generate barcode c# .net Writer s Cramp, Musician s Spasm, and Other So-Called Occupational Dystonias in Microsoft Office

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Writer s Cramp, Musician s Spasm, and Other So-Called Occupational Dystonias
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So-called occupational cramps or spasms should be mentioned here, since the prevailing opinion is that they are restricted or focal
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Drug-Induced Tardive Dyskinesias
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(See also Chap 43) As already mentioned, dyskinesia is a broadly encompassing term that is applied to all involuntary movements taking the forms of dystonia, chorea, athetosis, and tremor When modi ed by the ad-
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TREMOR, MYOCLONUS, FOCAL DYSTONIAS, AND TICS
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jective tardive, it refers speci cally to movements induced by the use of antipsychotic drugs, usually phenothiazines, that persist after the drugs are withdrawn The movements are intermittent or persistent and not subject to the will of the patient The facial, lingual, eyelid, and bulbar muscles are most often involved, but neck, shoulder, and spine muscles with arching of the back may be implicated in individual cases In particular, tardive dyskinesia has come to refer to striking repetitive, stereotyped, almost rhythmic mouth and tongue movements that follow exposure to an offending drug and that, once established, persists for months or years If the drug is discontinued immediately after the movements appear, the problem may not persist There may be added blepharospasm and truncal, hand, or neck movements and akathisia of the legs, but these are not nearly so prominent as the orofacial and lingual dyskinesias The problem is easily recognized and familiar to all physicians who treat psychiatric patients Oromandibular spasm and blepharospasm (Meige syndrome) and Huntington disease may cause dif culty in diagnosis In addition to the well-known phenothiazine drugs, less familiar ones such as metoclopramide, pimozide, amoxapine, and clebopride, some of which are used for disorders other than psychosis, and newer agents such as risperidone may also be the cause Longer exposure is more likely to cause the movements There are a number of other drug-induced tardive movement syndromes, mainly varieties of dystonias, some of which have been mentioned earlier, and akathisia (see further on) Often they begin focally in the neck and spread over time to the limbs One highly characteristic pattern combines retrocollis, backwards arching of the trunk, internal rotation of the arms, extension of the elbows, and exion of the wrists simulating a decerebrate posture A few patients have both orofacial and cervical dyskinesias Many patients report that the dystonia abates during walking and other activities, quite unlike idiopathic torsion dystonia In current thinking, these drug-induced dyskinesias are viewed as the result of changes in the concentration of dopamine receptors, ve of which are currently known, as discussed in Chap 4 Blockade and subsequent unmasking of the D2 receptor has been speci cally linked to the development of the tardive syndromes Treatment With reference to therapy, little has been found to be consistently effective If the movements follow withdrawal of one of the offending drugs, reinstitution of the medication in small doses often reduces the dyskinesias but has the undesired side effects of causing parkinsonism and drowsiness For this reason most clinicians who are experienced in this eld have tended to avoid using these drugs if possible The movements lessen over a period of months or years and mild cases abate on their own or leave little residual effect; rarely have the symptoms worsened Some of the newer atypical antipsychotic drugs (clozapine, quetiapine, etc) are reported to be helpful in a few cases and are favored as an initial treatment, particularly if persistent psychosis requires continued drug therapy Their effect is believed to be the result of slight blocking of D2 activity Dopamine and noradrenergic-depleting drugs such as reserpine and tetrabenazine have also been as successful if used carefully, but the more effective of the two, tetrabenazine, is dif cult to obtain in the United States The dystonias also respond to anticholinergic drugs (trihexyphenidyl 25 mg once or twice daily, increased by small increments weekly up to 125 mg) if high enough doses can be tolerated Further discussion of the side effects of the antipsychcosis drugs can be found on page 1327
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