Case ReportOral-paliperidone-induced tardive dyskinesia: a case report
Introduction
Tardive dyskinesia (TD) is generally considered the most severe extrapyramidal sequelae of antipsychotic treatment, and it is usually associated with greater premorbid impairment, longer duration of antipsychotic treatment at higher dosages, older age, female gender, concurrent affective disorders and greater severity of the psychotic disorder [1], [2]. It is characterized by involuntary movements, which usually involve the oral and facial region, but all parts of the body can be involved. The pathophysiology of TD remains unclear, and no definite treatments exist. Dopamine receptor hypersensitivity, GABA dysregulation and oxidative-stress-induced neurotoxicity may be implicated mechanisms for developing TD [3].
Current evidence supports a lower TD risk for second-generation antipsychotics (SGAs) than for first-generation antipsychotics (FGAs) [4]. Paliperidone extended release, the major active metabolite of the atypical antipsychotic risperidone, was a newly introduced second-generation antipsychotic agent in 2005 that has proven effects over both positive symptoms and negative symptoms of schizophrenia [5], [6]. However, TD could still be developed among patients under long-term paliperidone treatment.
Section snippets
Case report
Miss A is a 20-year-old single woman with a fair developmental history. At 14 years old, psychotic symptoms were first noted with persistent commanding auditory hallucinations, strong guilty delusions and severe psychotic behaviors such as self-talking and even wandering naked on the streets. Schizophrenia was diagnosed, and risperidone 2 mg daily was initially prescribed. One year later, even worse psychotic symptoms developed, along with manic symptoms of hyperactivity, hypersexuality and
Discussion
Tardive dyskinesia may be caused by both FGAs and SGAs, with a 1-year risk of 5.5% and 3.9% and a prevalence of 32.4% and 13.1%, respectively [7]. In past studies, only one patient was reported to have TD during paliperidone use; however, the 54-year-old woman suffered from TD symptoms before paliperidone use began [8]. Another 64-year-old woman who suffered from paliperidone-associated rabbit syndrome was also reported [9]. To our best knowledge, Miss A, with no past history of movement
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Cited by (9)
MSBIS: A Multi-Step Biomedical Informatics Screening Approach for Identifying Medications that Mitigate the Risks of Metoclopramide-Induced Tardive Dyskinesia
2017, EBioMedicineCitation Excerpt :Elevated Ach levels have been observed in the striatal region of the brain in animal models (Bymaster et al., 1986; Damsma et al., 1990; Schulze-Delrieu, 1981). As a result, anticholinergic (AC) medications have been employed to correct the DA-Ach imbalance and have had some success in treating various types of drug-induced movement disorders, including akathisia and dystonia (Greene et al., 1988; Qiu and Lim, 2011; Wei et al., 2012; Waln and Jankovic, 2013). However, in the case of drug-induced CTD, symptoms may persist or even exacerbate after AC medication co-administration (Brotchie et al., 2011; Rana et al., 2013).
Antipsychotic drugs
2014, Side Effects of Drugs AnnualCitation Excerpt :The trigger for this episode was not clear. Rabbit syndrome has been attributed to paliperidone [247A], as has tardive dyskinesia in a 20-year-old woman who took paliperidone 9 mg/day for 2 years after having taken risperidone 6–7 mg/day for about 4 years [248A] and tardive Tourette’s syndrome in a 22-year-old woman who took paliperidone 18 mg/day for 2 months [249A]. An acute dystonic reaction has been attributed to paliperidone [250A].
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2019, Contemporary Oral Medicine: A Comprehensive Approach to Clinical PracticePaliperidone palmitate-associated severe refractory tardive dyskinesia with tardive dystonia management and six-months follow-up
2016, Journal of Clinical PsychopharmacologyIdentification and management of tardive dyskinesia: A case series and literature review
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