Persistent neuroleptic-induced parkinsonism (NIP) is thought to be a major reason for patient noncompliance, subsequent relapse and rehospitalization. Previous studies have not elucidated the potential risk factors associated with persistent NIP. The main goal of this revised project is to evaluate the role of pre-existing extrapyramidal motor abnormalities in the development of acute and persistent NIP. The specific objectives of this prospective study are to address the following theoretical and clinically relevant questions: Do patients who exhibit extrapyramidal motor signs such as tremor, rigidity and bradykinesia prior to the initiation of neuroleptic treatment show a greater neuroleptic effect of the medication than patients who do not exhibit pre-treatment extrapyramidal system disturbances? What clinical and motor behavior factors observed two weeks following initiation of treatment predict persistent NIP when measured 16 weeks following treatment? There is evidence to suggest that schizophrenic patients exhibit motor abnormalities associated with disturbances of the basal ganglia. These extrapyramidal disturbances have been demonstrated in never-treated patients using sensitive laboratory-based procedures. Thus electromechanical procedures for the study of tremor, rigidity and bradykinesia will be used to evaluate patients prior to and for 16 weeks following the initiation of neuroleptic treatment. Early identification of patients at risk for persistent NIP has important medicolegal implications, specifically with respect to informed consent. Over the long term, quantitative studies of neuroleptic-induced extrapyramidal motor effects will contribute to more rationale, objective decisions regarding the use of prophylactic anticholinergic therapy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29MH045959-03
Application #
3475393
Study Section
Psychopathology and Clinical Biology Research Review Committee (PCB)
Project Start
1991-04-01
Project End
1996-03-31
Budget Start
1993-04-01
Budget End
1994-03-31
Support Year
3
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of California San Diego
Department
Type
Schools of Medicine
DUNS #
077758407
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Caligiuri, M P; Rockwell, E; Jeste, D V (1998) Extrapyramidal side effects in patients with Alzheimer's disease treated with low-dose neuroleptic medication. Am J Geriatr Psychiatry 6:75-82
Caligiuri, M P; Lohr, J B (1997) Instrumental motor predictors of neuroleptic-induced parkinsonism in newly medicated schizophrenia patients. J Neuropsychiatry Clin Neurosci 9:562-7
Lohr, J B; Caligiuri, M P (1997) Lateralized hemispheric dysfunction in the major psychotic disorders: historical perspectives and findings from a study of motor asymmetry in older patients. Schizophr Res 27:191-8
Lohr, J B; Caligiuri, M P (1996) A double-blind placebo-controlled study of vitamin E treatment of tardive dyskinesia. J Clin Psychiatry 57:167-73
Lohr, J B; Caligiuri, M P (1995) Motor asymmetry, a neurobiologic abnormality in the major psychoses. Psychiatry Res 57:279-82
Caligiuri, M P; Lohr, J B; Vaughan, R M et al. (1995) Fluctuation of tardive dyskinesia. Biol Psychiatry 38:336-9
Caligiuri, M P (1994) Portable device for quantifying parkinsonian wrist rigidity. Mov Disord 9:57-63
Caligiuri, M P; Lohr, J B (1994) A disturbance in the control of muscle force in neuroleptic-naive schizophrenic patients. Biol Psychiatry 35:104-11
Caligiuri, M P; Lohr, J B; Jeste, D V (1993) Parkinsonism in neuroleptic-naive schizophrenic patients. Am J Psychiatry 150:1343-8
Caligiuri, M P; Lohr, J B (1993) Worsening of postural tremor in patients with levodopa-induced dyskinesia: a quantitative analysis. Clin Neuropharmacol 16:244-50

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