title: Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII.
abstract: OBJECTIVE
  To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI).
  
  
  METHODS
  We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D₂) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models.
  
  
  RESULTS
  There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D₂ affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D₂ affinity switch model), while starting a high D₂ affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D₂ affinity switch model).
  
  
  CONCLUSIONS
  The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D₂ affinity antipsychotic may reduce the severity of TD.
authors.affiliation: Innova, GGz Centraal, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands. c.l.mentzel@gmail.com.|Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.|Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.
authors.forename: Charlotte L
authors.initials: CL
authors.lastname: Mentzel
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.|Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.
authors.forename: P Roberto
authors.initials: PR
authors.lastname: Bakker
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.|King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom.
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: Drukker
authors.affiliation: Psychiatric Centre GGz Curaçao, Groot Kwartier, Curaçao.
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Matroos
authors.affiliation: Parnassia Psychiatric Institute, The Hague, The Netherlands.|Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Epidemiology, Columbia University, New York, New York, USA.
authors.forename: Hans W
authors.initials: HW
authors.lastname: Hoek
authors.affiliation: Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Marina A J
authors.initials: MA
authors.lastname: Tijssen
authors.affiliation: Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands.|Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.
authors.forename: Peter N
authors.initials: PN
authors.lastname: van Harten
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D015259:Dopamine Agents / Q000009:adverse effects / Q000627:therapeutic use; D057915:Drug Substitution; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000453:epidemiology; D008875:Middle Aged; D009427:Netherlands Antilles; D009460:Neurologic Examination / Q000187:drug effects; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000453:epidemiology*; D000071057:Tardive Dyskinesia / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D015259:Dopamine Agents