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

Tardive dyskinesia and antiparkinsonian medication.

CLINICAL AND methylphenidate 235:1349-1351, 4. Lucas AR, Tardive RESEARCH REPORTS administration: a report Weiss M: Methylphenidate and dy...
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