Posted by SLS on July 15, 2000, at 11:36:21
In reply to Re: Whoa !!! here !!!!, posted by Sunnely on July 14, 2000, at 22:26:56
Dear Sunnely,
Thank you for posting such a comprehensive, organized, and well documented review regarding TD.
I recently bumped into one study that's statistics indicated that it was not age that was the associative factor, but rather the number of years on the medication. They concluded that it was the elderly population that have been taking neuroleptics the longest.
Your wording of #1 implies otherwise. However, I wonder what the rate is at which this elderly population have cycled on and off neuroleptics, perhaps with the waxing and waning of their illness or for having taken "drug holidays". Employing drug holidays had been the standard practice years ago, but we now know that this actually increases the risk of developing TD many fold.
Are blood-levels of neuroleptics ever used clinically?
- Scott
> Although in most cases, the symptoms of TD first show after several months or years of antipsychotic treatment, there are certain groups of patients who are at much higher risk for TD (and at earlier stage). At least, these things what are generally known about the risks of TD with antipsychotic drugs, sometimes called "major tranquilizers". They include:
>
> 1) Age - age is still the most consistent risk factor. The older the patient is, the higher the risk for TD. TD can develop in the elderly within a couple of weeks. This is the reason why, in this group of patients, it is recommended to do AIMS at much more frequent intervals than the others.
>
> 2) Gender - Women has higher risk of TD than men, although this may be limited to the geriatric age range. Postmenopausal women have a higher risk of TD than premenopausal.
>
> 3) Psychiatric Diagnoses - those with dementia (e.g., Alzheimer's disease) and other organic brain syndromes, history of brain injury, developemtally disabled or mentally retarded, and affective/mood disorders have higher risk for TD. Patients with depression and bipolar disorder have a higher risk for TD than patients with schizoprenia.
>
> 4) Dose and Duration of Antipsychotic Treatment - the higher the dose, the longer the treatment, the higher the risk for TD.
>
> 5) Early Signs of Extrapyramidal Symptoms such as acute dystonia, akathisia (motor restlessness), parkinsonism, are more likely to develop TD in the future, if treatment is continued.
>
> 6) Smokers - appears to be associated with higher risk for TD (but lower risk for Parkinson's disease).
>
> 7) Alcohol abuse - higher risk for TD than nonalcohol abusers.
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> 8) Diabetics (on antipsychotics) appear to have higher risk for TD than nondiabetics on antipsychotics.
>
> 9) Concomitant use of drugs that have the potential to cause TD such as tricyclic antidepressants, SSRI antidepressants, metoclopramide (Reglan).
>
> 9) Unknown individual factors - possibly a genetically determined vulnerability plays an essential part. For example, one may have a genetic polymorphism (defective) for certain liver enzymes (cytochrome enzymes) responsible for the metabolism of certain psychotropics leading to much higher blood level than the "normal" population, leading to higher risk for TD.
>
poster:SLS
thread:40349
URL: http://www.dr-bob.org/babble/20000708/msgs/40537.html