Mental Health Clinician Volume 1: Issue 7

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Recognizing movement disorders: Reviving old practices

PharmD, BCPP

Movement disorders have many different presentations and are defined as a group of syndromes that affect the ability for one to control movement in a given muscle or muscle group. Many of the medications we use to treat psychiatric illness (antipsychotics, lithium, and valproic acid) have the potential to cause movement disorders, often referred to as extrapyramidal side effects, though predictability is lacking. Antipsychotic-induced dopamine blockade can lead to acute dystonia, akathisia, and Parkinsonism, all of which are generally reversible if treatment is discontinued. A neuroleptic-induced movement disorder that may be irreversible is tardive dyskinesia. Both lithium and valproic acid

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Movement disorder toolbox

PharmD, BCPP

DOI: 10.9740/mhc.n91443

This toolbox starting on the next page includes several helpful documents regarding drug-induced movement disorders. A sample assessment policy is available as well as a handy reference chart. Sample assessment forms are available.

This toolbox will assist you in setting up a monitoring process for assessment of antipsychotic-induced movement disorders. Figure 1 is an example of a monitoring policy intended as a guide for frequency of monitoring patients. See the table below for links to examples of monitoring forms that are publicly available.

Figure 1.Example Monitoring Policy

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Lastly, Table 2

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CPNP-developed DVD on drug-induced movement disorders rating scales launches in early March

PharmD, BCPP

DOI: 10.9740/mhc.n90216

The new CPNP DVD covering Drug-Induced Movement Disorders: A Clinical Guide to Rating Scales is now available for advance purchase and delivery in early March. This article reviews the inspiration for its inception and describes how this DVD will both improve your assessment skills and serve as a crucial resource for teaching other professionals in assessing medication-induced movement disorders. The featured rating scales include the Dyskinesia Identification Scale: Condensed Users Scale, Abnormal Involuntary Movement Scale, Simpson Angus Scale, and the Barnes Akathisia Rating Scale.

The initial need for quality movement disorder training tools was identified here at the Center for

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The clinician's role in assessing for drug-induced movement disorders: Practices at a forensic psychiatric hospital

DOI: 10.9740/mhc.n91688

Here is one practitioner's perspective on movement disorder assessment. Read about his experience with assessing movement disorders, particularly tardive dyskinesia.

HOW OFTEN DO YOU ASSESS A PATIENT FOR A DRUG-INDUCED MOVEMENT DISORDER?

I work at a forensic psychiatric hospital where many of our patients are on multiple medications that can increase their risk of having drug-induced movement disorders. The rating scale that we use at Fulton to assess for these movement disorders is the Abnormal Involuntary Movement Scale (AIMS), which will be the primary rating scale discussed throughout this interview. All of our patients receive a baseline assessment with the

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Applied monitoring for tardive dyskinesia and other extrapyramidal side effects

M.Ed.

DOI: 10.9740/mhc.n92483

While the rate of tardive dyskinesia (TD) and other extrapyramidal side effects (EPSE) is lower with second generation antipsychotic medications compared to first generation antipsychotic medications, these side effects remain of clinical concern. This paper reviews the basis for the continued concern and the importance of secondary prevention, or early detection, within the primary-secondary-tertiary prevention model. The importance of standardized assessment instruments, education, and training is reviewed. Given the widespread use of antipsychotic drugs, the fact that antipsychotic drugs are the standard of care for several psychiatric conditions (with little indication that the magic bullet is on the immediate horizon to replace current antipsychotic drugs) applied monitoring and the early detection of TD and EPSE takes on added importance.

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Are extrapyramidal symptoms less recognized? Case report of modern practitioners' unfamiliarity with first generation antipsychotics

PharmD, BCPP

DOI: 10.9740/mhc.n91689

A case is presented where initial suspicion of lithium toxicity was mistaken. Drug-induced Parkinsonism and tardive dyskinesia were present, underscoring the need to improve training of movement disorder assessment.

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Drug-induced movement disorders

PharmD, FCCP, BCPS, CGP

DOI: 10.9740/mhc.n90206

This comprehensive review covers approaches for both the recognition and management of drug-induced movement disorders. Pharmacotherapeutic approaches for treating akathisia, dystonia, Parkinsonism and tardive dyskinesia are explored. The importance of early detection via periodic assessment is discussed.

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Lithium and valproate-induced tremors

PharmD,

PharmD Candidate, and

PharmD, BCPP

DOI: 10.9740/mhc.n92093

Lithium and valproate are mood stabilizers known to cause tremor. This article concisely addresses etiological questions, expected time frame of tremor onset, and treatment options for this medication-induced side effect. Along with dosage modifications of the tremor-inducing medication, authors review evidence from small trials of adjunctive treatment modalities.

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Professional involvement and activism no longer a luxury, it is a must

PharmD, MS, BCPP

DOI: 10.9740/mhc.n91779

As we move bravely forward into 2012, critical professional opportunities abound for psychiatric and neurologic pharmacists, and the pace of change appears to be quickening. CPNP is committed, in 2012 as in years past, to providing a platform for you to become engaged and to have a voice, not only in what is going on within CPNP, but at a national level as healthcare reform implementation proceeds. No longer is professional involvement and activism considered by thought leaders to be a luxury, or simply the duty of elected leadership. Rather, as the American Society of Health-System Pharmacists recently stated in

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CPNP Announcements

DOI: 10.9740/mhc.n90346

IS THERE A RATIONAL MANAGEMENT STRATEGY FOR TARDIVE DYSKINESIA?

The authors of “Is there a rational management strategy for tardive dyskinesia” emphasize the importance of preventing tardive dyskinesia via conservative dosing and routine movement disorder assessment. They also propose a management treatment algorithm for treatment of confirmed tardive dyskinesia.

A reminder that a special subscription price is available to Current Psychiatry, a monthly peer-reviewed publication, and the leading source of practical, evidence-based information for healthcare professionals treating psychiatric patients. Thanks to the CPNP partnership with Current Psychiatry, CPNP members can receive a

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Recognizing movement disorders: Reviving old practices

Movement disorder toolbox

CPNP-developed DVD on drug-induced movement disorders rating scales launches in early March

The clinician's role in assessing for drug-induced movement disorders: Practices at a forensic psychiatric hospital

HOW OFTEN DO YOU ASSESS A PATIENT FOR A DRUG-INDUCED MOVEMENT DISORDER?

Applied monitoring for tardive dyskinesia and other extrapyramidal side effects

Are extrapyramidal symptoms less recognized? Case report of modern practitioners' unfamiliarity with first generation antipsychotics

Drug-induced movement disorders

Lithium and valproate-induced tremors

Professional involvement and activism no longer a luxury, it is a must

CPNP Announcements

IS THERE A RATIONAL MANAGEMENT STRATEGY FOR TARDIVE DYSKINESIA?

Pharmacist administration of long-acting injectable medications for substance use disorders: A scoping review

Transitions of care: Assessment of adherence to long-acting injectable antipsychotic treatment following discharge from inpatient psychiatry

Use of atypical antipsychotics in individuals with anorexia nervosa

Potential changes impacting psychiatric pharmacy by 2030

A model for timely dissemination of critical information: Clozapine toxicity during the COVID pandemic