Informed consent and tardive dyskinesia

Article Abstract:

Tardive dyskinesia is an irreversible movement disorder which is a side effect of long-term use of neuroleptic (antipsychotic) drugs, occurring in 20 to 25 percent of those who use them. The American Psychiatric Association's definition of good practice includes the informed consent of patients in treatment. The problem of how to inform patients whose cognitive abilities are impaired to a point where they have limited capacity to understand the repercussions of their treatment is addressed. It has been generally observed that most schizophrenic patients taking neuroleptic drugs are unaware of the potential side effects of the medication and are sometimes even unaware of what they are taking. A group of schizophrenic outpatients was examined to see if improved communication would assist in the education of these patients. Twenty-one of the patients were given a standardized information form to read after it was read aloud to them; 27 of the patients were not given this information. All patients had been taking neuroleptics for at least six months and it was assumed that all had been informed about their medications in the conventional manner. Both groups were given a multiple choice questionnaire designed to measure knowledge about the drug. The group that had received the standardized information form had significantly higher mean scores. This was followed up with a repetition of the questionnaire six months later. The mean scores for the first group remained higher and it was concluded that an educational process had occurred. It was noted that increased awareness of the effects of the drugs did not have a negative effect upon the patients' overall behavior, need for treatment, or their compliance with prescribed therapies. Informed consent by many schizophrenic patients is possible and ethically desirable and the use of a standardized form may be a valuable tool for the physician in facilitating the educational process.

Analysis, Drug therapy, Ethical aspects, Patient education, Informed consent (Medical law), Informed consent, Schizophrenics, Psychiatric ethics

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Clonazepam treatment of tardive dyskinesia: a practical GABAmimetic strategy

Article Abstract:

One of the side effects of neuroleptics, drugs commonly used to treat mental disorders, is tardive dyskinesia, a condition characterized by involuntary muscle movement. Although there are currently no highly effective treatments for this disorder, gamma-aminobutyric acid (GABA) compounds (neurotransmitters present in the brain) are believed to play a role and are being investigated. Benzodiazepines, a group of drugs used primarily to treat anxiety and insomnia, have been shown to have an indirect effect on this mechanism and they do not produce the side effects of GABAmimetics (drugs that mimic the action of GABA). Clonazepam, a benzodiazepine, was administered to 19 chronically ill patients who were being treated with neuroleptics and had developed tardive dyskinesia. Two forms of tardive dyskinesia were noted in the subject group: dystonic movements (impaired muscle tone resulting in facial grimaces) and choreoathetoid movements (extreme range of jerking involuntary motions). The patients' baseline measurements were taken and clonazepam was dispensed in a double-blind randomized study which lasted 12 weeks, during which time the patients were monitored. When the data were analyzed, 35 percent of the patients had decreased dyskinesia ratings while taking clonazepam. Patients with dystonic movement experienced a greater reduction of symptoms (42 percent) than patients with choreoathetoid symptoms (27 percent). Five patients developed a tolerance to clonazepam, but after the drug was discontinued for two weeks, the antidyskinetic effect was regained. Ultimately, antipsychotic drugs must be developed that do not create tardive dyskinesia in patients. However, until these drugs are available, clonazepam can help to reduce this side effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Clonazepam

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Factors in the development of severe forms of tardive dyskinesia

Article Abstract:

Tardive dyskinesia (TD) is a defect in voluntary movement, which usually results from the use of antipsychotic (neuroleptic) drugs for psychiatric conditions. These symptoms may be mild, moderate, or severe, but severe symptoms are rare. This study was initiated to compare factors associated with the three severity levels of tardive dyskinesia. A total of 558 patients (263 men and 295 women) who had received neuroleptics for at least two years comprised the study group. One-third (191 patients) had TD in one or more body areas. The men with severe TD (seven patients) were younger and had been on the neuroleptic drug for a shorter period of time than the other patients with TD. The patients without TD tended to receive higher drug dose levels than the patients with TD; those with mild TD had a greater total drug intake than those with moderate or severe TD. These findings, in part, may be due to the fact that the physician lowered the dose when symptoms of TD became more obvious. TD was most common in men aged 40 and under, and in women aged 71 and older. Patients who started drug therapy later in life were more likely to have moderate than mild TD, and drug-free periods were more commonly found in the moderate and severe TD patients than in the patients with mild cases. Patients with mild TD were more likely to have a history of electric shock treatments than those in the other categories. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Causes of, Risk factors, Adverse drug reactions

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