Posted by yxibow on April 8, 2009, at 2:29:51
In reply to treating tardive syndromes: dopamine antagonists, posted by coincoin on April 7, 2009, at 13:02:10
> I know that dopamine antagonists (antipsychotics) and indirect dopamine antagonists (reserpine, TBZ) are used to treat tardive syndromes, however, if I understand correctly, wouldn't this just worsen the syndromes in the long run?
Only Clozaril is recommended to treat TD (and possibly TDy, which it could cause also). It has its risks, blood tests are mandatory early on and for life. Its never been known to directly cause TD in any statistical amount.
The really old fashioned idea if someone was on typical antipsychotic such as Haldol and there were signs of possible tardive syndromes, they would continue to push the medicine higher. Diminishing returns and rather cruel to the patient.
The only one I know that has been studied (Nitoman, now Xenazine for Huntingtons in the US), tetrabenazine, has had some success at Baylor College in small trials.The risk with it is that one could not just have pseudoparkinsonism EPS, but that they could have it permanently or for a long term, as a tradeoff for possibly changing TD.
TD by itself will remit in about 30% or more of the cases, stay the same in others, and get worse in about the remaining 1/3.
The best way to avoid TD is to use the MED (minimum effective dose), be monitored by a doctor who gives regular AIMS exams to monitor for any sign of TD....
....(people who have TD are actually -not- aware of it, at least not unless something is pointed out. If you have some syndrome that you're aware of, its not likely to be TD.)
That all being said, there can be other things, I have a rare non-tardive orofacial/orobuccal tic most likely from Seroquel which I continue to take for its off label use, and some sort of bilateral random arm/leg stiffness that may be some type of TDy (dystonia) from Zyprexa.
TDy can be rather dramatic, and dystonic disorders aren't always medication induced, but it has more treatment methods, such as judicious use of Seroquel, (yes, Zyprexa), and Clozaril, dopakmine agonists, Valium and some related benzodiazepines, and anticholinergics.
TD unfortunately doesn't have the medicine chest yet, except for experimental use of Clozaril and tetrabenazine. Although there are cases of people who were on typicals and received more favorable AIMS scores on atypicals such as Seroquel, if they had to continue treatment.Treatment on any medication may have to continue regardless of TD, because of the severity of a case.
I don't know quite what else to say -- there are researchers, I have been seen in the past by some, not that it was tardive but possibly a pre-tic syndrome.
There are places where there are literally dozens of neurologists with sub specialties, including movement disorders.
It still remains part of the research field.
Still, atypicals have a much lower risk of TD, aggregate about 5% per year (and that's hard to judge cumulatively) as opposed to 25% for typicals... there was a large study in the British Journal of Psychiatry if I recall that showed Zyprexa had about a risk of 0.5%, so you could say that Seroquel has maybe 0.25% or something by inference.
The only atypical so far that has noted cases of TD is Risperdal.-- hope that helps
-- Jay
poster:yxibow
thread:889225
URL: http://www.dr-bob.org/babble/20090330/msgs/889387.html