Posted by yxibow on January 16, 2007, at 19:15:33
In reply to Re: ABILIFY + EPS--alanjacobs, posted by Honore on January 16, 2007, at 11:09:50
> I was doing some reading on the EPS-TD relationship last night. Seems not to be absolute, although people with TD often have had EPS-- and people with EPS develop TD more than twice as frequently as people w/o it, in the first year after a study. (Those studies did not show a difference in the rate of developing TD between typical and atypical APs.)
This is a Venn diagram of sorts> But researchers seem unclear about the relationship. Definitely not clear that everyone who has TD had EPS-- or that everyone with EPS develops TD.
Also true, A and B Venn diagrams.
> I also noticed that Cogentin is used to treat EPS, but won't help TD. But also some indication that Cogentin, itself, could make TD worse.
This is true, unfortunately. Anticholinergics for reasons unclear will not help TD, and is one clear indication that something is not TD or not any manifestation that we could call TD.
> And that sometimes, a very early expression of EPS can be transitory with use of atypicals. This would seem to be very unclear, however, given that lack of definitive understanding of either syndrome, or the cause of relationships between them.
And can be transitory with typicals as well. Also can change with dose adjustments, I know personally.
> On the other hand, while there are many claims that atypicals greatly reduce the frequency of TD, this hasn't yet been fully substantiated. For one thing, there's a greater than usual number of false negatives for the presence of movement disorders in the type of testing that's used in studies. And some careful studies seem to suggest a higher rate than was previously hoped. Yet, it does seem to be less.
There are false negatives, and false negatives generated by doctors not trained in the nuances of TD versus ID or EPS. Careful monitoring of patients should always be done, and AIMS exams should always be done for long term use, its vital.The BJP (British Journal of Psychiatry) noted I believe a 1/2% per year on Zyprexa in one lengthy study a while ago.
Another accessible study showed in adults but not older adults 0.8% aggregate:
http://ajp.psychiatryonline.org/cgi/content/full/161/3/414
> I guess there's certain precedent for using Cogentin for EPS-- but I really couldn't find any study or article that considered whether there was masking. But definitely, it's important to monitor the situation pretty carefully.Some old articles make reference to masking, but this is unclear -- a lot of things about TD are still not completely clear. I agree, and there have been more than 50 years of monitoring of old line agents.
> Maybe if the symptom doesn't recur, it was transitory. On the other hand, with the old APs, about 65% of patients develop TD (over a fifteen year period, after which seemingly, the risk is greatly reduced). How much less this would be true of atypicals, and whether an early manifestation of EPS is a strong indication just isn't clear.Its hard to say whether its 65% -- possibly with high dose phenothiazines for years, but we don't really know. It is definately higher with old line drugs, that has been demonstrated.
> It's certainly a decision individuals have to make for themselves. Only they can evaluate the benefits and risks that they are prepared to take.
It's an individual decision, not one I take lightly with Seroquel. But I have the trust in both my psychopharmacologist and several personal meetings with leading experts in TD. Its something I think about because I present odd EPS formations but they would not occur in the way they do or the fashion that agents can attack it were they TD.
Its called informed consent -- that is, if your doctor informs you, you consent to it, unless you are in such a psychotic state that you have no lucidity and are in danger to others or yourself and have to be held in a 72 hour hold by the state or local authorities.
> Honore
poster:yxibow
thread:721839
URL: http://www.dr-bob.org/babble/20070113/msgs/722995.html