Posted by Larry Hoover on November 30, 2004, at 11:27:35
In reply to Re: drug-induced illness, posted by ed_uk on November 30, 2004, at 10:50:54
> After my own dire experience with AP-induced akathisia and dystonia I will be forever 'in awe' of the toxicity of APs.
> Although it is clear that dyskinesia may occur in the absence of neuroleptics, it is important not to forget that TD can occur in non-psychotic patients prescribed dopamine antagonists. I have no doubt in my mind that APs can cause TD.
> The use of anti-emetic dopamine antagonists to treat non-psychiatric problems provides an example of what I am saying. Metoclopramide for example......
I didn't mean my presentation of naturalistic data to be used to detract from awareness of the toxic effects of neuroleptics, or other dopaminergic meds. It's a part of the context that is seldom considered, and most seldom by the anti-med movement, I would assume.
I hold to a diathesis stressor model of dyskinesia. A person may be genetically vulnerable to the development of dyskinesia (the diathesis), but it requires some external agent acting on the individual (the stressor) for that genetic vulnerability to be revealed. That is true even for schizophrenics not exposed to medication. What the stressor might be in those cases is not clear, but immune function due to viral illness is one potential variable. Antioxidant status is another.
In the case of the pediatric dyskinesias as by metoclopramide, it is clear that the drug is the stressor involved. However, as it is not a general effect of that particular drug when used in infants, one must distinguish the effect as one arising from diathesis, i.e. due to genetic predisposition.
It makes me sad that anyone would be treated with e.g. a neuroleptic without full informed consent of the potential consequences, but e.g. psychosis might make such informed consent moot. I don't mean to distract into the ethics of treatment in those situations, though.