Posted by SalArmy4me on August 29, 2001, at 15:44:46
In reply to neuroleptics , posted by Shelley on August 29, 2001, at 14:44:26
http://www.vh.org/Providers/Conferences/CPS/08.html
Abstract: Year Book of Psychiatry and Applied Mental Health Volume 1999(8) Annual 1999 pp 385-386. Treatment of Tardive Dyskinesia:
"Introduction.-The introduction of clozapine and other atypical antipsychotic agents has raised hopes that tardive dyskinesia (TD) may be eradicated someday. For now, this disorder remains a significant clinical problem for patients and physicians. Management approaches to TD are described.
Managing TD.-Most TD is mild. Therapeutic efforts focus on minimizing neuroleptic exposure or changing treatment to atypical agents in patients with mild to moderate TD. Tardive dyskinesia typically does not progress, which indicates that the risk of remaining on typical neuroleptics is slight. Moderate to severe TD is more challenging, and patients typically require medication to suppress symptoms Table 4. Most suppressive agents have limited success. No treatment strategy is clearly superior or even successful in most patients. Raising the doses of typical neuroleptics may be useful for short-term suppression, yet the long-term efficacy and risk of this approach have not been clearly elucidated. Data on atypical neuroleptics are sparse. Clozapine has a short-term suppressive effect that is weak, but patients may experience improvement with long-term treatment.
Other Approaches.-Other medications that have relatively few side effects and may have suppressive properties include calcium blockers, adrenergic antagonists, and vitamin E. Gamma-amino-butyric acid agonists agents and dopamine can be helpful but are accompanied by troubling side effects. Anticholinergic agents and botulism toxin have also been effective in treating TD.
Conclusion.-Despite the new generation of neuroleptics, TD remains a challenging clinical problem. A better understanding of the mechanisms of actions of atypical neuroleptics and of the physiology of the basal ganglia should enhance treatment approaches.
[r tri, filled] This article was completed by a research team who is well known in the area of antipsychotic medication treatment. This thorough review covers the waterfront of the various options available to us and presents a thoughtful flow diagram (untested) that is useful for clinicians. The authors end with the hope that the newer agents that appear to have a lower risk for development of tardive dyskinesia may provide a brighter future for patients who require treatment with antipsychotics. The article itself is certainly well worth reading, with a take-home message (see table) which will probably be useful to many busy clinicians."
R.B. Lydiard, Ph.D., M.D.
Professor of Psychiatry and Behavioral Sciences, Medical University of South Carolina; Director, Clinical Psychopharmacology Research Division, Institute of Psychiatry, Medical University of South Carolina, Charleston, South Carolina.
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The Salvation Army Life Service Conference 2001: Heart to God, Hand to Man.
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