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Dr. Bob is Robert Hsiung, MD,
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Posted by Jamal Spelling on February 25, 2008, at 14:36:39
I think the claims made in this article, published in 1982, have since been disproven. It makes for amusing reading though.
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J Clin Psychopharmacol. 1982 Oct;2(5):336-40.Links
Abnormal involuntary movements in schizophrenia: are they related to the disease process or its treatment? Are they associated with changes in dopamine receptors?
Crow TJ, Cross AJ, Johnstone EC, Owen F, Owens DG, Waddington JL.Abnormal involuntary movements indistinguishable from those now described as tardive dyskinesia were reported in schizophrenic patients by Kraepelin long before the introduction of neuroleptic drugs. Two large surveys of mental hospital patients including patients who had never received neuroleptics also revealed involuntary movements; indeed, the incidence was not substantially different from that in drug-treated patients. This fact casts doubt on the widely held assumption that these movements are persistent and irreversible effects of neuroleptic drugs. In an animal model of dyskinesia, abnormal movements were seen after administration of a phenothiazine and a thioxanthene but not after haloperidol. The syndrome appeared to be unrelated to dopamine receptor blockade or to changes in dopamine receptors. In postmortem striatal tissue from patients with schizophrenia, ligand binding to D-1 and D-2 dopamine receptors was not increased in patients who had been found to have abnormal involuntary movements in comparison with those who did not have such movements; as previously reported, binding to D-2 receptors was increased in patients with schizophrenia in comparison with controls. It is concluded that dyskinetic changes occur as a consequence of the process of schizophrenia and perhaps other diseases. Whether or not persistent and irreversible changes can be caused either in animals or humans by neuroleptic administration has yet to be clearly established. Whether they occur as a manifestation of the disease process or a consequence of drug administration, such dyskinesias are unassociated with changes in D-1 or D-2 receptors.
PMID: 7130435 [PubMed - indexed for MEDLINE]
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Posted by Quintal on February 28, 2008, at 23:57:33
In reply to TD? What TD?, posted by Jamal Spelling on February 25, 2008, at 14:36:39
It's pretty easy to spot because it looks so unnatural. I can tell there are a few people taking APs round my way from the peculiar walk they have. In the early days doctors would deliberately titrate the dose until EPS appeared as they thought this was necessary for the drugs to be effective, so I would think the claims of this article would have been suspect at the time. Having said that, I remember reading in the archives where one poster as late as 2001 claimed movement disorders were a byproduct of the psychotic process. She claimed to have found evidence that psychosis itself was neurotoxic (and therefore brain damage was caused by psychosis itself and not the neuroleptic drugs). I thought it was a bit of wishful thinking at the time. From what I remember, that particular poster was fond of taking Thioridazine as a sleep aid, for reasons known unto herself... Enough said?
Q
Posted by Larry Hoover on March 1, 2008, at 17:36:58
In reply to TD? What TD?, posted by Jamal Spelling on February 25, 2008, at 14:36:39
I'm aware of considerable subsequent work verifying the presence of dyskinesia in unmedicated schizophrenics. Full-text on the final piece lets you check references, etc.
Lar
Br J Psychiatry. 1996 Feb;168(2):221-6.
Abnormal movements in never-medicated Indian patients with schizophrenia.
McCreadie RG, Thara R, Kamath S, Padmavathy R, Latha S, Mathrubootham N,
Menon MS.Clinical Research, Crichton Royal Hospital, Dumfries.
BACKGROUND: Historical records suggest dyskinesia was observed in severely
ill institutionalised patients with schizophrenia in the pre-neuroleptic
era. More recent work has not found dyskinesia in never-medicated younger
and middle aged patients. The present study complements this recent work and
avoids the confounders of severity of illness and institutionalism by
examining elderly patients in a wide variety of community settings. METHOD:
Movement disorders were examined in 308 elderly individuals in Madras,
India, using the Abnormal Involuntary Movements Scale, the Simpson and Angus
Parkinsonism Scale and the Barnes Akathisia Scale. Patients' mental state
was assessed by the Positive and Negative Syndrome Scale. RESULTS:
Dyskinesia was found in 15% of normal subjects (n = 101, mean age 63 years),
15% of first degree blood relatives of younger schizophrenic patients (n =
103, mean age 63 years), 38% of never medicated patients (n = 21, mean age
65 years) and 41% of medicated patients (n = 83, mean age 57 years). The
respective prevalences for Parkinsonism were 6%, 11%, 24% and 36%; and for
akathisia 9%, 5%, 21% and 23%. Dyskinesia was associated with negative
schizophrenic symptoms. CONCLUSIONS: Dyskinesia in elderly schizophrenic
patients is an integral part of the illness and not associated with
antipsychotic medication.J Clin Psychiatry. 2000;61 Suppl 4:10-4.
Prevalence of spontaneous dyskinesia in schizophrenia.
Fenton WS.
Chestnut Lodge Hospital, Rockville, MD 20850, USA. WSFMD@AOL.COM
Spontaneous abnormal involuntary movements phenomenologically identical to
neuroleptic-induced tardive dyskinesia have been described in schizophrenia
for over a century. Because at present nearly all patients with
schizophrenia are exposed to neuroleptic medications, information about the
prevalence of spontaneous dyskinesia is obtained from accounts from the
preneuroleptic era, evaluations of first-episode patients before neuroleptic
treatment, and the identification and assessment of drug-naive patients in
developing countries. In this report, data from 14 studies of
neuroleptic-naive patients with schizophrenia are used to generate
age-adjusted estimates of the prevalence of spontaneous dyskinesia. While
the precision of this estimate is limited by the difficulty of obtaining
large, untreated samples, available data suggest a spontaneous dyskinesia
rate of approximately 4% in first-episode schizophrenic patients, 12% for
patients ill several years but below age 30 years, 25% for those aged
between 30 and 50 years, and 40% for those aged 60 years or older. Relative
to the incidence and accrued prevalence of spontaneous dyskinesia expected
during the natural history of untreated schizophrenia, the cumulative impact
of treatment with new neuroleptic agents has yet to be determined.J Psychiatr Res. 2005 May;39(3):261-6.
Extrapyramidal symptoms in unmedicated schizophrenia.
McCreadie RG, Srinivasan TN, Padmavati R, Thara R.
Crichton Royal Hospital, Dumfries, DG1 4XB, Scotland, UK.Studies of spontaneous extrapyramidal symptoms, dyskinesia and parkinsonism, in unmedicated schizophrenia are of importance in understanding their underlying pathology and relation to the psychosis. This is a study of extrapyramidal symptoms using Abnormal Involuntary Movements Scale for dyskinesia and Simpson-Angus Scale for parkinsonism in 143 schizophrenia patients who never received antipsychotic medication. Psychopathology was measured using the Positive and Negative Syndrome Scale. Dyskinesia was present in 35% of patients and parkinsonism in 15%. The two disorders coexisted in 11 subjects. Orofacial dyskinesia, rigidity and tremor were common symptoms noted. There was no significant change in the rates and total scores of dyskinesia and parkinsonism with gender, age, duration of illness or age at onset of psychosis. Dyskinesia was unrelated to psychopathology. Parkinsonism score correlated positively with the motor symptom cluster of psychopathology. Dyskinesia and parkinsonism scores correlated positively with each other and parkinsonism score discriminated presence of dyskinesia. The associations between the spontaneous abnormal movements and other aspects of schizophrenia differed from those described in treated patients. Dyskinesia and parkinsonism are an integral part of the schizophrenia disease process whose relationship with other factors could be influenced by antipsychotic drug treatment.
Br J Psychiatry. 2002 Aug;181:135-7. Full-text: http://bjp.rcpsych.org/cgi/content/full/181/2/135
Spontaneous dyskinesia and parkinsonism in never-medicated, chronically ill patients with schizophrenia: 18-month follow-up.
McCreadie RG, Padmavati R, Thara R, Srinivasan TN.
Crichton Royal Hospital, Dumfries, UK. rgmccreadie_crh@compuserve.comBACKGROUND: Spontaneous dyskinesia and parkinsonism have been reported in never-medicated patients with schizophrenia but there has been no previous study of the natural history of these conditions. AIMS: To determine the prevalence of spontaneous dyskinesia and parkinsonism in a group of never-medicated, chronically ill patients with schizophrenia on two occasions separated by an 18-month interval. METHOD: Dyskinesia was assessed by the Abnormal Involuntary Movements Scale using Schooler and Kane criteria for its presence; parkinsonism by the Simpson and Angus scale; and mental state by the Positive and Negative Syndrome Scale for schizophrenia. RESULTS: Thirty-seven patients were examined on two occasions. Nine (24%) had dyskinesia on both occasions, 12 (33%) on one occasion and 16 (43%) on neither occasion. Twenty-one (57%) had dyskinesia on at least one occasion. Thirteen patients (35%) had parkinsonism on at least one occasion. CONCLUSIONS: Spontaneous dyskinesia and parkinsonism fluctuate over time. The former was found on at least one occasion in the majority of patients. It is an integral part of the schizophrenic disease process.
Posted by Jamal Spelling on March 2, 2008, at 6:04:43
In reply to Re: TD? What TD? » Jamal Spelling, posted by Larry Hoover on March 1, 2008, at 17:36:58
> AIMS: To determine the prevalence of spontaneous dyskinesia and parkinsonism in a group of never-medicated, chronically ill patients with schizophrenia on two occasions separated by an 18-month interval.
It took me a while to make sense of this sentence. I kept reading AIMS as "Abnormal and Involuntary Movement Scale".
This is the end of the thread.
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