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Am J Psychiatry 1991; 148:1322-1328
Copyright © 1991 by American Psychiatric Association
Neuroleptic use, parkinsonian symptoms, tardive dyskinesia, and associated factors in child and adolescent psychiatric patients
MA Richardson, G Haugland and TJ Craig
Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962.
OBJECTIVE: The authors' goal was to determine the prevalence of and risk
factors for neuroleptic-induced movement disorders in a group of
psychiatrically hospitalized children and adolescents. METHOD: They
evaluated the presence or absence of parkinsonism, tardive dyskinesia, and
akathisia in 104 children and adolescents who were in residence in or
admitted over a 6-month period to a state-operated child psychiatric
center. They applied a standardized, structured assessment procedure used
in research on adult and geriatric psychiatric patients and the mentally
retarded. RESULTS: The prevalence of parkinsonism among the 61 subjects at
risk was 34% and was significantly associated with longer neuroleptic
treatment periods immediately before evaluation. The prevalence of
treatment-emergent tardive dyskinesia among the 41 subjects at risk was 12%
and showed no association with quantitative neuroleptic treatment
variables. However, patients with tardive dyskinesia were significantly
more likely to have a family history of mental illness and significantly
less likely to have a history of assaultive behavior. A pattern of complex
pharmacological responses for parkinsonism and tardive dyskinesia, some of
which are not typical of those most commonly reported in adults, was seen
in this group of young patients. CONCLUSIONS: The study data highlight the
acute sensitivity of the neuroleptic-treated child and adolescent to the
development of parkinsonism, the possible role of certain patient
characteristics in the vulnerability to develop tardive dyskinesia, and the
possibility that neuroleptic-induced side effects experienced by children
and adolescents differ in some ways from those experienced by adults. The
data further strongly support the need for systematic monitoring of
neuroleptic-treated child and adolescent patients for a full range of side
effects.
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