Early extrapyramidal side-effects as risk factors for later tardive dyskinesia: a prospective study.
OBJECTIVE
To determine whether acute neuroleptic-induced parkinsonism and akathisia were risk factors for the later development of tardive dyskinesia (TD) in patients on typical neuroleptics.


METHODS
Of 100 subjects examined for parkinsonism and akathisia after the initiation of typical neuroleptic medication, 78 were followed up for TD after a mean 41.2 months.


RESULTS
Nine (11.5%) subjects were diagnosed with TD, predominantly manifesting as oro-facial dyskinesia. They had greater severity of parkinsonism and akathisia at baseline, and a larger neuroleptic load, than those who did not develop TD. On regression analyses, parkinsonism at baseline was a significant predictor of later TD. Examined independently of parkinsonism, akathisia severity at 2 weeks was also a significant predictor of later TD.


CONCLUSIONS
Acute drug-induced parkinsonism and akathisia are both predictors of TD, with parkinsonism having greater predictive value. Acute and tardive extrapyramidal syndromes may share vulnerability factors.
Sachdev
Perminder
P
School of Psychiatry, University of New South Wales, New South Wales, Australia. p.sachdev@unsw.edu.au
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001480:Basal Ganglia Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020734:Parkinsonian Disorders / Q000188:drug therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D014150:Antipsychotic Agents