Venlafaxine (original) (raw)

1998, The Journal of Clinical Psychiatry

Sir: Tardive dyskinesia (TD) is one of the most troublesome side effects associated with the use of antipsychotics. It is estimated that 20% to 30% of patients on long-term administration of neuroleptics will develop these abnormal involuntary movements that involve most commonly the tongue, face, fingers, arms, shoulders, and legs. 1,2 Elderly patients seem to be particularly vulnerable to the development of these side effects 3,4-this is a particular concern because antipsychotics are often used for the treatment of a number of mental disorders in old age. 5,6 Attempts to treat TD symptoms with neuroleptics, cholinergic drugs, benzodiazepines, and calcium channel blockers have not produced encouraging results. 7 The potential benefit of vitamin E in preventing or reducing the severity of TD has been supported by some studies 8,9 and is probably due to its antioxidant properties (free radical mechanisms). Recent reports have also suggested that the novel atypical antipsychotics may be beneficial in managing at least some types of dyskinesias. 10-12 This report describes the case of an elderly chronic schizophrenic woman who developed moderately severe neuroleptic-induced dyskinetic movements that responded to the use of the recently introduced atypical antipsychotic olanzapine. Case report. Ms. A, a 76-year-old single lady with a diagnosis of schizophrenia since age 24, was referred for the treatment of chronic auditory hallucinations and delusions. She also displayed signs of mild increase in muscle tone and dyskinetic movements of the face, jaw, lips, tongue, arms, and feet that had started sometime during the previous 2 years. At the time of assessment, she was receiving propranolol (40 mg/day), haloperidol (5 mg/day), clomipramine (75 mg/day), and chlorpropamide (125 mg/day). After a 5-week period of drug adjustment, Ms. A was kept on haloperidol, 5 mg/day, biperiden, 3 mg/day, and bromazepam, 4.5 mg/day, for 7 months. Toward the end of this 7-month period, she experienced deterioration of her clinical state and of her dyskinetic movements. The dose of haloperidol was then increased to 7.5 mg/day for another 5 months, which was followed by mental state improvement but further deterioration of the extrapyramidal signs to a point that they often interfered with her eating. After 12 months of follow-up, the abnormal movements were rated according to the AIMS guidelines 13-scores ranged from minimal (face, tongue, and lower limbs) to moderate (lips, jaw, and upper limbs). There was mild muscle rigidity at evaluation, but no gait problems. Treatment alternatives were discussed with Ms. A and her main caregiver (brother). It was agreed that Ms. A would gradually discontinue the use of haloperidol and biperiden over 1 week and that olanzapine would be then introduced up to a dose of 10 mg/day over the next week. There was substantial im