lactic role of antiparkinson drugs in a prospective manner. In nddition. the relative metits of conventional anticholinergic drugs versus antihislamtnic agents (e.p ...
108
A Pilot Study of the Role of Prophylactic Antiparkiiisoii Treatment During Neuroleptic Therapy A . Perirtyi^. U. Goswar)}/^. E . Frecxka^, F.\7ier
, G, B arest A. Kaamy-Farknx^
’ National In stitiiltro r N m o iis and M potal (Ji>!eases, nndaprsl, Hungary ^ Dftpanmcnl o f Psychiatry, Jaw aharlal Institute of Poslgraduat? M edical Education and Reseatcl), Ptindiclierry, India, and Visiting Eellow oflhe InlcmatiDnal Brain Research O rg a n ia a tio n flB R O / U N E S C O ). Hungary
Summary
rilotsludic iibcr die Rulle det itropbylnktisehen ArHparkinstitibehflitdlung bel der neuroleptlSeheit Theraple
The authors adminiflered tialoperidol 4.5 mg t.i.d. k) .1.1 tlrug-frce schizophrenic pafienls. Ten patients did * not receive anything else (group H P L ), whife ten patienls re 33 unbehandellett Schizoptirenen wiirde 4.5 ceived procyclidine 5 tng t.t.d., and 11 patients were given mg Haloperidol 3ma) taglich verabreicht. Zehn Patienten erpTomethaz:iite2; rng I.i.d,(groups M P R C and H P R ^ f respechiclten nur das Ncurnleptiknm (Gnippe f IP L ), ItJ aiiBerdem lively) in addition. Seven patients dropped out of Ihe H P L 5 mg Procyclidine 3inal taphch (G iuppe H P R C ), tind 13 Pagmijp and three ou( of the H P R M group, hut none rrul of the ticnten hekamcn Haloperidol iind 35 ing Promethazin 3ma1 MF’R f ' group. These drop outs were due to the development taglich (G nippe H P R M ) , Siebeii Patienten derGtttppe H P L of early estrapyrarnidal side elTecIs, which were ahsent in the iind 3 der Gruppc H P R M sind ivegen Priiherscheinung exH P R f ' group. The findings suggest that antiparkinson pro Irapyramidaler Nebcnwirkutigen ansgeschieden. Rei ketphylaxis is useful during commencement of therapy with iieni der Patienten der G tuppe H P R C warden diesc Nehenhiph-pDtency netirolcplic agents. wirkiingcn beobachtet. Die Prgcbliisse wciscn darauf hin, daM die Antiparkinson-Prophylaxe sicH bet Beginn einer Medikalion mit fioclipoteiilcti Ncuroleptika gut bewahrt.
intrud iicUon In recent years, several authors have drawn alfeniton to the problem of noncomplimice with tieuroleplic drtigs in schizophrenic patients due to the development of un pleasant e.xlrapyraniidai .side effectj: (f.P S ) (F f f ’tti et a f. I98f); vail Puiten. 1974; van Piirreft et al., 1984), In this context, the issue of prophylactic anitparkinson treatment is currently a reciueigent topic of enquiry. The prophylactic efficacy of commoTily prescribed antiparkinson agents has remained a highly cniitroversial topic in psychopharmacotogy, and their routine nthntnistralion al the initiation of neuiolcplic therapy has been debated (BalAesvarfnf, I9RI); lln llh ifr, 1980; A/ciiietal., lOftO) "White some investigators conclude that aiili-EP.S pro phylaxis isunneces.saryt Dmrcr.tcmand DpiFi(gr7an, 197t>; EwcH ct al., 1977), others suggest the opposite {Oitotf et a ! , 1974; /{(in ln iiel al.. I9d(i: ffccperjel al., 1983; S!re» and yfrtdfcson, 1979) Ih f present study was designed to evaluate the prophy lactic role o f antiparkinson drugs in a prospective manner. In nddition. the relative metits of conventional anticholinergic drugs versus antihislamtnic agents (e.p promethazine) were asscsscrf Tlte latter tend to he widely used for iienroleptic-ind u e e r in ^ .a t least in Hungary ( Gardoj el id,, I9B0; Pcrcnyiel nf. lus.i).
rbnr-mcrip.^icbiai, 2)(19P9) H)p_ | m f rieSS 9. R IVRS
FftaiTttacopsycliiuL 22 ( 1989} 109
A PihlSiudyn/ihe Ro!eo/ProphyIaakAnlrpark!rixon_ IfT R C &n;t H T R M groups addilionatly received procvdidine S mg. l i d and prnmclbfiiriiie 25 mg. td.d., respectivdy, for the same f«riod. Initially, it wa.s planned to include ten paliems in each group. witK a provirmn 10 replace those who dropped titit, if any, with new patients. F'atirnts were eidrided if they developed incapncilaling Okatlii,S!a ancf/or p.arltinson symplnnis or if they received a seorcof four on nny two of the first five suhscales of the T A K E or had two dystonic reac tions in a 2^-hour period. All the patients were rated by the same per son ill a blind manner. Rating.s were obtained at the baseline (t?ny 0), and thereafler one a weett for the corsenjtive four weeks. Statistical analysis was carried out using one way analysis of variance (A N O V A ) itr tom part the ovetage Hge ii) the three treatment groups, The Friedrnan lest was used for the analysis of cbnnges on the T A K E and B P R S , followed by the Wilcmton Rank liiini test as a post-hoc procedure whenever a significarl HilTeienre was found in the former exercise, Chi square was done to compare the dropout rales belween the groups with and without anliparkinson prophylaxK.
'
t
RcsulLs The clinical ctiaracterislics of the three treat ment groups are given in Ihb le I . The groups did not difTer significnntly with respcd to age or sex disturbalton. White none of (he subjeclK dropped out of the M PRC group, there were three dropniitsin tlie H P R M group. In keeping with the initial policy they were replaced with new patients, hence the 13 patients in IIR R M shown in Table I. Seven patients dropped out of the H P T group, leaving nnly three who could tolerate haioperidol without any prophylactic drugs. f>iie to ethical considcralions, and alst) because this dropout dala was itnporlanl in itself, these patients were not replaced with new patients, as was planned originally. Therefore, there are only ten patients in this group in Table 1. Significantly more patients dropped nut of the t IP L group than out of the groups on antiparkinsort prophylaxis, H PRC , and H P R M . Since the sire of the H P L group decreased significantly, data from this
Table 1 Mean age SO and male female ratio in the three experinnenlal groups HFFtM, H PR C , Snd HP1.
Groups
Mean Age
M als-Fem ale
R atio u rn M tim e H rf
13* 10 10_____ ^
39.7 ± 0.17 30.9 ± 10.07 38.9±14.e
10:3 7:3 7:3
* For further explanation a ee the results section
group were not subjected to fuither statistical analysis. Thus, a total of ten patients dropped out of the study-three from IIT R M and seven from H PT. In this sludy, while only one patient was excluded because of scores on T A K E , nine patients were excluded becau.se of disabling E P S : evidently the side-efTeciswete very unpleasant. Table 2 shows the total scoies on the Ti PR S and on the first five of the subscales of the T A K E for the two treattnent groups receiving prophylactic antiparkinson therapy (H P R M and M PRT). Ih e re are ten patients in each group hecause the three dropouts in the H P R M group were excluded from the analysis. In Ihe T A K E , no significant dianges could be observed in either of the patient groups in any of the first five items. This may simply indicate ihat the subjecls wlio completed the four-week sludy period did not develop any severe E P S , which was expected. Computation of the bascltne B P R S data and those from the fnllowitig four weeks show (hat both IIP R C and H P R M groups improved significantly. It is w'ofth noting that a significant drop in the B P R S occurred ear lier in the ItP R C group (week t> than in the H P R M group (week 2). Ulscnsslun The most ittiporlanl finrling oftliis.study is that significantly more patients dropped out of the group receiving no antiparkiusoii prophylaxis than cut of the olhet two groups taken together. H ie rate at which the patients dropped out r>f the H P L group(70"/i)seenis high, htil these data agree with the findings of KetTierjetal, (I9S3J, who reported that, of patients receiving no anti-EPS prophylaxis, ^ simiiar proportion developed early E PS. Recently, Mntrmnn et a!, (1986) and HTnifowet al. (I9&6) alstv found that prophylactic aniiparkin son treatment was useful. Iri this context, the authors would like to stress that the results may he valid for this dosage regi men only: for example, 7af
