Parkinsonism

One-third of all children and adolescents treated with antipsychotic drugs in a New York psychiatric hospital developed symptoms of parkinsonism--mainly muscular rigidity and slowed movements -that interfered with daily activities and of ten persisted for weeks or months after antipsychotic use stopped, researchers report in the October AMERICAN JOURNAL OF PSYCHIATRY.

The findings, which have broad implications for treating psychiatrically disturbed youngsters, "demonstrate no easy solutions, but rather a serious, complex and troublesome phenomenon that demands monitoring by the clinician and more attention from the research community," conclude the investigators, led by psychologist Mary Ann Richardson of the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, N.Y.

In contrast, about one in eight children and teens in the study who had taken antipsychotic drugs also known as neuroleptics) for at least three months developed tardive dyskinesia, a condition marked by rapid, involuntary twitching or jerking of the mouth, lips, tongue or body One-quarter of adults who take antipsychotic drugs develop tardive dyskinesia (SN: 5/11/91, p.293).

Mental health clinicians tend to underestimate a variety of antipsychotic-induced movement disorders, maintains psychiatrist C. Thomas Gualtieri of the University of North Carolina at Chapel Hill. Further studies must establish whether youngsters receiving these drugs consistently prove more likely to develop parkinsonian symptoms than tardive dyskinesia, he says. "But this new study suggests that neuroleptics are still being prescribed for childhood disorders, such as conduct disorder, for which they have no legitimate medical use," he asserts.

Conduct disorder involves persistent stealing, fighting and other violent behavior.

Evidence of widespread prescription of neuroleptics to control aggressive and violent behavior among U.S. children with a variety of diagnoses, such as mental retardation and autism, turned up in the early 1980s, although this practice has since declined, Gualtieri notes.

Richardson's team studied 104 youngsters, averaging 15 years old, living in or admitted to a state-operated child psychiatric center in New York during a six-month period. The patients' psychiatric diagnoses ran the gamut, including conduct disorder, schizophrenia, severe depression, drug abuse and hyperactivity

Of 61 youngsters who received neuroleptics upon entering the study 21 displayed clear and often "striking" parkinsonian symptoms, Richardson says. Those with longer histories of antipsychotic treatment developed the most severe rigidity and slowed movement. Of 11 neuroleptic-treated children who took specific drugs to quell those symptoms, three nevertheless exhibited parkinsonism. In five of the 21 with parkinsonism, symptoms persisted for several weeks or months after neuroleptic treatment ceased.

Several troubling trends stand out, Richardson contends. First, schizophrenia and other severe disorders considered the prime candidates for neuroleptic treatment accounted for only slightly more than one-quarter of the diagnoses among youngsters receiving the drugs. Second, staff clinicians rarely looked for parkinsonian symptoms, although the severity of symptoms in some children interfered with running, swimming and other activities. Moreover, children felt that these symptoms made them "zombie-like," increasing the chance that they would discontinue neuroleptic use when they started outpatient treatment.

Clinicians did not dispense neuroleptics in a "cavalier manner" or use them as chemical straitjackets, Richardson asserts. Still, the specificity of these drugs for particular psychiatric symptoms remains very primitive," she says, and it's all a crap shoot" when physicians decide which antipsychotics to prescribe for children with severe mental disorders.

The new study underscores the need to pay special attention to parkinsonian symptoms among youths receiving neuroleptics, she says. "Clinicians are in a bind," she adds. "Drugs that treat parkinsonian symptoms can cause cognitive problems and interfere with school performance."

COPYRIGHT 1991 Science Service, Inc.
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