Posted by Scott L. Schofield on April 8, 2000, at 17:19:06
In reply to Unknown origins of symptomology, posted by Whitney and Beth on April 6, 2000, at 14:42:08
> We are working with a 9 year old boy who has been sexually and physically abused. There is a history of depressive disorders in the family. The child was recently prescribed Resperidol and Clonidine. He has, in the past, been on Adderal, Ritalin, Paxil and probably others. He has recently begun very vigorous (to the point of drawing blood) nose-picking, licking his lips and his hands to the point that they are very dry and cracked and bloody. Is this a neuroleptic-induced tardive dyskinesia?
No.The word "tardive" is used to describe that such abnormal movements develop after an extended period of time. Tardive-dyskinesia is malignant and irreversible. I don't think you need to worry about this, though. What you are describing are abnormal behaviors, and not simply the abnormal movements associated with dyskinesia.
These behaviors could be the result of akathisia, another neuroleptic-induced phenomenon. I have no real background to suggest this with any confidence - it's more like a somewhat-less-than-wild guess.
There is some controversy surrounding the definition and description of akathisia, but symptoms can be divided into two major categories:
1. Subjective
- feelings of inner restlessness
- anxiety
- an urge or compulsion to move
- desire to be in constant motion2. Observable
- inability to sit still
- restless legs
- rocking
- crossing and uncrossing of legs
- repetitive movements or behaviors
* these may be more likely to occur while seated
I haven't seen it yet, but you may find a much better diagnostic description in the DSM IV.Diagnosis: 333.99 Neuroleptic-Induced Acute Akathisia
-------------------------------------------------From Dr. Bob's Psychopharmacology Tips:
From: neurosis@ac.net (John G. Wagnitz, MD)
Date: Wed, 27 Mar 1996 22:11:01 -0500
Subject: Tardive akathisiaI have had two patients recently who were switched from standard neuroleptics to risperidone who appear to have developed tardive akathisia. I understand propoxephene may be of benefit.
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I guess the most prudent thing to do would be to try lowering the dosage of Rispersal or perhaps switch to Zyprexa.
- Akathisia is seen more often with the use of Risperdal (risperidone) than with Zyprexa (olanzapine).
- Akathisia is often exacerbated, and can even be precipitated by SSRI antidepressants.- Akathisia is often treated with propanolol; anticholinergics seem to be a bad idea
Is clonidine being used to treat AD/HD? Anxiety?
I don't know how it might fit in with Noa's reply, but there is a rather strong association between Tourette's Syndrome and ADD AD/HD.
Clonidine is sometimes used to treat akathisia, tardive-dyskinesia, and Tourette's Syndrome, although its efficacy for akathisia seems to be equivocal at this point. That this child is currently taking clonidine might indicate that his behaviors are not the result of akathisia.
Of course, an idiosyncratic paradoxical reaction to clonidine is conceivable. Perhaps its current application could contribute to a precipitation of akathisia. Akathisia is thought to involve disturbances in noradrenergic/cholinergic balance, unlike the other extrapyramidal symptoms (EPS) that are thought to involve dopaminergic/cholinergic balance. Clonidine acts as an agonist to both presynaptic and postsynaptic noradrenergic receptors.
I hope this situation resolves quickly.
- Scott
poster:Scott L. Schofield
thread:29099
URL: http://www.dr-bob.org/babble/20000401/msgs/29351.html