Bruce L. Saltz

Side effects of antipsychotic drugs. Avoiding and minimizing their impact in elderly patients.

PREVIEW Clearly, the use of antipsychotic drugs can be extremely helpful in elderly patients to reduce psychotic symptoms and agitation. However, these drugs may produce serious side effects, such as parkinsonism, akathisia, dystonia, and tardive dyskinesia, that can range in intensity from mild to severe. In this article, the authors describe how to use antipsychotic agents in the most careful fashion possible.

Pharmacologic studies of tardive dyskinesia.

Based on the results of two preliminary studies, we concluded that late-developing persistent drug-induced movement disorders are pharmacologically heterogeneous, and this heterogeneity is seen between individual patients (and groups of patients) as well as within body areas of individual patients; dystonic pathology has a distinct and more consistent response to pharmacologic stimulation than does nondystonic tardive dyskinesia (TD); and, although disturbances in dopamine and acetylcholine appear to be involved in these disorders, they do not in all cases exist in functionally opposite relationships. The observed pharmacologic heterogeneity in TD response reflects the limitations of the dopamine/acetylcholine model of TD, which oversimplifies the neuroanatomy of the basal ganglia and the pathophysiology of TD. The chemical and anatomical complexity of this region suggests that other neurotransmitter systems and neuronal circuits within and extending from the basal ganglia may be disturbed in the pathogenesis of TD.

Polydipsia and tardive dyskinesia in chronic psychiatric patients: Related disorder?

Dopamine supersensitivity, presumably playing a role in tardive dyskinesia, has been implicated in the unexplained polydipsia occurring in chronic psychiatric patients. To investigate this hypothesis, the authors compared laboratory measurements indicating the fluid status of 65 patients before and after the development of tardive dyskinesia. No evidence was found that patients who develop tardive dyskinesia concurrently develop abnormalities in fluid regulation.