Zesiewicz TA et al: Update on treatment of essential tremor. Curr Treat Options Neurol 2013;15:410.
The history is suggestive of parkinsonism, but the incon-spicuous tremor and early cognitive changes raise the possi-bility of atypical parkinsonism rather than classic Parkinson’s disease. The prognosis of these disorders is worse than that of classic Parkinson’s disease. Given the cognitive changes and his age, the use of a dopamine agonist was unwise, as these agents are more likely than levodopa to exacerbate or precipitate behavioral and cognitive disturbances. Sleep attacks may occur spontaneously but are especially noted in patients receiving dopamine agonists. The patient has also developed punding, which is a recognized adverse effect of dopaminergic medication. Surgical treatment (deep brain stimulation) is contraindicated in patients with cognitive changes or atypical parkinsonism.
Charles DeBattista, MD * severe akathisia. Although more costly, lurasidone is then prescribed, which, over the course of several weeks of treatment, improves his symptoms and is tolerated by the patient. What signs and symptoms would support an initial diagnosis of schizophrenia? In the treatment of schizophre-nia, what benefits do the second-generation antipsychotic drugs offer over the traditional agents such as haloperidol? In addition to the management of schizophrenia, what other clinical indications warrant consideration of the use of drugs nominally classified as antipsychotics? A 19-year-old male student is brought into the clinic by his mother who has been concerned about her son’s erratic behavior and strange beliefs. He destroyed a TV because he felt the TV was sending harassing messages to him. In addition, he reports hearing voices telling him that fam-ily members are trying to poison his food. As a result, he is not eating. After a diagnosis is made, haloperidol is prescribed at a gradually increasing dose on an outpatient basis. The drug improves the patient’s positive symptoms but ultimately causes intolerable adverse effects including
Antipsychotic drugs are able to reduce psychotic symptoms in a wide variety of conditions, including schizophrenia, bipolar disorder, psychotic depression, psychoses associated with dementia, and drug-induced psychoses. They are also able to improve mood and reduce anxiety and sleep disturbances, but they are not the treatment of choice when these symptoms are the primary disturbance in nonpsychotic patients. A neuroleptic is a subtype of antipsychotic drug that produces a high incidence of extrapyramidal side effects (EPS) at clinically effective doses, or catalepsy in laboratory animals. The second-generation or “atypical” antipsychotic drugs are now the most widely used type of antipsychotic drug.
Reserpine and chlorpromazine were the first drugs found to be useful to reduce psychotic symptoms in schizophrenia. Reserpine
The author thanks Herbert Meltzer, MD, PhD, for his contributions to prior editions of this chapter.