Improvement of tardive dyskinesia and dystonia associated with aripiprazole following a switch to quetiapine: Case report and review of the literature

Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Journal of Clinical Pharmacy and Therapeutics (Impact Factor: 1.67). 10/2011; 37(3):370-2. DOI: 10.1111/j.1365-2710.2011.01290.x
Source: PubMed


Aripiprazole has a low risk of extrapyramidal symptoms. Switching to aripiprazole has been reported to improve tardive dyskinesia caused by other medications. The authors report a case and review previous reports of dystonia and dyskinesia associated with aripiprazole.
We present a case of a 22-year-old man with schizophrenia who experienced dyskinesia and dystonia associated with aripiprazole. Switching from olanzapine to aripiprazole resulted in worsening dyskinesia and new onset of dystonia. The patient's dyskinesia and dystonia improved after switching from aripiprazole to quetiapine therapy.
There were several previous case reports on dyskinesia and dystonia associated with aripiprazole medication. The risk factors for tardive dyskinesia include older age and female sex. However, our case was a male patient who was younger compared with the previous cases and so should have been less at risk for dyskinesia in comparison with the previous cases. The effects of aripiprazole can include tardive movement disorders. Dyskinesia, dystonia and psychotic symptoms were improved with relatively small dose of quetiapine in this case. Whether some second-generation antipsychotics are more effective than others in the treatment of tardive dyskinesia remains unclear.

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    • "Quetiapine-related TD was noted and described in an early case report about 15 years ago.5) However, some reports also mention contrary findings of quetiapine's ability to relieve TD.1,2,8,9,10,11,12,13) Emsley et al.14) found that quetiapine could effectively reduce TD severity in patients with established TD, but the mechanism of this action is unclear. Quetiapine is the atypical antipsychotic most similar to clozapine (without its hematologic side effects) based on receptor and pharmacologic profile, which may explain its treatment effects for TD.11) Quetiapine is believed to express lower affinity for D2 receptors in striatal and extrastriatal regions of brain,15) which could explain the mechanisms by which it can treat or relieve TD side effects. "
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    ABSTRACT: The atypical antipsychotics were believed to induce less extrapyramidal syndrome, including tardive dyskinesia (TD). Since the introduction of the quetiapine, it is also reported with less TD side effects. It even can relieve the symptoms of severe TD and reduce the risk of TD. The quetiapine's low affinity and fast dissociation from postsynaptic dopamine D2 receptors should give the least risk of producing the symptoms of TD. The quetiapine even can reduce the TD side effects related to clozapine, which has the lowest risk for TD. However, since the first case report of TD side effects related to quetiapine published on 1999, the safety of quetiapine in TD aspect has been questioned. Therefore, we want to share this case report, which was written to describe the severe late-onset TD side effects after long-term use of quetiapine in a patient with psychotic depression. The patient had no significant findings after concurrent comprehensive neurological examinations, magnetic resonance imaging of brain and electroencephalogram since the onset of TD.
    Clinical Psychopharmacology and Neuroscience 08/2014; 12(2):163-5. DOI:10.9758/cpn.2014.12.2.163
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    • "In early industry-sponsored clinical trials, aripiprazole showed slightly more extrapyramidal symptoms and akathisia compared with placebo, but less than for haloperidol or risperidone.58 Later, there were several reports of general extrapyramidal symptoms,59–61 acute dystonic reactions,62–65 and tardive dyskinesia66 in patients on treatment with aripiprazole. On the other hand, in some cases, treatment with aripiprazole led to improvements in antipsychotic-induced tardive dyskinesia.67,68 "
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    ABSTRACT: About one third of patients with schizophrenia respond unsatisfactorily to antipsychotic treatment and are termed "treatment-resistant". Clozapine is still the gold standard in these cases. However, 40%-70% of patients do not improve sufficiently on clozapine either. In the search for more efficacious strategies for treatment-resistant schizophrenia, drugs with different pharmacological profiles seem to raise new hopes, but are they valid? The aim of this review was to evaluate the evidence for aripiprazole as a potential strategy in monotherapy or combination therapy for patients with treatment-resistant schizophrenia. The evidence for aripiprazole monotherapy and for the combination of aripiprazole with psychotropics other than clozapine is scant, and no recommendation can be made on the basis of the currently available data. More effort has been made in describing combinations of aripiprazole and clozapine. Most of the open-label and case studies as well as case reports have shown positive effects of this combination on overall psychopathology and to some extent on negative symptoms. Several reports describe the possibility of dose reduction for clozapine in combination with aripiprazole, a strategy that might help so-called "treatment-intolerant" patients. The findings of four randomized controlled trials with respect to changes in psychopathology seem less conclusive. The most commonly found beneficial effects are better metabolic outcomes and indicators of the possibility of reducing the clozapine dose. However, other side effects, such as akathisia, are repeatedly reported. Further, none of the studies report longer-term outcomes. In the absence of alternatives, polypharmacy is a common strategy in clinical practice. Combining aripiprazole with clozapine in clozapine-resistant or clozapine-intolerant patients seems to be worthy of further investigation from the pharmacological and clinical points of view.
    Neuropsychiatric Disease and Treatment 05/2012; 8:235-44. DOI:10.2147/NDT.S13830 · 1.74 Impact Factor
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    ABSTRACT: Both typical and atypical antipsychotic drugs are D2 receptor antagonists but yet appear to have markedly different effects upon the induction of dopamine sensitization. This study aims to compare the effects of subchronic regimens of low-dose olanzapine and haloperidol administered to rats previously sensitized to apomorphine. Initially, rats received apomorphine (2.0 mg/kg) or vehicle treatments for five consecutive days followed by a conditioning test and an apomorphine challenge test. Next, there was an antipsychotic exposure phase in which three vehicle groups and three apomorphine groups received 10 daily injections of either vehicle, haloperidol (0.03 mg/kg) or olanzapine (0.01 mg/kg). In the final phase, all groups were given a second conditioning test and apomorphine challenge test. Apomorphine induced sensitization and conditioning effects. Following haloperidol exposure, apomorphine conditioned and sensitization effects were potentiated but, in contrast, olanzapine exposure eliminated apomorphine sensitization effects. In addition, the sensitization induced by apomorphine transformed the low-dose haloperidol treatment into a potent locomotor stimulant treatment. In the vehicle groups, haloperidol and olanzapine exposure effects were equivalent and not different from vehicle treatment. The profound differences observed between typical and atypical antipsychotic exposure in animals with an upregulated dopamine system are consistent with clinical evidence for lower risk of psychomotor disturbances with chronic treatment with atypical antipsychotic. Importantly, the finding that a very low dose of olanzapine reversed sensitization effects suggests that low-dose olanzapine may have clinical utility in a variety of disorders linked to sensitization of the dopamine system.
    Psychopharmacology 07/2013; 230(4). DOI:10.1007/s00213-013-3184-8 · 3.88 Impact Factor
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