Severe and Uncommon Involuntary Movement Disorders due to Psychotropic Drugs

Disorders of involuntary movement due to psychotropic drugs pose a major problem when treating mentally ill patients. These adverse drug reactions (ADR) frequently undermine the patients’ compliance and may have serious consequences as well.

The drug safety program in psychiatry AMSP (Arzneimittelsicherheit in der Psychiatrie) surveyed a population of 122,562 patients between 1993 and 2000, and documented 129 especially severe or uncommon involuntary movement disorders (IMD): 9 episodes of severe acute dyskinesia, 32 of severe Parkinsonism, 5 of especially severe akathisia, 16 of ‘atypical dyskinesia’, 38 of Pisa syndrome, 6 of catatonic neuroleptic syndrome, 15 of neuroleptic malignant syndrome, and 8 of tardive dyskinesia. The epidemiological data for this population were systematically analyzed as regards the patient’s history of medication, comedication, and clinical course. In those cases, in which a certain drug was imputed to cause an ADR alone and the causal relationship was rated as definite or probable, typical neuroleptics with mainly antipsychotic effects showed a relatively high incidence of 0.1047 %, those with hypnotic-sedative effect a lower incidence of 0.0198 %, and the atypical neuroleptics an incidence of 0.0567 %. This difference was highly significant in an χ²-analysis (χ² = 18.81, df = 2, p < 0.0001).

Our data provide important information on the frequency, severity, and the consequences of ARD for the patients’ compliance, and thus are of clinical interest.

References

• 1 Agresti A, Coull B A. Approximate is better than ”exact” for interval estimation of binominal proportions.  The American Statistician. 1998;  52 119-126
• 2 Barnes T RE, McPhillips M A. Novel antipsychotics, extrapyramidal side effects and tardive dyskinesia.  Int Clin Psychopharmacol. 1998;  13(suppl 3) S49-57
• 3 Berry R V, Sheldon H K, Kline A. An unusual complication following the use of Trilafon in children.  U.S Armed Forces Med J. 1958;  9 745-749
• 4 Blain P G, Stewart-Wynne E. Neurological disorders. In: Davies DM, ed. Textbook of adverse drug reactions. 3. ed Oxford, New York, Toronto; Oxford University Press 1985
• 5 Caroff S N. The neuroleptic malignant syndrome.  J Clin Psychiatry. 1980;  41 79-83
• 6 Caroff S N, Mann S C, Campbell E C, Sullivan K A. Movement Disorders Associated With Atypical Antipsychotic Drugs.  J Clin Psychiatry. 2002;  63(suppl 4) 12-19
• 7 Clopper C J, Pearson E S. The use of confidence of fiducial limits illustrated in the case of the binominal.  Biometrika. 1934;  26 404-413
• 8 Ekbom K, Lindholm H, Ljungberg I. New dystonic syndrome associated with butyrophenone therapy.  Z Neurol. 1972;  202 94-103
• 9 Engel R, Grohmann R, Rüther E, Hippius H. Research Methods in Drug Surveillance.  Pharmacopsychiatry. 2004;  37 Suppl 1 S12-15
• 10 Fallgatter A J, Strik W K. Reversible neuropsychiatrische Nebenwirkungen von Lithium bei normalen Serumspiegeln.  Nervenarzt. 1997;  68 586-590
• 11 Gaertner H J, Hörner W, Bartels M. Katatonieforme Symptome als Nebenwirkung neuroleptischer Behandlung.  Nervenarzt. 1983;  54 250-254
• 12 Gelenberg A J, Mandel M R. Catatonic Reactions to High-Potency Neuroleptic Drugs.  Arch Gen Psychiatry. 1977;  34 947-950
• 13 Grohmann R, Helmchen H, Hippius H, Rüther E, Schmidt L. The AMÜP Study for Drug Surveillance in Psychiatry - a Summary on Inpatient Data.  Pharmacopsychiatry. 2004;  37 Suppl 1 S16-26
• 14 Grohmann R, Engel R R, Geissler K H, Rüther E. Psychotropic Drug Use in Psychiatric Inpatients: Recent Trends and Changes Over Time - Data from the AMSP Study.  Pharmacopsychiatry. 2004;  37 Suppl 1 S27-38
• 15 Grohmann R, Rüther E, Schmidt L. Unerwünschte Wirkungen von Psychopharmaka. Ergebnisse der AMÜP-Studie. Berlin, Heidelberg, New York, London, Paris, Tokyo, Hong Kong, Barcelona, Budapest; Springer-Verlag 1994
• 16 Heinze M, Andreae D, Grohmann R. Rivastigmin and impaired motor function.  Pharmacopsychiatry. 2002;  35(2) 79-80
• 17 Koeck R J, Pi E H. Acute laryngeal dystonic reactions to neuroleptics.  Psychosomatics. 1989;  30 359
• 18 Miller C H, Mohr F, Umbricht D, Woerner M, Fleischhacker W W, Liebermann J A. The Prevalence of Acute Extrapyramidal Signs and Symptoms in Patients Treated With Clozapine, Risperidone, and Conventional Antipsychotics.  J Clin Psychiatry. 1998;  59(2) 69-75
• 19 Grohmann R, Engel R, Rüther E, Hippius H. The AMSP Drug Safety Program: Methods and Global Results.  Pharmacopsychiatry. 2004;  37 Suppl 1 S4-11
• 20 Simpson G M, Pi E H, Sramek J r. JJ. Management of tardive dyskinesia: current update.  Drugs. 1982;  23 382
• 21 Simpson G M, Pi E H, Sramek Jr. J J. Neuroleptics and antipsychotics. In: Dukes MNG, ed Meyler¿s Side Effects of Drugs. 13. ed. Amsterdam, Lausanne, New York, Oxford, Shannon, Tokyo: Elsevier; 1996
• 22 Stübner S, Padberg F, Grohmann R ,. et al . Pisa Syndrome (Pleurothotonus): Report of a Multicenter Drug Safety Surveillance Project.  J Clin Psychiatry. 2000;  61 569-574