Predicting the incidence of antipsychotic-induced movement disorders in long-stay patients: A prospective study.

Tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia are antipsychotic-induced movement disorders that remain a cause for concern in the treatment of patients with psychotic disorder. Movement disorders secondary to antipsychotics constitute a major reason for non-compliance, which results in an increased risk of psychotic relapse (Robinson et al. 2002; Lambert et al. 2004; Casey, 2006). Although second generation antipsychotics (SGAs) may be associated with a lower incidence of movement disorders, these medications nevertheless still carry risk. We further refer to our previous publication (Bakker et al. 2011). A high-risk group for movement disorders consists of patients with chronic mental illness and therefore chronically exposed to antipsychotic medication, particularly long-stay patients (i.e. patients institutionalized for long periods) with supervised medication regimes (Bakker et al. 2011). Antipsychotic-induced movement disorders (Owens, 1999; Factor et al. 2005) can be divided into acute syndromes, such as parkinsonism and akathisia, that occur within hours/days or weeks after initiating antipsychotic treatment or increasing the antipsychotic dose (or cessation of anticholinergics), and tardive syndromes, such as TD and tardive dystonia, that develop after months or years of treatment. Given that combinations of acute and chronic movement disorders occur in patients undergoing long-term treatment with antipsychotics, prediction models should include both syndromes, i.e., the four major types of movement disorders (TD, parkinsonism, akathisia and tardive dystonia). Given the above considerations, the aim of the current prospective study of movement disorders was to provide clinicians with risk information regarding new occurrences of movement disorders for prevention purposes in the population currently most at risk: long-stay patients with chronic mental illness requiring long-term antipsychotic treatment.