice, while 15 (93.7%) of the Thai psychiatrists who did not prescribe anticholinergics at the moment of the survey answered that they had prescribed these drugs in the past.

Conclusion: According to this preliminary survey, the practice to use anticholinergics as a treatment for tardive syndromes is still relatively common, particularly in psychiatrists of the older generation, but seemingly in decline over the years.

References

Meredith G, De Souza I, Hyde T, Tipper G, Wong M, Egan M . Persistent alterations in dendrites, spines, and dynorphinergic synapses in the nucleus accumbens shell of rats with neuroleptic-induced dyskinesias. J Neurosci. 2000; 20(20):7798-806. PMC: 6772873. View

Cunningham C, Quan H, Hemmelgarn B, Noseworthy T, Beck C, Dixon E . Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015; 15:32. PMC: 4404667. DOI: 10.1186/s12874-015-0016-z. View

Coupland C, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J . Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019; 179(8):1084-1093. PMC: 6593623. DOI: 10.1001/jamainternmed.2019.0677. View

Kang U, Burke R, Fahn S . Natural history and treatment of tardive dystonia. Mov Disord. 1986; 1(3):193-208. DOI: 10.1002/mds.870010305. View

Thenganatt M, Jankovic J . Treatment of dystonia. Neurotherapeutics. 2013; 11(1):139-52. PMC: 3899473. DOI: 10.1007/s13311-013-0231-4. View

Schooler N, Kane J . Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982; 39(4):486-7. DOI: 10.1001/archpsyc.1982.04290040080014. View

Meshul C, Stallbaumer R, Taylor B, Janowsky A . Haloperidol-induced morphological changes in striatum are associated with glutamate synapses. Brain Res. 1994; 648(2):181-95. DOI: 10.1016/0006-8993(94)91117-7. View

van Harten P, Matroos G, Hoek H, Kahn R . The prevalence of tardive dystonia, tardive dyskinesia, parkinsonism and akathisia The Curaçao Extrapyramidal Syndromes Study: I. Schizophr Res. 1996; 19(2-3):195-203. DOI: 10.1016/0920-9964(95)00096-8. View

Bhidayasiri R, Fahn S, Weiner W, Gronseth G, Sullivan K, Zesiewicz T . Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013; 81(5):463-9. DOI: 10.1212/WNL.0b013e31829d86b6. View

10.

Kane J . Tardive dyskinesia rates with atypical antipsychotics in adults: prevalence and incidence. J Clin Psychiatry. 2004; 65 Suppl 9:16-20. View

11.

Bhidayasiri R, Jitkritsadakul O, Friedman J, Fahn S . Updating the recommendations for treatment of tardive syndromes: A systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018; 389:67-75. DOI: 10.1016/j.jns.2018.02.010. View

12.

Ayd Jr F . A survey of drug-induced extrapyramidal reactions. JAMA. 1961; 175:1054-60. DOI: 10.1001/jama.1961.03040120016004. View

13.

Lerner P, Miodownik C, Lerner V . Tardive dyskinesia (syndrome): Current concept and modern approaches to its management. Psychiatry Clin Neurosci. 2015; 69(6):321-34. DOI: 10.1111/pcn.12270. View

14.

Jeste D . Tardive dyskinesia rates with atypical antipsychotics in older adults. J Clin Psychiatry. 2004; 65 Suppl 9:21-4. View

15.

Wu J, Chen D, Tan Y, Soares J, Zhang X . Mn-superoxide dismutase activity is associated with orofacial involuntary movements in schizophrenia patients with tardive dyskinesia. Hum Psychopharmacol. 2015; 30(1):57-63. DOI: 10.1002/hup.2453. View