Magazine article Clinical Psychiatry News

Vitamin E for Tardive Dyskinesia

Magazine article Clinical Psychiatry News

Vitamin E for Tardive Dyskinesia

Article excerpt

The Patient

You have two patients diagnosed with schizophrenia. Both have been treated with typical and atypical antipsychotics for years. You routinely administer the Abnormal Involuntary Movement Scale and discover that one of your patients has developed tardive dyskinesia. You consider prescribing vitamin E to both patients.

The Question

Does vitamin E provide protection against the development of tardive dyskinesia and/or actually treat TD in schizophrenic patients treated with antipsychotics?

The Analysis

We performed a PubMed search for "tardive dyskinesia AND vitamin E." Good fortune was on our side as the search revealed a review from the Cochrane Database of Systematic Reviews titled "Vitamin E for neuroleptic-induced tardive dyskinesia" that was completed Sept. 24, 2003. (Abstracts from the Cochrane Library can be found at www.cochrane.org).

The Evidence

TD is a neurologic syndrome characterized by repetitive, involuntary, and purposeless movements that can cause considerable social and medical disability. Overall prevalence is 15%-25% of patients treated with antipsychotics; every year, 4%-5% of those continuing on antipsychotics may develop TD. Tardive dyskinesia rarely occurs with fewer than 6 months of antipsychotic treatment, but incidence increases sharply after 1 year of treatment.

The cause of TD is often alleged to be dopamine receptor supersensitivity from long-term dopamine receptor blockade. In an alternative theory--the so-called freeradical hypothesis--blocking dopamine receptors with antipsychotics may increase dopamine turnover and lead to the formation of dopamine quinines and hydrogen peroxide (free radicals), which are neurotoxic. In this alternative theory, vitamin E, a free-radical scavenger, could neutralize the free radicals and therefore act as an effective treatment in TD.

For the Cochrane Review, K. V.S. Soares and J.J. McGrath electronically searched Biological Abstracts, EMBASE, LILACS, MEDLINE, PsycLIT, and SCISEARCH, then hand-searched the references of all identified studies and contacted the first author of each included trial.

Studies were included if participants were diagnosed with schizophrenia or other chronic mental illness, were treated with antipsychotics for more than 3 months, developed TD during antipsychotic treatment, were dose stable for at least 1 month, and were randomized. Efficacy of vitamin E treatment was defined as lessening of TD symptoms by 50% or more after at least 6 weeks of treatment. …

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