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Tardive dyskinesia is a condition characterized by involuntary repetitious movements of the muscles; it can be caused by certain antipsychotic drugs such as phenothiazine. Elderly people who are treated with antipsychotic medication are more susceptible to the side effects of this medication, including tardive dyskinesia. The incidence of tardive dyskinesia is three times greater in patients over 40 than in younger patients. A prospective study was undertaken to investigate the incidence of tardive dyskinesia in elderly patients who were beginning anti-psychotic drug treatment, and to identify risk factors for this side effect. Preliminary information is presented for 160 older patients (over 55 years of age) enrolled in the study. Follow-up ranged from 3 to 119 weeks. The average age was 77 years, 72 percent were women, and 87 percent were white. The majority of patients (67 percent) received medication to treat organic brain syndrome (condition involving impaired function of the brain), and 42 percent had a psychiatric diagnosis. The incidence of tardive dyskinesia caused by medication was 31 percent at the end of 43 weeks of drug treatment. Increased vulnerability to tardive dyskinesia was associated with psychiatric diagnosis and the early onset of extrapyramidal signs such as tremors, twitching, slow snake-like movements of the upper body, or facial grimace. These findings should aid in assessing the risks and benefits of using antipsychotic drugs for treating elderly patients. (Consumer Summary produced by Reliance Medical Information, Inc.), Objectives.--To investigate the incidence of tardive dyskinesia in elderly individuals beginning treatment with antipsychotic drugs and to identify risk factors for the development of tardive dyskinesia in the elderly. Design.--A cohort of previously neuroleptic-naive patients was identified at the time of initiation of antipsychotic drug treatment. Patients were evaluated at baseline and followed up at 3-month intervals for periods ranging from 3 to 1 1 9 weeks. Setting.--Subjects were recruited from the psychiatric and geriatric medical services of two medical centers, a geriatric institute, and three nursing homes in the metropolitan area of New York City, NY. Patients.--Two hundred fifteen individuals older than 55 years have entered the study thus far. Preliminary data are presented for 160 patients who were followed up for at least 1 month. Their age range was 57 to 99 years (mean, 77 years). Seventy-two percent were women and 87% were white. Sixty-seven percent of patients had a diagnosis of organic mental syndrome and 42% had a psychiatric diagnosis. Interventions.--A naturalistic, longitudinal, repeated assessment paradigm was employed. Assessments included abnormal involuntary movements, extrapyramidal signs, psychiatric symptoms, and medical and drug treatment histories. Main Outcome Measure.--The incidence of tardive dyskinesia was determined using a standardized rating instrument and survival analysis. Results.--The incidence of neuroleptic-induced dyskinesia was 31% (95% confidence interval, 20%, 42%) after 43 weeks of cumulative neuroleptic treatment. Psychiatric (as opposed to organic) diagnosis and presence of extrapyramidal signs early in treatment were associated with increased tardive dyskinesia vulnerability. (JAMA. 1991;266:2402-2406)

Los estudios de seguimiento han demostrado que un numero considerable de pacientes con esquizofrenia se recupera completamente (es decir, experimentan una mejoría constante, tanto sintomática como en su funcionamiento social y profesional) cuando son examinados décadas después de un primer ingreso hospitalario. Este estudio evaluó la recuperación durante la fase inicial determinante de la enfermedad. Método: Se llevo a cabo una valoración inicial de individuos que presentaban un primer episodio de esquizofrenia o trastorno esquizoafectivo (n = 118) y que se trataron según un algoritmo farmacoterapéutico. La recuperación completa exigía la remisión concurrente de los síntomas positivos y negativos y una adecuada actividad social y profesional (cumplimiento de las expectativas de rol propias de la edad, realización no supervisada de las tareas cotidianas y participación en las interacciones sociales). Resultados: A los 5 años el 47,2 % (IC del 95 % = 36-5B. 4 %) de los individuos alcanzo la remisión sintomática y el 25,5 % (IC del 95 % = 16,1-34,7 %] había presentado un funcionamiento social adecuado durante, al menos, 2 años. Sólo el 13,7 % (IC del 95 % = 6,4-20,9 %} de los individuos había cumplido todos los criterios de recuperación durante un período mínimo de dos años. Un mejor funcionamiento cognitivo en el momento de estabilizarse el cuadro se relacionó con una recuperación completa, un funcionamiento social y profesional adecuado y la remisión sintomática. La menor duración de la psicosis antes de incorporarse al estudio pronostico tanto la plena recuperación como la remisión sintomática. Una mayor asimetría cerebral se relaciono con la recuperación total y el adecuado funcionamiento sociaI y profesionaI; eI diagnóstico de trastorno esquizoafectivo pronóstico la remisión sintomática. Conclusiones: Aunque algunos pacientes con un primer episodio de esquizofrenia pueden alcanzar una recuperación sintomática y funcional continuada, el índice de recuperación general durante los primeros años de la enfermedad es bajo. [ABSTRACT FROM PUBLISHER]

The article presents a study of birth weight and length in schizophrenics and personality disorder patients compared with their siblings. The subjects of the study were patients consecutively admitted to Hillside Hospital who were 15-35 years of age with at least one biological sibling aged 13 to 37 and a mother who had reared both patient and sib. Birth weight patient samples were obtained from medical records. Findings revealed that no significant differences between patients and their sibs on either measure for either diagnostic group and no difference between diagnostic groups. However, the weight of schizophrenics are less than six ounces compared with their same-sex siblings.

Although atypical antipsychotics differ from conventional antipsychotics in their decreased ability to cause reversible drug-induced movement disorders/motor side effects such as dystonia, drug-induced parkinsonism, and akathisia and potentially persistent drug-induced movement disorders/motor side effects such as tardive dyskinesia, no antipsychotic agent completely eradicates this risk. Antipsychotic agents are frequently used in facilities for the elderly and in general hospitals to treat older patients with behavioral problems. Drug-induced movement disorders are more common and more persistent in elderly patients than in younger patients, and this problem is exacerbated by the fact that antipsychotic medications are often misused by practitioners lacking adequate psychopharmacologic training. Movement disorders can be detrimental to an elderly patient's quality of life and may transform what were otherwise routine activities into difficult tasks. Educational programs are needed to teach primary care physicians, specialists, and patients and their families how to identify and manage drug-induced movement disorders in order to achieve safer and more efficacious care for elderly patients.