A Systematic Review on the Use of Clozapine in Treatment of Tardive Dyskinesia and Tardive Dystonia in Patients with Psychiatric Disorders

Overview

Journal Psychopharmacology (Berl)

Specialty Pharmacology

Date 2022 Sep 30

PMID 36180741

Authors

Jocelyn Wong

Tiffanie Pang

Natalie Kwok Wing Cheuk

Yingqi Liao

Tarun Bastiampillai

Sherry Kit Wa Chan

Affiliations

Soon will be listed here.

Abstract

Rationale: Though clozapine is recommended for treatment of tardive dyskinesia (TD) relating to the use of antipsychotic medications, studies comprehensively investigating the treatment effect of clozapine on TD are still limited.

Objectives: This review examines the effectiveness of clozapine as an intervention for tardive dyskinesia and dystonia in patients with all psychiatric conditions. Effectiveness of clozapine, duration to exert the effect and dosage used were also analysed.

Methods: A search in the PubMed, PsycINFO and clinicaltrials databases was performed, using the search terms "Clozapine" AND "dyskinesia" OR "dystonia". Full-text articles that reported the use of clozapine to treat abnormal involuntary movements and were written in English were included.

Results: A total of 48 studies were identified, of which 13 were clinical trials and 35 were case reports. Significant improvement was seen in 86.7% of patients with schizophrenia spectrum disorders (average dose of clozapine = 355 mg/day) and 93% of patients with other psychiatric disorders (average dose of clozapine = 152.5 mg/day). Patients with other psychiatric diagnoses had faster improvement than the patients with schizophrenia spectrum disorders. Variation in improvements and dosage were also seen in the clinical trials.

Conclusion: Results suggested an overall effectiveness of clozapine in the treatment of TD for patients with a range of psychiatric conditions. Different response time and clozapine dosage were seen in patients with different psychiatric conditions, suggesting different treatment protocols are required for different conditions. Most of the studies identified are of inadequate qualities, highlighting the need for high quality studies to provide clearer evidence.

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References

Adityanjee , Estrera A . Successful treatment of tardive dystonia with clozapine. Biol Psychiatry. 1996; 39(12):1064-5. DOI: 10.1016/0006-3223(95)00633-8. View

Arya D, Khan T, Margolius A, Fernandez H . Tardive Dyskinesia: Treatment Update. Curr Neurol Neurosci Rep. 2019; 19(9):69. DOI: 10.1007/s11910-019-0976-1. View

Baptista T, De Leon J . Positive response to clozapine augmentation in a patient with obsessive-compulsive disorder complicated by a tardive movement disorder. Braz J Psychiatry. 2018; 40(2):229-230. PMC: 6900772. DOI: 10.1590/1516-4446-2017-2565. View

Bassitt D, Louza Neto M . Clozapine efficacy in tardive dyskinesia in schizophrenic patients. Eur Arch Psychiatry Clin Neurosci. 1998; 248(4):209-11. DOI: 10.1007/s004060050039. 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

Carroll B, Curtis G, Kokmen E . Paradoxical response to dopamine agonists in tardive dyskinesia. Am J Psychiatry. 1977; 134(7):785-9. DOI: 10.1176/ajp.134.7.785. View

Chakrabarti S, Chand P . Lithium - induced tardive dystonia. Neurol India. 2003; 50(4):473-5. View

Conus P, Zullino D, Baumann P . Clozapine is more efficacious for tongue dystonia than olanzapine. Psychopharmacology (Berl). 2002; 162(1):89. DOI: 10.1007/s00213-002-1063-9. View

Dalack G, Becks L, Meador-Woodruff J . Tardive dyskinesia, clozapine, and treatment response. Prog Neuropsychopharmacol Biol Psychiatry. 1998; 22(4):567-73. DOI: 10.1016/s0278-5846(98)00026-8. View

10.

Delecluse F, Elosegi J, Gerard J . A case of tardive tremor successfully treated with clozapine. Mov Disord. 1998; 13(5):846-7. DOI: 10.1002/mds.870130517. View

11.

Duggal H, Mendhekar D . Atypical antipsychotics, tardive dyskinesia, and D(2) receptors. Am J Psychiatry. 2006; 163(8):1449-50. DOI: 10.1176/ajp.2006.163.8.1449b. View

12.

Frei K . Tardive dyskinesia: Who gets it and why. Parkinsonism Relat Disord. 2018; 59:151-154. DOI: 10.1016/j.parkreldis.2018.11.017. View

13.

Friedman J . Clozapine treatment of psychosis in patients with tardive dystonia: report of three cases. Mov Disord. 1994; 9(3):321-4. DOI: 10.1002/mds.870090308. View

14.

Gagnier J, Kienle G, Altman D, Moher D, Sox H, Riley D . The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Glob Adv Health Med. 2014; 2(5):38-43. PMC: 3833570. DOI: 10.7453/gahmj.2013.008. View

15.

Glazer W, Morgenstern H, Doucette J . Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. J Clin Psychiatry. 1993; 54(4):133-9. View

16.

Gowda G, Sastry Nagavarapu L, Mukku S, Ali S . Amisulpride Induced Oropharyngeal Dyskinesia in a patient with Schizophrenia: A case report and review of literature. Asian J Psychiatr. 2017; 41:78-81. DOI: 10.1016/j.ajp.2017.10.010. View

17.

Grover S, Hazari N, Kate N, Chakraborty K, Sharma A, Singh D . Management of tardive syndromes with clozapine: a case series. Asian J Psychiatr. 2014; 8:111-4. DOI: 10.1016/j.ajp.2013.12.016. View

18.

Haile K, Umer H . The use of clozapine and clonazepam co-administration in the treatment of a severe tardive dyskinesia: A case report. SAGE Open Med Case Rep. 2019; 7:2050313X19833254. PMC: 6393946. DOI: 10.1177/2050313X19833254. View

19.

Hazari N, Kate N, Grover S . Clozapine and tardive movement disorders: a review. Asian J Psychiatr. 2013; 6(6):439-51. DOI: 10.1016/j.ajp.2013.08.067. View

20.

Jaffe E, Tremeau F, Sharif Z, REIDER R . Clozapine in tardive Tourette syndrome. Biol Psychiatry. 1995; 38(3):196-7. DOI: 10.1016/0006-3223(95)00218-6. View