CLINICAL
AND
methylphenidate 235:1349-1351, 4. Lucas AR,
Tardive
RESEARCH
REPORTS
administration:
a report
Weiss
M:
Methylphenidate
and
dyskinesia, hyperkinetic
involuntary,
ments sites
217:1079-1081, 5.
BY GUY CHOUINARD, M.D., AND LAWRENCE ANNABLE,
by
of 20 cases. JAMA
1976
Dyskinesia
Tardive pyramidal
Am
M.SC. B.SC.,
a
in
JAMA
Antiparkinsonian
and
localization include
CLAUDE
nesia. ease,
extracharacterized
purposeless
week
long-term
ncuroleptics,
maintenance
we reported
nesia
and
fewer
parkinsonian
that
that
patients
with
treatment
31%
had
tardive
symptoms,
tardive
ophrcnic
dyskinesia
patients
dyski-
dyskinesia
particularly
treatment with neuroleptics. of the administration and the central anticholinergic procyclidine 20 patients
maintenance
We examined the effects subsequent withdrawal of (antiparkinsonian) agent
HC1 on the with significant
extrapyramidal symptoms tardive dyskinesia.
of
Method Subjects.
Twenty
chronic
schizophrenic
men and 10 women) were wards of H#{244}pitalLouis-H. lection
criteria
long-term least
required
that
maintenance
5 years,
2) had
patients
neuroleptic not
patients
selected from Lafontainc,
taken
week
(10
the long-term Montreal. Sc1) had
treatment
antiparkinsonian
the
study.
(1 week
was
after
with
The
stopped
withdrawal
completed and C. de rating was
received
for
PH.D.,
All subjects
completed
procyclidine
and
patients’
ages
the
1 week
ranged
discx-
from
2-
with-
34 to
for 1 week.
All patients
except
I
were receiving neuroleptics at the time ofthe trial. The neuroleptic dose, which in chlorpromazine equivalents (3) ranged from 20 to 1850 mg/day (median =400 mg; mean=560 mg), was kept constant during the study penod. One patient required a reduction (240 chlorpromazinc units) and 2 patients required increases (150 and 200 chlorpromazine units) in their maintenance neuroleptic medication during the trial, but for the patients in question these were relatively minor changes. No other psychotropic drugs, hypnotics, or minor tranquilizers were given during the trial. Patients were rated on Chouinard and Ross-Chouinard’s extrapyramidal symptom rating scale (ESRS) (4) before and after procyclidine treatment (days 0 and 8), and again I
in schiz-
long-term
from trial
the drug
had
of the hy-
and parkinsonism
receiving
Am J Psy-
73 years (median=59), and their total length of hospitalization was 5 .6-39.8 years (median = 28.3). Drug administration and assessment procedure. Patients were given procyclidine HCI (Kemadrin) 30 mg/ day (10 mg t.i.d. in 5-mg tablets) for 1 week and then
pokinetic type, than those without tardive dyskinesia (2). These results suggest a balance between parkinsonian and dyskinetic symptoms. The present study was undertaken to investigate further the relationship
between
choreoathetosis.
with physical illness, neurologic epilepsy, or drug addiction were
out procyclidine).
with
tardive
M.D.,
All patients alcoholism,
cluded
move-
and jaw, and, at times there are chorcoathetoid movemcnts ofthc neck, trunk or limbs (1). In a recent study of tardive dyskinesia in 261 schizophrenic outpatients undergoing
1971
I: Methylphenidate-induced 135:252-253, 1978
DE MONTIGNY,
and form. Common mouth, lips, tongue,
the
1979
136:2, February
Medication
(PHARMACOL), DIP. STAT.
neuroleptic-induced syndrome, is
repetitive,
that vary of involvement
hallucinosis.
Extein chiatry
J Psychiatry
at
of procyclidine.
The
ESRS
independently by two psychiatrists M.) during the same interview and made by consensus.
was (G.C. a final
Results
drugs
for at least 3 weeks before the study; and 3) had significant tardive dyskinesia (a score of at least 5 on a 9-
Table 1 shows the mean scores and after 8 days of procyclidine
point
scores at day 8 were compared with those at day 0 using the paired t test. Procyclidine treatment led to a significant decrease in the mean total score for parkinsonism (excluding nonacute dystonia). However, there were significant increases in the mean scores for dyskinesia of the jaw and other involuntary dyskinetic movements and a tendency toward higher total scores for tardive dyskinesia. There was a negative correlation that approached significance (r= .45, p= .06) be-
clinical
Received
Sept.
global
29, 1978;
impression
accepted
scale
Nov.
of tardivc
dyski-
6, 1978.
Dr. Chouinard and Mr. Annable are Assistant Professors, Department of Psychiatry, McGill University, Montreal, Que. , Canada. Dr. Chouinard is also Psychiatrist, Research Department, H#{244}pital Louis-H. Lafontaine, 7401 rue Hochelaga, Montreal, Que., Canada H1N 3M5, where Dr. de Montigny is Psychiatrist; and Professor, Institut National de la Recherche Scientifique-Sant#{233}, where Mr. Annable is Biostatistician. Dr. de Montigny is also Assistant Professor, Universit#{233} de Montreal. The authors
228
wish
to thank
Ms. Marilyn
E. Levy
0002-953X179/02/0228/02/$00.35
©
1979
before Mean
-
tween the changes in total scores symptoms and dyskinetic movements, patients
for her assistance.
for the ESRS treatment.
American
with
increased
Psychiatric
scores
Association
for
for
parkinsonian indicating that
dyskinetic
move-
Am
J Psychiatry /36:2, February
/979
CLINICAL
TABLE 1 Mean Scores for Extrapyramidal Symptom Rating After 8 Days of Procyclidine Treatment (N =20)
Scale
Extrapyramidal
Day 0
Day 8
p
6.3
3.4