Dyskinesia and Neuroleptic Exposure in Elderly Psychiatric Inpatients

Abstract

A wide variation in prevalence rates of tardive dyskinesia and spontaneous orofacial dyskinesia has been reported in the elderly. To clarify these discrepancies, we studied 45 patients over the age of 60 years admitted to a short-term psychiatr unit. Standardized criteria for the diagnosis of dyskinesia were used. We found a rate of tardive dyskinesia of only 21% (7/33) in our patients having a history of neuroleptic exposure. We found no cases (0/12) of spontaneous orofacial dysknesia. There was a significant association between tardive dyskinesia and psychiatric diagnosis, with the highest rate of tardive dyskinesia in those patients with schizophrenic disorders, followed by those with organic disorders and mood disorders, respectively. There was also a significant association between the presence of tardive dyskinesia and radio-graphic evidence of cortical atrophy, and a trend towards an association with leukoencephalopathy. Our results suggest that published rates of tardive and spontaneous dyskinesia in the elderly may overestimate the prevalence of these disorders, especially among geriatric patients with acute psychiatric presentations. (J Geriatr Psychiatry Neurol 1992;5:156–161).

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References

1. Weiner WJ , Lang AE : Movement Disorders: A Comprehensive Survey. Mount Kisco, NY, Futura Publishing, 1989, p 660.

2. Casey DE : Tardive dyskinesia, in Meltzer HY (ed): Psychophar-macology the Third Generation of Progress. New York, Raven Press, 1987, p 1411.

3. Bourgeois M , Bouilh P , Tignol J , Yesavage J : Spontaneous dyskinesias vs neuroleptic-induced dyskinesias in 270 elderly. subjects. J Nerv Ment Dis 1980; 168:177–178.

4. Klawans HL , Barr A : Prevalence of spontaneous lingual-facial-buccal dyskinesias in the elderly. Neurology 1987; 32:558–559.

5. Barnes TRE , Rossor M , Trauer T : A comparison of purposeless movements in psychiatric patients treated with antipsychotic drugs, and normal individuals. J Neurol Neurosurg Psychiatry 1983; 46:540–546.

6. Varga E , Sugerman AA , Varga V , et al: Prevalence of spontaneous oral dyskinesia in the elderly. Am J Psychiatry 1982; 139:329–331.

7. Molsa PK , Marttila RJ , Rinne UK : Extrapyramidal signs in Alzheimer's disease. Neurology 1984; 34:1114–1116.

8. Delwaide PJ , Desseilles M : Spontaneous buccolinguofacial dyskinesia in the elderly. Acta Neurol Scand 1977; 56:256–262.

9. Kane JM , Weinhold P , Kinon B , et al: Prevalence of abnormal involuntary movements (“spontaneous dyskinesias”) in the normal elderly. Psychopharmacology 1982; 77:105–108.

10.

10. D'Alessandro R , Benassi G , Cristina E , et al: The prevalence of lingual-facial-buccal dyskinesias in the elderly. Neurology 1986; 36:1350–1351.

11.

11. Ticehurst SB : Is spontaneous orofacial dyskinesia an artifact due to incomplete drug history? J Geriatr Psychiatry Neurol 1990; 3:208–211.

12.

12. Smith JM , Baldessarini RJ : Changes in prevalence, severity, and recovery in tardive dyskinesia with age. Arch Gen Psychiatry 1980; 37:1368–1373.

13.

13. Kane JM , Smith JM : Tardive dyskinesia: Prevalence and risk factors, 1959 to 1979. Arch Gen Psychiatry 1982; 39:473–481.

14.

14. Karson CG , Bracha HS , Powell A , Adams L : Dyskinetic movements, cognitive impairment, and negative symptoms in elderly neuropsychiatric patients. Am J Psychiatry 1990; 147:1646–1649.

15.

15. Woerner MG , Kane JM , Lieberman JA , et al: The prevalence of tardive dyskinesia. J Clin Psychopharmacol 1991; 11:34–42.

16.

16. Lieberman J , Kane JM , Woerner M , Weinhold P : Prevalence of tardive dyskinesia in elderly samples. Psychopharmacol Bull 1984; 20:22–26.

17.

17. Zubenko GS : Progression of illness in the differential diagnosis of primary dementia. Am J Psychiatry 1990; 147:435–438.

18.

18. Psychopharmacology Research Branch, NIMH: Abnormal involuntary movement scale, in Guy W (ed): ECDEU Assessment Manual For Psychopharmacology, revised. Rockville, MD, National Institute of Mental Health, 1976, pp 534–537.

19.

19. Zubenko GS , Sullivan P , Nelson JP , et al: Brain imaging abnormalities in mental disorders of late life. Arch Neurol 1990; 47:1107–1111.

20.

20. Schooler NR , Kane JM : Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry 1982; 39:486–487.

21.

21. Saltz BL , Kane JM , Woerner MG , et al: Prospective study of tardive dyskinesia in the elderly. Psychopharmacol Bull 1989; 25:52–56.

22.

22. Schooler NR : Evaluation of drug-related movement disorders in the aged. Psychopharmacol Bull 1988; 24:603–607.

23.

23. Yassa R , Ghadirian AM , Schwartz G : Prevalence of tardive dyskinesia in affective disorder patients. J Clin Psychiatry 1983; 44:410–412.

24.

24. Kane JM , Woerner M , Borenstein M , et al: Integrating incidence and prevalence of tardive dyskinesia. Psychopharmacol Bull 1986; 22:254–258.

25.

25. Richardson MA , Haugland G , Pass R , Craig TJ : The prevalence of tardive dyskinesia in a mentally retarded population. Psychopharmacol Bull 1986; 22:243–249.

26.

26. Waddington JL , Youssef HA : An unusual cluster of tardive dyskinesia in schizophrenia: Association with cognitive dysfunction and negative symptoms. Am J Psychiatry 1986; 143:1162–1165.

27.

27. Swayze VW , Yates WR , Andreasen NC , Alliger RJ : CT abnormalities in tardive dyskinesia. Psychiatry Res 1988; 26:51–58.