1/22. buspirone as an antidote to SSRI-induced bruxism in 4 cases.BACKGROUND: One hypothesis to explain selective serotonin reuptake inhibitor (SSRI)-induced bruxism states that SSRIs increase extrapyramidal serotonin levels, thereby inhibiting dopaminergic pathways controlling movement. Previous reports have emphasized buspirone's postsynaptic dopaminergic effect as a partial antidote to the suppressed dopamine levels. case reports: Four patients, recently started on treatment with the SSRI sertraline, presented with new-onset complaints attributable to SSRI-induced bruxism. All 4 responded to adjunctive buspirone, a serotonin-1A (5-HT1A) receptor agonist, with relief of bruxism and associated symptoms. DISCUSSION: We expand the hypothesis put forth in previous reports by proposing that buspirone is not only acting postsynaptically in the extrapyramidal system, but also presynaptically on serotonergic neurons that influence masticatory modulation in the mesocortical tract. Our 4 cases support the concept of buspirone acting as a full agonist at the presynaptic 5-HT1A somatodendritic receptors located on the cell bodies of raphe serotonergic neurons that project to the ventral tegmental area (VTA) of the midbrain. These serotonergic neurons modulate the firing of the mesocortical tract, which itself projects from the VTA to the prefrontal cortex and acts on masticatory muscle activity through inhibiting spontaneous movements such as bruxism. While the literature is confusing and contradictory on definitions of bruxism and etiologies of incompletely understood movement disorders, we believe SSRI-induced bruxism is best conceptualized as a form of akathisia.- - - - - - - - - - ranking = 1keywords = extrapyramidal, muscle (Clic here for more details about this article) |
2/22. Restlessness in suboccipital muscles as a manifestation of akathisia.Antipsychotic-induced akathisia is primarily manifested as restlessness, particularly expressed in the legs. Consequently, rating scales and the research criteria of DSM-IV regard restlessness in the legs as the major sign of akathisia, although it has been suggested that such restlessness may occur in other areas of the body. A case of antipsychotic-induced akathisia is reported where the region of inner restlessness (the subjective component) was identified in posterior cervical muscles. The patient was initially suspected to be experiencing somatic delusions and the dose of antipsychotic medication was increased. This did not improve the symptoms, and upon careful questioning about his head discomfort, the patient acknowledged that he felt an inner restlessness in the suboccipital muscles. The restlessness ceased with intramuscular biperiden and subsequent discontinuation of antipsychotic medication. This case suggests that subjective restlessness may occur in muscle groups that are not usually associated with akathisia. Thus, this report may assist clinicians in the diagnosis of akathisia that could be overlooked or misdiagnosed as somatic delusions or the worsening of the patient's psychosis.- - - - - - - - - - ranking = 9.9297990610486E-5keywords = muscle (Clic here for more details about this article) |
3/22. Quetiapine-Induced extrapyramidal side effects in patients with Parkinson's disease: case report.Although quetiapine is the antipsychotic of choice for the psychosis associated with Parkinson's disease (PD) and often is also helpful for sleep, we report two cases of quetiapine-induced extrapyramidal side effects. The patients described were unusual in their frailty and severity of illness and may not represent the majority of patients with PD.- - - - - - - - - - ranking = 2.4999645364319keywords = extrapyramidal (Clic here for more details about this article) |
4/22. Neuromotor dysfunction in early psychosis.Neuromotor dysfunction, particularly extrapyramidal signs and symptoms (EPSS), plays an important role in the assessment and treatment of patients in the early stages of psychotic disorders such as schizophrenia. By blocking dopamine D2 receptors, antipsychotic medications can produce EPSS, including tardive dyskinesia. EPSS is also observed in a third or more of patients first presenting with a psychotic disorder, prior to initiation of antipsychotic pharmacotherapy. This suggests that abnormalities in neuromotor control may be an integral component of the brain mechanisms associated with psychosis. Atypical antipsychotic agents can alleviate psychosis without inducing EPSS. Preexisting EPSS may be corrected.- - - - - - - - - - ranking = 0.49999290728638keywords = extrapyramidal (Clic here for more details about this article) |
5/22. Akathisia, panic, agoraphobia, and major depression following brief exposure to metoclopramide.Psychiatric complications from nonpsychiatric medications are common. Our understanding of these phenomena is often limited, due to the relative infrequency of their occurrence for individual agents and the complexity of the pharmacological systems involved. This case report presents a patient who developed psychiatric sequelae following the administration of metoclopramide. Akathisia, panic disorder, agoraphobia, and major depressive disorder all developed sequentially after only 2 days of exposure to metoclopramide, leading to months of disability. Dopaminergic blockade was implicated as the precipitating pharmacological event. The pharmacology of benzamides is reviewed, as is the literature concerning benzamide-induced extrapyramidal and psychiatric symptoms. Finally, potential pharmacological mechanisms regarding these complications are discussed, with particular attention to the role of interactions between dopaminergic and serotonergic systems.- - - - - - - - - - ranking = 0.49999290728638keywords = extrapyramidal (Clic here for more details about this article) |
6/22. Akathisia as a side effect of antipsychotic treatment with quetiapine in a patient with Parkinson's disease.Due to its low profile for extrapyramidal side-effects, quetiapine has become an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease (PD). We describe the case of a patient with PD who developed severe akathisia, a common complication with classical antipsychotics, with quetiapine.- - - - - - - - - - ranking = 0.49999290728638keywords = extrapyramidal (Clic here for more details about this article) |
7/22. Distinguishing acute and tardive akathisia by monitoring microvibration: a pilot study.One acute and one tardive akathisia patients, respectively, and 10 neuroleptic-treated schizophrenic patients were injected with biperiden 5 mg or saline and the response to anticholinergics was monitored by microvibration (MV) as an indicator of muscle tonus. These data were subjected to the Fast Fourier Transform and an averaged power spectrum was computed. The biperiden injection markedly reduced the power spectral values of MV in acute akathisia. In contrast with acute akathisia, the biperiden injection significantly increased the power spectral values of MV in tardive akathisia. The subjective feelings of akathisia patients were parallel to the power spectral values of MV. Control patients were not affected by such treatment. The present findings show that the subjective symptoms of akathisia can be well defined by the objective, differential response to anticholinergics in a manner similar to the visible extrapyramidal symptoms (dystonia, dyskinesia) induced by neuroleptics.- - - - - - - - - - ranking = 0.50000709271362keywords = extrapyramidal, muscle (Clic here for more details about this article) |
8/22. Gabapentin in the treatment of antipsychotic-induced akathisia in schizophrenia.Antipsychotic-induced akathisia is characterized by subjective and objective motor restlessness, which is observed as a common extrapyramidal side-effect of antipsychotic agents. A patient is described who had antipsychotic-induced akathisia unresponsive to conventional therapy, and who began gabapentin therapy for insomnia. Significant improvement in his akathisia occurred when the gabapentin dose was increased, and his other treatment for akathisia was decreased and discontinued. Gabapentin may be effective by mechanisms similar to its action in restless legs syndrome and Parkinsonism, and/or via the GABA neurotransmitter system.- - - - - - - - - - ranking = 0.49999290728638keywords = extrapyramidal (Clic here for more details about this article) |
9/22. Acute akathisia associated with quetiapine use.Because of their better side-effect profile, atypical antipsychotic agents have replaced conventional antipsychotic agents as the first-line treatment for schizophrenia. Although atypical agents are less likely to be associated with extrapyramidal symptoms, such symptoms sometimes do occur in patients treated with atypical agents. The authors report the cases of two patients who developed akathisia after treatment with quetiapine for insomnia, consider previously reported cases of akathisia induced by atypical antipsychotic agents, discuss other medications that can induce similar symptoms, discuss treatments for akathisia, and examine issues in the use of quetiapine as a soporific agent.- - - - - - - - - - ranking = 0.49999290728638keywords = extrapyramidal (Clic here for more details about this article) |
10/22. Extrapyramidal side effects of antiemetics presenting as psychiatric illness.Although extrapyramidal side effects of two commonly used antiemetics, metoclopramide and prochlorperazine, are well known, it may be difficult for even the experienced practitioner to distinguish some of these extrapyramidal reactions from such psychiatric symptoms as anxiety, depression, or catatonia. Certain patient groups have increased susceptibility to these extrapyramidal reactions, including patients under 30, those with AIDS, those with renal disease, oncology patients, and possibly women. physicians should maintain a high index of suspicion for depression, anxiety, or catatonia if their patients are taking antiemetics. These symptoms may be extrapyramidal side effects of the antiemetic rather than indications of a primary mental disorder.- - - - - - - - - - ranking = 1.9999716291455keywords = extrapyramidal (Clic here for more details about this article) |
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