Neuroleptics are among the most widely prescribed psychotropic drugs. But these drugs are also associated with troublesome adverse effects, of which movement disorders are probably the most serious ones in terms of frequency, persistence, and overall impact on the well-being of patients and caregivers. Neuroleptic-induced movement disorders include extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). These side effect tend to be much more common and also more problematic in older than in younger patients. The newer atypical antipsychotic drugs have a lower risk of EPS and probably of TD. Nonetheless, the atypical antipsycotics are not entirely free of the risk of inducing movement disorders. Furthermore, the newer antipsychotics are considerably more expensive than the typical ones- an increasingly important consideration in these days of managed care. Our studies to date have shown that a majority of psychiatric patients over age 45 treated with conventional neuroleptics, even at low dosages, develop acute EPS. The cumulative annual incidence of TD in this population is 29%, which is six times greater than that reported in younger adults. However, the risk of EPS and TD with the atypical agents has not been documented in longitudinal research, especially that involving older patients, and done primarily without pharmaceutical industry support. We propose to study the incidence of and risk factors (including instrumentally detected motor abnormalities and neuropsychological deficits) for EPS and TD associated with the three most commonly used atypical antipsychotics (risperidone, olanzapine, and quetiapine) among middle-aged and elderly psychiatric patients. Additionally, we propose to examine the potentially positive influence of the three atypical agents on pre- existing neuroleptic- induced TD. Finally, we will explore the impact of movement disorders on everyday functioning and quality of life. We believe that our findings will have major therapeutic implications for the use of antipsychotics, particularly in older patients.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH059101-02
Application #
6186295
Study Section
Mental Disorders of Aging Review Committee (MDA)
Program Officer
Olin, Jason T
Project Start
1999-09-15
Project End
2004-05-31
Budget Start
2000-06-01
Budget End
2001-05-31
Support Year
2
Fiscal Year
2000
Total Cost
$602,868
Indirect Cost
Name
Veterans Medical Research Fdn/San Diego
Department
Type
DUNS #
933863508
City
San Diego
State
CA
Country
United States
Zip Code
92161
Reichstadt, Jennifer; Sengupta, Geetika; Depp, Colin A et al. (2010) Older adults' perspectives on successful aging: qualitative interviews. Am J Geriatr Psychiatry 18:567-75
Depp, Colin A; Savla, Gauri N; Moore, David J et al. (2008) Short-term course of neuropsychological abilities in middle-aged and older adults with bipolar disorder. Bipolar Disord 10:684-90
Lamond, Amanda J; Depp, Colin A; Allison, Matthew et al. (2008) Measurement and predictors of resilience among community-dwelling older women. J Psychiatr Res 43:148-54
Jeste, Dilip V; Dunn, Laura B; Folsom, David P et al. (2008) Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials. J Psychiatr Res 42:1-21
Bucardo, Jesus A; Patterson, Thomas L; Jeste, Dilip V (2008) Cultural formulation with attention to language and cultural dynamics in a mexican psychiatric patient treated in San Diego, California. Cult Med Psychiatry 32:102-21
Depp, Colin; Lebowitz, Barry D (2007) Clinical trials: bridging the gap between efficacy and effectiveness. Int Rev Psychiatry 19:531-9
Depp, Colin A; Lebowitz, Barry D; Patterson, Thomas L et al. (2007) Medication adherence skills training for middle-aged and elderly adults with bipolar disorder: development and pilot study. Bipolar Disord 9:636-45
Moore, David J; Palmer, Barton W; Patterson, Thomas L et al. (2007) A review of performance-based measures of functional living skills. J Psychiatr Res 41:97-118
Reichstadt, Jennifer; Depp, Colin A; Palinkas, Lawrence A et al. (2007) Building blocks of successful aging: a focus group study of older adults'perceived contributors to successful aging. Am J Geriatr Psychiatry 15:194-201
Depp, Colin A; Moore, David J; Sitzer, David et al. (2007) Neurocognitive impairment in middle-aged and older adults with bipolar disorder: comparison to schizophrenia and normal comparison subjects. J Affect Disord 101:201-9

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