Neuroleptic Advers Reaction
Neuroleptic Advers Reaction
Neuroleptic Advers Reaction
1
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
2
Contents continued…
3
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
5
Adverse Drug Reactions and Side Effects
6
Neuroleptics and Neurotransmitters
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.
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
9
Tardive Dyskinesia (TD)
10
Tardive Dyskinesia (TD)
11
Less Well Known Tardive Dyskinesia Symptoms
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
13
Anti-Cholinergic Adverse Drug Reactions
14
Tardive Dystonia
15
Oculogyric Crisis
16
Associated Dystonic Symptoms with Oculogyric Crisis
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
18
Akathesia
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.
20
Endocrine Disorders Caused by Neuroleptic Dopamine
Disruption
Metabolic Syndrome
Sexual Dysfunctions
Osteoporosis
Thyroid Disorders
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
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)
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
31
Respiratory Disease
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
35
Brain Damage Associated with Poor Outcomes
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
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
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.
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
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
(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
(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
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
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
(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.
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.
(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
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
(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
(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)
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
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
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
63
Contributors:
Catherine Clarke SRN, SCM, MSSCH, MBChA
Jan Evans MCSP. Grad Dip Phys
November 2011
Revised March 2015
64
65