Neuroleptic Advers Reaction

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Neuroleptic Physical

Adverse Drug Reactions

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Contents:
Neuroleptics and Antipsychotics………………………...……….……………………………………...…………....…4
Neuroleptic Adverse Drug Reactions and Pharmacogenetics…………………..….…5
Neuroleptics and Neurotransmitters…………………………………………………………..………...……………7
Neuroleptic Iatrogenic Adverse Reactions:
Body Movement Disorders.….…………………………………………..………….…………………..…. …………..…9
Tardive Dyskinesia….…………………………………………………………....………….………..…….……..……………..10
Parkinsonism…………………………………..……………………………………………..………………………….…….…….….13
Tardive Dystonia……..…………………………………...….…………………………………………………………....….…….15
Oculogyric Crisis…………………………………………………………...………………………………………………………16
Akathesia………………………………………………………...………………………………………….…………………..…….….…19
Endocrine Disorders…………………………………………………………………………………………..………………………21
Metabolic Syndrome……………………..…………………………………………………………..…………………….……22
Sexual Dysfunction Male or Female…………………………………………...…………………….....………23
Osteoporosis……………………………..……….…………………………………………………………………………..…..….…..25
Disruption of Thyroid…..……………………………………………………..…………..….…………………..……....……26

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Contents continued…

Cerebro-Vascular and Cardiac Disease …………………………………………….…………………….….27


Neuroleptic Malignant Syndrome.………………………………………………….…………..…...………….……29
Temperature Dysregulation.………………………………………………………………………………………….……...31
Respiratory Disease………………………………………………………………………………………………………...…………32
Agranolocytosis…………………………………………………………………………………………………………...…………….....33
Neuro-degenerative Brain Changes…………………………………………..……….……………….…….…….34
Additional Neuroleptic Iatrogenic Adverse Reactions…………………………..…….…...37
Sudden Unexplained Deaths……………………………..….…………………………………………………………..…39
Tardive Tourettism………………………………………………………………………………………………………………….…43
Conclusion……………………………………………….……………………………………………………………………………..….….…44
Ethics…………………………………………………………………………………………………………….………………….……………….…45
Successful non Neuroleptic Treatments…………………………………...………….…….…………….….46
References………………………………………………………………………………………………………..……………………………....47

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Neuroleptics and Antipsychotics
The terms ‘antipsychotic’ and ‘neuroleptic’ are used interchangeably in
research papers, although in clinical guidelines and practice, ‘antipsychotic’ is
the most frequently used.
Prior to these terms these medications were known as ‘Major Tranquillisers’.
The term ‘neuroleptic’ was accepted in 1955 and eventually became known as
‘antipsychotic’ by drug companies who used it as a marketing ploy to
influence doctors and patients to believe that the drug’s specific action was to
treat and prevent psychosis. However this ploy puts considerable distance from
numerous other ‘antipsychotic’ actions and the hard reality of what the drug
does to the brain.
Neuroleptic literally means to ‘seize the nerve’, a chilling scenario. For this
reason, throughout this document the word ‘Neuroleptic’ will be used in place
of ‘Antipsychotic.’

4
Neuroleptic Adverse Drug Reactions and Pharmacogenetics

Neuroleptic ADR are caused by the way the drugs act on neurons and
neurotransmitters in the brain and body and are therefore
IATROGENIC. i.e. neuroleptic induced.
ADR are influenced by the genetically predetermined rate of
metabolism known as Pharmacogenetics. When people have the in-
born slower rates of metabolism i.e. Poor Metaboliser or an
Intermediate Metaboliser Genotype profiles, neuro-toxicity increases
which is associated with the severity of ADR. 1, 2

All people who take neuroleptics will be affected by various ADRs,


either within a short or longer period of time.
60% of patients experience severe/very severe side effects.3

5
Adverse Drug Reactions and Side Effects

In both patient and professional literature, to explain the ‘undesired


effects of medication’, pharmaceutical companies commonly use the
term ‘side effects’. Because the term both minimises and obscures the
cause of ‘side effects’, the term is replaced by Adverse Drug Reactions
(ADRs) in this document.

Many neuroleptic physical ADRs are not found in mainstream literature.


In order to readdress this situation, this document provides up to date
and concise ADR information for mental health and social care
practitioners.

6
Neuroleptics and Neurotransmitters

It is well known that neuroleptic medication depletes dopamine by


disrupting the dopamine neurotransmitters in the brain.
What is not so well known is that atypical neuroleptic medication disrupts
other neurotransmitters such as serotonin, adrenaline, noradrenaline and
acetylcholine, that play an important role in the maintenance of all body
systems.
It is the balance between all of the neurotransmitters that is important and
this balance is in constant flux to maintain long term stability. If the level
of one neurotransmitter is artificially raised or lowered by medication, all
other neurotransmitters are relatively affected and stability is lost.
Unnatural interference with neurotransmitters by neuroleptics causes
deterioration of physical health and leads to various iatrogenic illnesses.

7
Physical Functions of Dopamine
Dopamine as a neurotransmitter:
 Co-ordination of voluntary and involuntary movements and
muscular strength.
 Participates in thermoregulation and regulates metabolism.
 Enables the natural regulation of fat and sugar, sleep patterns,
control of hunger, thirst, fatigue, and circadian cycles.

Dopamine as an endocrine neurohormone:


 Participates in the regulation of blood pressure, heart rate, cardiac
output, fluid and sodium balance, gastric motility, lactation, fertility,
and bone strength.4
 Enables the flight and fight responses in the face of danger.5

8
Introduction to Body Movement Disorders
The Extra Pyramidal System in the brain controls normal body movements
with dopamine playing an important role. Neuroleptics reduce dopamine
causing excessive abnormal body movements.
Neuroleptic Induced Extra Pyramidal Symptoms (EPS):
 Tardive Dyskinesia
 Parkinsonism
 Tardive Dystonia
 Oculogyric Crisis
 Akathesia
These iatrogenic conditions result from adverse structural brain changes.6,7 & 8

Adverse neuroleptic reactions can be due to people's inability to metabolise


psychiatric medication when they have Poor Metaboliser Genotype Enzymes.1

9
Tardive Dyskinesia (TD)

In 1959 TD was first reported to be linked to neuroleptics.9

TD is due to neuroleptic induced Target Organ Toxicity causing


irreversible damage to the brain cells. TD can appear within 6 months,
is caused by both typical and atypical drugs and the risk increases with
chronic long-term exposure.10, 11, 12

Memory impairment is associated with patients with high TD scores.13

5-HT2C serotonin receptor gene variants are associated with Tardive


Dyskinesia, depending on age, duration of treatment, dose and sex.14

10
Tardive Dyskinesia (TD)

TD symptoms are disfiguring and include:


 Chewing movements of lower jaw.
 Lip sucking and smacking.
 Blowing in and out and bulging of cheeks.
 Facial grimacing.
 Abnormal tongue movements i.e. the tongue quivers – protrudes.
 Finger movements as though an invisible guitar is played.
 Rocking and swaying of the body.

Body actions are involuntary, potentially irreversible and there is no


proven treatment.

11
Less Well Known Tardive Dyskinesia Symptoms

There are many other "lesser" appreciated symptoms of TD:


 Restless legs (especially at night)
 Poor sleep
 Loss of gag reflex/swallow – can lead to pneumonia
 Unstable blood pressure and heart rate due to autonomic dysfunction.
 Pain syndrome i.e. tardive pain
 Depression.
 Psychosis as the condition progresses.
 Dementia

All the above ‘lesser known symptoms’ are all possible (if not likely) in
Tardive syndromes, largely because of neuroleptic drug treatments, and will be
found if doctors take the time to "think" and ask questions carefully.
(G. E. Jackson MD, Personal Communication)

12
Parkinsonism

Neuroleptic Induced Extra Pyramidal Symptoms (EPS) manifest in the


same way as they do in Parkinson’s Disease:
 Tremor, ranging from being almost imperceptible to incessant
shaking.
 Hypersalivation: excessive salivation
 Bradykinesia: slowing down of large muscle movement
 Shuffling gait
 Reduced emotional expression
 Rigid stiff muscles

When anti-cholinergic medications are prescribed to alleviate EPS,


patients are then exposed to additional ADRs.

13
Anti-Cholinergic Adverse Drug Reactions

The role of the Peripheral Nervous System is to connect the Central


Nervous System (brain & spinal cord) to the limbs and organs.

Anticholinergic medications disrupt the Peripheral Nervous System


causing the following ADRs:
Blurred vision Urine retention and Bladder distension
Dry eyes Constipation
Dry mouth Headaches
Increased heart rate Nasal congestion15
Nausea & vomiting16

Anticholinergic (antimuscarinic) medications increase brain damage associated


with cognitive impairment and worsen Tardive Dyskinesia.16, 17

14
Tardive Dystonia

Dystonia is characterised by involuntary twisting and repetitive


movements, or abnormal postures18, 19, 20 due to dysfunction or over-
activity, in the brain structures that control movement.

These sustained and disfiguring painful muscle spasms include:


 Torticollis- head and neck are twisted to one side
 Retrocollis - head and neck are pulled back between the shoulder
blades
 Blepharospasm - eyelids are forcefully squeezed shut.
 Excessive arching of the back.

15
Oculogyric Crisis

Oculogyric Crisis is an acute dystonic reaction to certain drugs


including neuroleptics, such as Olanzapine,21, 22 Risperidone, 23
Amisulpiride24 and Clozapine.25

In addition to the acute presentation, it can develop as a recurrent


syndrome.26, 27, 28

Characteristics include rotating of the eyeballs with extreme and


sustained upward deviation accompanied by ocular pain. The eyes
may converge, deviate upward and laterally, or downward.27, 28

16
Associated Dystonic Symptoms with Oculogyric Crisis

Some of these are similar to the symptoms described in Tardive


Dyskinesia, Parkinsonism and Tardive Dystonia as there is a degree of
overlap.

Blepharospasm Respiratory dyskinesia


Periorbital twitches Backwards and lateral flexion of neck
Protracted staring episodes Widely opened mouth
Eye blinking Tongue protrusion
Lacrimation Intensely painful jaw spasm which
Drooling may result in breaking a tooth
Refs 27, 28

17
Associated Psychiatric Symptoms with Oculogyric Crisis
The clinical spectrum of Oculogyric Crisis is poorly understood, leading to the
frequent mislabel of a psychogenic disorder.27
Vertigo Paranoia Mutism
Anxiety Depression Palilalia
Agitation Recurrent fixed ideas Violence
Compulsive thinking Depersonalization Obscene language
Refs 27, 28

“A wave of exhaustion follows some episodes. The abrupt termination of the


psychiatric symptoms at the conclusion of the crisis is most striking.” 27, 28, 29
Other Symptoms Associated with Oculogyric Crisis
Increased blood pressure & heart rate Facial flushing
Pupil dilation Headache
Refs 27, 28

18
Akathesia

Neuroleptic induced symptoms of Akathesia are characterized by


unpleasant sensations of inner restlessness that manifest with a
physical inability to sit still or to remain motionless.

Patients have described the feeling as a sense of inner tension and


torment.

Because of the severe negative psychological effects associated


akathesia, it is described in greater detail in:
‘Neuroleptic Psychological Adverse Reactions’30

19
Conclusion to Body Movement Disorders

Tardive Dyskinesia
Tardive Dystonia
Oculgyric Crisis
Akathesia
Extra Pyramidal Symptoms
- are frequent combinations that make patients look ‘odd’, making
them extremely vulnerable in the public environment.

Abnormal body moments such as TD present an obvious stigma of


'madness' and constitute a severe social handicap ... by causing
embarrassment to the family and friends and apprehension on the part of
the potential employers.31

20
Endocrine Disorders Caused by Neuroleptic Dopamine
Disruption

Metabolic Syndrome
Sexual Dysfunctions
Osteoporosis
Thyroid Disorders

These conditions have a follow on effect causing:


Cerebro Vascular and Cardiac Disease

21
“Metabolic Syndrome”
Symptoms:
 Cortisolaemia i.e. obesity with excessive abdominal fat
 Diabetes type-2
 Hyperlipidemia i.e. Lipid abnormalities or High Cholesterol
 Hypertension or High Blood Pressure
 Insulin resistant Diabetes.32
Some neuroleptics interfere with appetite regulation networks in the brain
resulting in excessive appetite and massive weight gain associated with
diabetes and heart disease.33
5-HTT (serotonin transporter) and 5-HT2A (serotonin receptor) gene variants
are associated with obesity and tryptophan hydroxylase 2, (TPH2) gene
variants are found to be associated with diabetes.14
The occurrence of metabolic syndrome with typical and atypical neuroleptics is 2-
4 times higher than in people who are not prescribed neuroleptics.34

22
Sexual Dysfunction Male and Female

Dopamine as a neurohormone acts as a natural brake by inhibiting


excess production of prolactin hormone that is involved in normal
sexual functions i.e. lactation and sexual gratification.35

Dopamine depletion by neuroleptics removes the brake causing


high levels of prolactin hormone, a condition known as
Hyperprolactemia. This condition creates many sexual
dysfunctions.36, 37, 38

23
Sexual Dysfunction Male and Female
Symptoms of Hyperprolactemia:
MALE FEMALE
Gynecomastia: enlarged breast Galactorrhoea: production and
tissue secretion of breast milk
Galactorrhoea: production and Amenorrhoea: irregular or
secretion of breast milk absent menstruation
Retrograde Ejaculation Loss of Libido
Loss of Libido Anorgasmia
Sterility or damaged sperm DNA Infertility
Erectile dysfunction Birth defects due to damaged
DNA/sperm
Testicular atrophy
Refs 36, 37, 38

24
Osteoporosis
Osteoporosis is associated with neuroleptic induced
Hyperprolactemia.39, 40

Osteoporosis aetiology:
 Long term prolactin-raising neuroleptics pose a high risk of bone
density reduction36
 Reduced bone density in neurolepticized males39
 Risk factor for osteoporosis in young women40

Osteoporosis symptoms:
 Bone pain
 Vulnerability to fractures

25
Neuroleptic Disruption of Thyroid Production
The thyroid is an endocrine organ and it’s function will inevitably be
disrupted in both the short and long term by neuroleptic drugs in a
similar way to other endocrine disorders caused by neuroleptic
interference.
Limited research indicates thyroid dysfunction is relatively common in
patients with schizophrenia41 and long-term neuroleptic treatment can
induce thyroid autoimmunity associated with hyperprolactinaemia.38
Serum levels of T4 (Thyroxine) have been found to decline after
treatment with neuroleptics, and other psychiatric drugs.42
Both Hyperthyroidism and Hypothyroidism can mimic psychiatric
symptoms which may lead to misdiagnosis with the potential to incur
neuroleptic prescribing.

26
Cerebro-Vascular Disease
The neuroleptic impact on the endocrine system increases the risk of
microvascular and macrovascular disease,8 causing the following cerbro-
vascular conditions.

Symptoms:
 Hyperlipidemia (High Cholesterol)
 Cerebral Vascular Accidents i.e. Stroke
 Cardiac Rhythm abnormalities
 Heart Failure
 Myocardial Infarction (heart attack)
 Cardiac Death43
 Deep Vein Thrombosis
 Pulmonary Embolus - potentially fatal
 Vascular Dementia

27
Neuroleptic Cardiotoxicity
Animal studies have demonstrated the cardiotoxic effects of neuroleptic
drugs.44
Neuroleptic drug resulted in cardiac lesions of variable magnitude in
animals, with changes that include thickening of blood vessels, damage
to cardiac muscle fibres, such as disintegration, swelling, fibrotic
scarring45 and cell death (necrosis).46
Based on their discoveries, the authors recommended that patients
receive an ECG (electrocardiogram) and cardiac ultrasound
(echocardiogram) PRIOR to beginning any antipsychotic drug therapy.46
These tests will not prevent the development of neuroleptic
cardiotoxicity.

28
Neuroleptic Malignant Syndrome (NMS)

This condition is similar to a viral infection of the brain i.e.


Encephalitis.
NMS results from the dysregulation of the sympathetic nervous system47
which is part of the autonomic nervous system, and is vital for the
stability of life functions.

NMS is associated with:


 All neuroleptics, typical and atypical.48, 49
 Rapid and large increases in neuroleptic dose
 Conjunction with other neuroleptics (polypharmacy).

29
Neuroleptic Malignant Syndrome (NMS)
Clinical Symptoms of NMS:
Hyperpyrexia Generalised muscle rigidity
Altered mental status Sweating
Hypertension Seizures
Hypotension Cardiac arrhythmia
Tachycardia Renal failure
Tremor Respiratory failure
Incontinence Sialorrhea (drooling)
Muscle weakness Dysarthria (speech difficulty)

Mortality rates for NMS, once reported at 20-30% are now estimated at 5-
11.6%. Incidence is probably less now than in the past because of increased
awareness of NMS and efforts at prevention.49

30
Temperature Dysregulation

Neuroleptics disable thermoregulatory mechanisms50 causing


temperature dysregulation i.e. Hypothermia and Hyperthermia.

Neuroleptics most commonly cause hyperthermia51 although they can


also cause hypothermia. This highlights the complexity of the
temperature regulation system.48

The disruption of normal acetylcholine transmission by neuroleptics


causes Hyperthermia i.e. reduced sweating.

During heat waves, neuroleptic medications increase patients' risk of


death from heat stroke, two fold compared to the general population.52

31
Respiratory Disease

Dopamine plays a key role in the regulation of the brain’s


respiratory/breathing centre and clearance of excess lung mucous. OK

Neuroleptic dopamine depletion causes:


 Respiratory Dyskinesia - difficulty in breathing.53
 Respiratory Arrest
 Impaired clearance of excessive lung mucous.4
 Impaired recovery from pulmonary oedema due to cardiac disease.4
 Choking and aspiration.53
 Excess mortality among in-patients.54
 Deaths from respiratory disorders gave rise to the highest relative risk
after accidental deaths.54

32
Agranolocytosis
Clozapine can cause Agranulocytosis which is a blood disorder in which the
total white blood cell (WBC) count falls to a dangerous level. Blood tests are
taken prior to initial prescribing to ascertain the WBC is normal.
In order to prevent fatalities from Agranulocytosis, mandatory blood tests are
taken through out Clozapine prescribing at various time intervals. WBC can
drop spontaneously or due to bacterial infections; patients have to stop
Clozapine immediately, causing emergency hospital admission and change of
neuroleptic medication. Specific antibiotic medications have to be used as
some antibiotics further decrease one type of WBC.
Blood monitoring may prevent neurolepticised people from dying from
agranulocytosis, but it does not prevent iatrogenic blood dyscrasia.
Clozapine has been linked to 950 deaths since being licensed in 1990 —
equivalent to nearly one fatality a week.55

33
Neuro-degenerative Brain Changes
The book “Drug induced Dementia: A Perfect Crime” presents a
methodical analysis of the scientific and epidemiological evidence
which confirms psychopharmaceuticals as a cause of brain damage and
premature death.8
The Jellinger Study, 1977. Human Autopsies56
46% of patients exposed to neuroleptics displayed prominent injury to
the caudate nucleus, compared with 4% of psychotic patients who had
avoided neuroleptic drugs. The caudate nucleus plays a key role in the
modulation of movement, cognition, and mood.
The brain cell changes showed the brain’s response to chemical injury;
cell death (necrosis), disintegration and inflammation, also found in
systemic lupus patients and Parkinson’s Disease.8

34
Neuroleptics and Progressive Brain Damage

There are 25 medical articles on brain damage associated with


neuroleptic drug treatment compiled by the late psychiatrist Loren
Mosher, MD.57

Researchers in Denmark found a dose dependent association with brain


shrinkage, estimating the risk of atrophy to be 6.4% for each additional
10 grams of chlorpromazine, or other neuroleptic in terms of equivalent
dose.7, 8

35
Brain Damage Associated with Poor Outcomes

Neuroimaging Studies of Humans:


Following one year of neuroleptic therapy, patients demonstrated an 8%
increase in lateral ventricle volume, a 1% reduction in total brain
volume, and a 3% reduction in whole brain grey matter.

These brain changes were significant statistically, being clinically


related to poor outcomes in terms of psychotic symptoms, physical
health, social intimacy, and independence. The grey matter changes
corresponded to cumulative neuroleptic dose.8, 30, 58

36
Additional Neuroleptic Iatrogenic Adverse Reactions

Liver malfunction:
Atypical antipsychotics commonly cause symptomless increase in
aminotransferase liver enzyme levels. Elevated transaminases, which
can be an indicator of liver damage59 have been reported with
olanzapine.60

Kidney failure:
Acute renal failure induced by neuroleptics. 61

Constipation:
Bowel obstructions.62, 63

37
Additional Neuroleptic Iatrogenic Adverse Reactions

Muscular Weakness:
Loss of muscle power is associated with high neuroleptic dose, in
conjunction with polypharmacy and NMS.64

Sunburn:
Photosensitivity occurs with atypical neuroleptics, i.e. Amisulpride65 and
Clozapine.66 Patients are more prone to increased Sun Sensitivity when
polypharmacy is practised.

Ocular Changes:
Cataracts can occur with Neuroleptics.67

38
Sudden ‘Unexplained’ Deaths

Many reports are available of sudden deaths of patients who were


medicated with high dosages of neuroleptics. 68, 69,70

Cardiovascular causes of death are most common, accounting for the


majority of sudden and unexpected deaths, thought to result from fatal
arrhythmias. Some neuroleptics prolong the cardiac QTC interval even
at therapeutic doses.71

The risk of sudden cardiac death is elevated at low doses, even among
patients who receive neuroleptic drugs for non-schizophrenic
conditions.4, 72

39
Sudden ‘Unexplained’ Deaths cont…
 The death of Orville Blackwood in 1991 from heart failure, resulted
from being injected with a cocktail of Promazine and Fluphenazine.73
 In 1990, there were thirteen sudden deaths of patients who were
medicated with Pimozide in the UK.74
 20 people died whilst taking Olanzapine out of 2,500.75
 In 2009 sudden unexplained deaths of psychiatric in-patients were at an
eight year high.76
In England the increase in rates of Sudden Unexplained Deaths is significant.
8.8% per year overall, 7.6% in men and 10.4% in women.77
"We know therefore that the mortality rate among people who are in contact
with specialist mental health services is nearly four times that for the general
population.”78
As more people are diagnosed and treated with neuroleptics, the number of
patient mortalities has increased.79

40
Conditions Contributing to Premature Death

“When key regions of the brain are destroyed, numerous life-sustaining


functions are affected.” (G. E. Jackson M. D. Personal Communication)

Metabolic Syndrome Hyperthermia – Heat Stroke


Hyperprolactemia Hypothermia
Cardiac Conditions Kidney Failure
NMS Bowel Obstruction
Parkinsonism Cerebro-vascular disease
Respiratory conditions Tardive Dyskinesia & Dystonia

All these conditions leading to premature death result from unnatural


medication interference with the natural life-sustaining functions of the
brain.

41
Premature Death, Parkinsonism and Tardive Conditions
“Parkinson's disease and Tardive Dyskinesia (TD) both contribute to
premature death. The reason for this is that both conditions reflect brain
damage.” (Source G. E. Jackson M. D. Personal Communication)
In a cohort of 608 Asian patients diagnosed with schizophrenia…,
Risk of death was 2.6 times higher among those with TD.80
Sample of 200 patients receiving neuroleptics was assessed in 1995.
Deceased patients had higher average scores for Parkinson syndrome
than those who survived.81
10-year mortality rate among patients with TD.
TD was significantly associated with increase in mortality.82
41% of TD patients died within 10 years vs. 20% of those without TD.83

42
Tardive Tourettism
Tardive Tourettism has the same symptoms of Tourette’s Syndrome and is
caused by neuroleptics.84, 85

Tourette’s syndrome includes physical and vocal tics, which can either be both
simple and complex.

Physical tics include jerking the head, teeth grinding, rolling eyes and jumping
up and down.

Vocal tics include blowing, squeaking, sniffing, swearing, verbalising


involuntary obscene thoughts, repeating other people’s phrases and
inappropriate language with sexual connotations.86, 87

Tourette’s poses social difficulties and includes low self-esteem,


embarrassment and becoming isolated socially.

43
Conclusion
The physical Adverse Reactions of neuroleptic medication may be
described as ‘side effects’, but in fact are the main control effects of these
medications acting on the Central Nervous System.
In general medicine, when severe iatrogenic adverse reactions are caused
by common medications, then the ‘offending’ medication is scrutinised and
banned.
However this sanction does not happen within psychiatry. Neuroleptic
adverse reactions are either treated with common medications, - which
patients may or may not be able to break down efficiently, depending on
their genotype profile - dismissed, ignored, or often seen as part of the
psychiatric illness resulting in treatment with further psychiatric
medications. On occasion surgery to rectify the adverse reaction is
performed.

44
Ethics
Some UK Key Opinion Leaders are insistent that not all neuroleptic
‘side effects’ should be revealed to patients, for fear they may not want
to take neuroleptic medication.
This attitude and practice poses serious ethical questions. The deliberate
hiding of ‘side effects’ information from patients, carers and
professionals is blatant deception and is misleading and disrespectful.
The result is that many people are being coerced into thinking
neuroleptics are safe medications. Nothing could be further from the
truth.
Neuroleptic medications compromise and slowly impoverish peoples’
lives, how their bodies function, their dignity and self respect.
None of this is conducive to social inclusion or the potential of a full
recovery.

45
Successful Non – Neuroleptic Treatment

There is alternative successful treatment without the use of


neuroleptic medications. This rich and sadly suppressed history of
humanistic alternative treatment has been shown consistently to
present outcomes far superior to those of treatment with
neuroleptic medications.

Successful Non-Neuroleptic Treatments for “Schizophrenia” 88

46
References:

(1) Schillevoort I., Boer de A., Weide van der J., Steijns L.S.W., Roos R.A.C., Jansen P.
A J., Leufkens H., G., M. (2002). ‘Antipsychotic-induced extrapyramidal syndromes and
cytochrome P450 2D6 genotype: a case-control study.’ Pharmacogenetics.2002 Apr;12 (3): 235-
40 11927839 http://lib.bioinfo.pl/pmid:11927839

(2) Clarke C. and Evans J., Pharmacogenetics & Mental Health, Professional Mental Health
Awareness Information Series http://www.neuroleptic-
awareness.co.uk/PMHIS/?Professional_Mental_Health_Information_Series:Pharmacogenetics_a
nd_Mental_Health%26nbsp%3B

(3) Rogers A., Pilgrim D., Lacey R., (1993) 'Experiencing Psychiatry: Users views of services'
London: MIND /Macmillan

(4) Jackson G.E., (2005) “Rethinking Psychiatric Drugs: A Guide for Informed Consent"
Authorhouse

47
(5) Robinson D., Ed. “Biology: Brain and Behaviour. Neurobiology”. Springer in association
with ©The Open University.1998.

(6) Gur, R.E., et al, ‘Subcortical MRI volumes in neuroleptic-naive and treated patients with
schizophrenia.’ American Journal of Psychiatry, 155 (12), 1711-1717. December 1998
http://ajp.psychiatryonline.org/cgi/content/full/155/12/1711#F1

(7) Madsen, A.L., et al ‘Neuroleptics in progressive structural brain abnormalities in psychiatric


illness.’ The Lancet, 352, 784-785. Sept. 5, 1998.

(8) Jackson G. E ., MD. (2009), "Drug-Induced Dementia: a Perfect Crime" AuthorHouse

(9) A Research Timeline for Antipsychotic Drugs. “Mad in America” Basic Books, Perseus
Books Group New York © 2002 Robert Whitaker
http://www.madinamerica.com/madinamerica.com/Timeline.html

(10) Klawans, H.L. (1973) 'The pharmacology of tardive dyskinesia', American Journal of
Psychiatry 130: 82-6.

48
(11) Smith, R.C., Strizich, R. and Klass, D. (1978) 'Drug history and tardive dyskinesia',
American Journal of Psychiatry 135: 1402-3.

(12) Mukherjee, S., Rosen, A.M., Cardenas, C., Varia, V. and Orlarte, S. (1982) 'Tardive
Dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic
clinical and drug history variables', Archives of General Psychiatry 39:466-9.

(13) Thomas, P. and McGuire, R. (1986) 'Orofacial Dyskinesia, Cognitive Function and
Medication', British Journal of Psychiatry 149:216-20.

(14) Al-Janabi, Ismail, et al. "Association study of serotonergic gene variants with
antipsychotic-induced adverse reactions." Psychiatric genetics 19.6 (2009): 305-311.
http://journals.lww.com/psychgenetics/Abstract/2009/12000/Association_study_of_serotonergic
_gene_variants.3.aspx

(15) Lieberman J.A (2004) ‘Metabolic Changes Associated With Antipsychotic Use. Primary
Care.’ Companion Journal of Clinical Psychiatry 6 (Suppl.2), 8-13.

(16) British National Formulary, (BNF) September 2006, Section 4.9.2: Central Nervous
System, Drugs used in Parkinsonism and related Drugs, Antimuscinaric drugs. bnf.org

49
(17) Alexander B., Lund BC. ‘Tardive Dyskinesia.’ Clinical Psychopharmacology Seminar
1996-1997 Virtual Hospital
(18) Fahn S, Marsden, CD, Calne DB. ‘Classification and Investigation of Dystonia.’ In:
Marsden CD, Fahn S. Movement Disorders, Vol. 2. London: Butterworths; 1987:332-358.

(19) Schneider, D. MD and Ravin, Paula D MD, ‘Dystonia, Tardive’ Overview in Medscape
Clinical Reference Updated: Apr 2, 2010
http://emedicine.medscape.com/article/287230-overview

(20) The Dystonia Society – Tardive Dystonia


http://www.dystonia.org.uk/index.php/introduction/9

(21) Praharaj SK, Jana AK, Sarkar S, Sinha VK (December 2009). "Olanzapine-induced tardive
oculogyric crisis". J Clin Psychopharmacol 29 (6): 604–6.
http://www.ncbi.nlm.nih.gov/pubmed/19910730

(22) Rudraprosad Chakraborty, Arunima Chatterjee, Suprakash Chaudhury. “Olanzapine-


induced oculogyric crisis in a patient with schizophrenia” Indian Journal of Medical Sciences,
2008 Vol:62 (6) 238-239 Department of Psychiatry, Ranchi Institute of Neuropsychiatry and
Allied Sciences, India http://www.bioline.org.br/request?ms08043

50
(23) Marios Adamou, M.D., M.Sc., LL.M., M.R.C.Psych., and Anthony S. Hale, B.Sc.,
M.B.B.S., Ph.D., F.R.C.Psych. “Extrapyramidal Syndrome and Long-Acting Injectable
Risperidone” Am J Psychiatry 161:756-757, April 2004 © 2004 American Psychiatric
Association http://ajp.psychiatryonline.org/cgi/content/full/161/4/756-a

(24) Mendhekar DN, Lohia D, Kataria P “Tardive oculogyric crisis associated with amisulpride
monotherapy.” J Postgrad Med. 2010 Oct-Dec;56(4):305-6.
http://www.ncbi.nlm.nih.gov/pubmed/20935407

(25) Uzun O, Doruk A. “Tardive oculogyric crisis during treatment with clozapine: report of
three cases.” Clin Drug Investig. 2007;27(12):861-4.
http://www.ncbi.nlm.nih.gov/pubmed/18020545

(26) Sachdev P. “Tardive and chronically recurrent oculogyric crises.” Mov Disord.
1993;8(1):93-7. http://www.ncbi.nlm.nih.gov/pubmed/8093550

(27) The Canadian Movement Disorder Group - Oculogyric Crisis


http://www.cmdg.org/Movement_/drug/Oculogyric_Crisis/oculogyric_crisis.htm

51
(28) Oculogyric Crisis. From Wikipedia.
http://en.wikipedia.org/wiki/Oculogyric_crisis

(29) Abe K. “Psychiatric symptoms associated with oculogyric crisis: a review of literature for
the characterization of antipsychotic-induced episodes.” World J Biol Psychiatry. 2006;7(2):70-
4. http://www.ncbi.nlm.nih.gov/pubmed/16684678

(30) Clarke C. and Evans J., Antipsychotic Psychological Adverse Reactions


http://www.neuroleptic-
awareness.co.uk/PMHIS/?Professional_Mental_Health_Information_Series:Antipsychotic_Adverse_Reactions

(31) Barnes, T.R.E., and Kidger, T. ‘Tardive dyskinesia and problems of assessment.’ In: Gaind,
R., and Hudson, B.L., eds. Current Themes in Psychiatry. London, England: Macmillan Press,
1978. pp. 145- 162.

(32) Poa N.R., Edgar P.F., (2007) ‘Insulin Resistance Is Associated With Hypercortisolemia in
Polynesian Patients Treated With Antipsychotic Medication’ Diabetes Care 30:1425-1429.
American Diabetes Association

52
(33) Varley, Christopher K. MD; McClellan, Jon MD, ‘Implications of Marked Weight Gain
Associated With Atypical Antipsychotic Medications in Children and Adolescents' JAMA.
2009;302(16):1811-1812. doi: 10.1001/jama.2009.1558
http://jama.ama-assn.org/content/302/16/1811.extract?home

(34) Heiskanen, T., Niskanen, L., Lyytikainen, R., et al (2003) ‘Metabolic syndrome in patients
with schizophrenia’. Journal of Clinical Psychiatry, 64, 575 -579.

(35) DOPAMINE en.wikipedia.org/wiki/Dopamine http://en.wikipedia.org/wiki/Dopamine

(36) O'Keane,V.et al ‘Antipsychotic-induced hyperprolactinaemia, hypogonadism and


osteoporosis in the treatment of schizophrenia’ Journal of Psychopharmacology, Vol. 22, No. 2
suppl, 70-75 (2008)

(37) Montgomery J et al, (2004) ‘Prevalence of hyperprolactinemia in schizophrenia: association


with typical and atypical antipsychotic treatment.’ J Clin Psychiatry. 2004 Nov;65(11):1491-8.

(38) Poyraz BC, Aksoy C, Balcioğlu I, ‘Increased incidence of autoimmune thyroiditis in


patients with antipsychotic-induced hyperprolactinemia’.
http://www.ncbi.nlm.nih.gov/pubmed/18539008

53
(39) Hummer M., Malik P., Gasser R W,. Hofer A., Kemmler G,. Naveda R C M., Rettenbacher
M A., Fleischhacker WW. (2005) ‘Osteoporosis in Patients with Schizophrenia’ Am J
Psychiatry 162:162-167, January 2005

(40) O'Keane V and Meaney AM ‘Antipsychotic drugs: a new risk factor for osteoporosis in
young women with schizophrenia?’ J of Clin Psychopharmacology 2005; 25(1):26-31.

(41) Kelly DL, Conley RR ‘Thyroid function in treatment-resistant schizophrenia patients


treated with quetiapine, risperidone, or fluphenazine.’ J Clin Psychiatry. 2005 Jan;66(1):80-4.
http://www.ncbi.nlm.nih.gov/pubmed/15669892

(42) Baumgartner A., (2000) ‘Thyroxine and the treatment of affective disorders: an overview of
the results of basic and clinical research’ The International Journal of
Neuropsychopharmacology, 3:149-165 Cambridge University Press

(43) Kuehn B M. ‘Antipsychotic Risks’ JAMA 2009;301(8):817.15

(44) ‘Antipsychotic drugs, thyroid, and cardiac death’ — by Grace Jackson MD


February 21, 2011
http://bipolarblast.wordpress.com/2011/02/21/antipsychoticsgracejackson/

54
(45) Saito, K. et al (1985). ‘Chlorpromazine-induced cardiomyopathy in rats’, Heart Vessels
Suppl 1:283-285.

(46) Belhani, D. et al (2006). ‘Cardiac lesions induced by neuroleptic drugs in the rabbit.’
Experimental and Toxicologic Pathology 57:207-212.

(47) Gurrera, R. J., (1999) ‘Sympathoadrenal Hyperactivity and the Etiology of Neuroleptic
Malignant Syndrome' Am J Psychiatry 156: 169-180, February

(48) Blass, D.M., Chuen, M. ‘Olanzapine-Associated Hypothermia’ Psychosomatics 45:135-


139, April 2004

(49) Strawn JR, Keck PE Jr, Caroff SN. ‘Neuroleptic malignant syndrome.’ Am J Psychiatry.
Jun 2007;164(6):870-6 http://ajp.psychiatryonline.org/cgi/content/full/164/6/870
Sourced from: Benzer TI, MD, PhD, et al, (2010) ‘Neuroleptic Malignant Syndrome in
Emergency Medicine.’ http://emedicine.medscape.com/article/816018-overview#a0199
http://emedicine.medscape.com/article/816018-overview

55
(50) Wyngaarden, JB, MD, Ed., Lloyd H. Smith, Jr., MD and J. Claude Bennett, MD. "Cecil
Textbook of Medicine 19th edition" p. 1569. Pub.. W.B. Saunders Company, Harcourt Brace
Jovanovich, Inc. Philadelphia London, Toronto, Montreal, Sydney, Tokyo.

(51) Clark WG, Lipton JM: ‘Changes in body temperature after administration of amino acids,
peptides, dopamine, neuroleptics and related agents: II.’ Neurosci Biobehav Rev 1985; 9:299–
371 http://www.sciencedirect.com/science/article/pii/0149763485900521

(52) Bark N., (1998) ‘Deaths of Psychiatric Patients During Heat Waves’ Psychiatr Serv
49:1088-1090 http://psychservices.psychiatryonline.org/cgi/content/full/49/8/1088

(53) Ruschena D., Mullen P.E., Palmer S., Burgess P., Cordner S. M., Drummer O. H., Wallace
C., Barry-Walsh J. (2003) ‘Choking Deaths: the role of antipsychotic medication’ British journal
of Psychiatry 183: 446-450 http://www.ncbi.nlm.nih.gov/pubmed/14594921

(54) Prior P., Hassall C., Cross K.W. ‘Causes of death associated with psychiatric illness’
Oxford Journals Journal of Public Health Volume18, Issue 4 p. 381-389 Accepted February 13,
1996. http://jpubhealth.oxfordjournals.org/content/18/4/381.full.pdf+html

56
(55) Analysis of MHRA figures by mental Health Charity MIND
http://www.timesonline.co.uk/tol/life_and_style/health/mental_health/article5968642.ece

(56) Jellinger, K. (1977). Neuropathologic findings after neuroleptic long-term therapy. In L.


Roizin, H. Shiraki, and N. Grdevit (Eds.), Neurotoxicology (pp. 25-45). New York: Raven
Press.

(57) Compilation of Medical articles on neuroleptic brain damage.


http://www.mindfreedom.org/kb/psychiatric-drugs/antipsychotics/neuroleptic-brain-
damage/mosher-bibliography/

(58) Cahn W., Hulshoff H.E., Lems E.B.T.E., Neelje E.M., van Haren M.S., Schnack H.G, et al
‘Brain Volume Changes in First Episode Schizophrenia.’ Archives of General Psychiatry 59
(2002): 1002-1010)

(59) Transaminase http://en.wikipedia.org/wiki/Transaminase

57
(60) Ozcanli T, Erdogan A, Ozdemir S, Onen B, Ozmen M, Doksat K, Sonsuz A ‘Severe liver
enzyme elevations after three years of olanzapine treatment: a case report and review of
olanzapine associated hepatotoxicity’ Prog Neuropsychopharmacol Biol Psychiatry 2006 Aug
30;30(6):1163-6.

(61) Soejima A. et al, (1996) ‘Clinical investigation of 10 cases with acute renal failure induced
by neuroleptics.’ Nippon Jinzo Gakkai Shi. Japanese Journal of Nephrology
(1996) Aug; 38(8): 335-41.

(62) Hibbard K.R., Propst A., Frank D.E., Wyse J. ‘Fatalities Associated With Clozapine-
Related Constipation and Bowel Obstruction: A Literature Review and Two Case Reports’
Psychosomatics 2009; 50:416-419

(63) Dome P., Teleki Z., Kotanyi R. (2006) ‘Paralytic ileus associated with combined atypical
antipsychotic therapy’ Progress in Neuro-Psychopharmacology and Biological Psychiatry,
Volume 31, Issue 2, 30 March 2007, Pages 557-560

(64) Downey, G.P., Rosenberg, M., Caroff, S., Beck, S., Rosenberg, H., Gerber, J.C., Heiman-
Patterson, T.D., Aronson, M.D. ‘Neuroleptic malignant syndrome. Patient with unique clinical
and physiologic features’ Am. J. Med. (1984)

58
(65) Borras, L., M.D. and Huguelet, P., M.D. ‘A Case Report of Photosensitivity to
Amisulpride’ Prim Care Companion J Clin Psychiatry. 2007; 9(2): 153

(66) Howanitz E., Pardo M., Losonczy M. ‘Photosensitivity to clozapine’ [Letter] Journal of
Clinical Psychiatry 56; 589,1995

(67) Sajida Shahzad, M.D., et al, ‘Cataract Occurrence With Antipsychotic Drugs’
Psychosomatics 43:354-359, October 2002
© 2002 The Academy of Psychosomatic Medicine

(68) Simpson, G.M., Davies, J., Jefferson, J.W. et al (1997) 'Sudden deaths in psychiatric
patients: the role of neuroleptic drugs.' in American Psychiatric Association task force report.

(69) Mehtonen, O.P., Aranko, K., Malkonen, L. et al. (1991) 'A study of sudden death associated
with the use of anti psychotic or antidepressant drugs', Acta Psychiatrica Scandinavica 84: 58-
64.

(70) Thompson, C. (1994) 'The use of high dose antipsychotic medication', British Journal of
Psychiatry 164: 448-58.

59
(71) Abdelmawla N.and Mitchell AJ. ‘Sudden cardiac death and antipsychotics. Part 1: Risk
factors and mechanisms.’ Advances in Psychiatric Treatment (2006) 12: 35-44 © 2006 The
Royal College of Psychiatrists

(72) Straus S. M. J. M., Bleumink G. S., Dieleman J. P., Johan van der Lei, Geert W., 't Jong,
Herre Kingma, Miriam C. J. M. Sturkenboom, Bruno H.C. Stricker ‘Antipsychotics and the
Sudden risk of Cardiac Death.’ Archives of Internal Medicine 164 (2004): 1293-1297
http://archinte.ama-assn.org/cgi/content/abstract/164/12/1293

(73) Thomas, P. (1997) “The Dialectics of Schizophrenia”. Free Association Books. London /
New York.

(74) Mohammed Fayek, M.D., Steven J. Kingsbury, M.D., Ph.D., Jaafar Zada, M.D. and George
M. Simpson, M.D. ‘Psychopharmacology: Cardiac Effects of Antipsychotic Medications.’
Psychiatr Serv 52:607-609, May 2001 © 2001 American Psychiatric Association
http://ps.psychiatryonline.org/cgi/content/full/52/5/607

(75) Whitaker, R. (2002), “Mad in America”, Perseus Publishing. p. 281.

60
(76) Samuels, Zephaniah 20/08/09 ‘Unexplained death of psychiatric in-patients at highest level
in eight years.’
http://www.blackmentalhealth.org.uk/index.php?option=com_content&task=view&id=647&Ite
mid=117

(77) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
Annual Report. England and Wales July 2009. University of Manchester.
http://www.medicine.manchester.ac.uk/mentalhealth/research/suicide/prevention/nci/inquiryann
ualreports/annualreportjuly2009.pdf

(78) Mortality rate three times as high among mental health service users than in general
population. HSCIC, Health and Social Care Information Centre. February 19, 2013
http://www.hscic.gov.uk/article/2543/Mortality-rate-three-times-as-high-among-mental-health-
service-users-than-in-general-population

(79) Saha S., Chant D., McGrath J. ‘A Systematic Review of Mortality in Schizophrenia. Is the
Differential Mortality Gap Worsening Over Time?’ Arch Gen Psychiatry. 2007;64:1123-1131.

(80) Chong et al (2009). ‘Mortality rates among patients with schizophrenia and tardive
dyskinesia.’ Journal of Clinical Psychopharmacology 29(1):5-8./

61
(81) Modestin et al (2009). ‘Relationship between neuroleptic extrapyramidal syndromes and
patients’ all-cause mortality.’ Pharmacopsychiatry 42(2):57-60.

(82) Dean, CE and Thuras, PD (2009). ‘Mortality and tardive dyskinesia: long-term study using
the US National Death Index.’ British Journal of Psychiatry 194(4):360-364.

(83) Yagi et al (1989). ‘Mortality rate of schizophrenic patients with tardive dyskinesia during
10 years: controlled study.’ Keio Journal of Medicine 38(1):70-72.

(84) Bharucha KJ, Sethi KD. Tardive tourettism after exposure to neuroleptic
therapy. Mov Disord. 1995 Nov;10(6):791-3. Review. PubMed PMID: 8749999.
http://www.ncbi.nlm.nih.gov/pubmed/8749999

(85) Fountoulakis KN, Samara M, Siapera M, Iacovides A. Tardive Tourette-like


syndrome: a systematic review. Int Clin Psychopharmacol. 2011 Sep;26(5):237-42.
http://www.ncbi.nlm.nih.gov/pubmed/21811171

(86) Tourette's syndrome – Symptoms. NHS Choices


http://www.nhs.uk/Conditions/Tourette-syndrome/Pages/Symptoms.aspx

62
(87) TS Parents Online. Coprolalia, Part 1: The Nature of Coprolalia
http://www.njcts.org/tsparents/coprolalia-part-1-the-nature-of-coprolalia

(88) Clarke C. and Evans J., Successful Non-Neuroleptic Treatments for “Schizophrenia”
http://www.neuroleptic-awareness.co.uk/?download=Successful%20non-
neuroleptic%20treatments%20for%20Schizophrenia.pdf

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Contributors:
Catherine Clarke SRN, SCM, MSSCH, MBChA
Jan Evans MCSP. Grad Dip Phys

November 2011
Revised March 2015

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