Psychopharmacology for the Clinician
The information in this column is not intended as a definitive treatment strategy but as a suggested approach for clinicians treating patientswith similar histories. Individual cases may vary and should be evaluated carefully before treatment is provided. The patient described in thiscolumn is a composite with characteristics of several real patients. Off-label antipsychotic use and tardive
dyskinesia in at-risk popu lations: new
drugs with old side effects
over the years, with limited response.
anxiety, led to an antipsychotic trial.
in off-label antipsychotic use across all age groups,1–5 perhaps reflecting their reputation. In addition, the field is sanc- fect. In the second year of treatment, he were initially attributed to on going den- with the atypical antipsychotics,9–11 all tients, 2 populations particularly sensi- part of our clinical decision-making.
Gary Remington, MD, PhD
Margaret Hahn, MD, PhD

abuse, race, sex and genetics.11–15 There Centre for Addiction and Mental Health and to schizophrenia itself.16–19 Studies Competing interests: Both authors declare
also declares consulting fees from Roche, chroneron and grants from Neurocrine andMedicure.
ments (i.e., localized, perioral). Within Psychopharmacology for the Clinician columns are usually based on a case report that illustrates a point of interest in clinical psychopharma-cology. They are about 650 words long. Columns can include a bibliography which will be available only onthe journal website. J Psychiatry Neurosci 2014;39(1)
Off-label antipsychotic use and tardive dyskinesia ment. Int Rev Neurobiol 2011;98:187-210.
a systematic review of 1-year studies.
Am J Psychiatry 2004;161:414-25.
schizophrenia: relationship of ‘tardive’ A, et al. Increasing off-label use of an- nesia and new antipsychotics. Curr Opin and negative symptoms. Br J Psychiatry States, 1995-2008. Pharmacoepidemiol Wade JB, Taylor MA, Kasprisin A, et al.
pairment. Biol Psychiatry 1987;22:393-5.
Psychiatr Serv 2008;59:507-14.
editors. Handbook of Clinical Neurology: Hyperkinetic Movement Disorders. New medication use in Australia 2002-2007.
Aust N Z J Psychiatry 2010;44:372-7.
Jeste DV, Caligiuri MP, Paulsen JS, et al.
study. J Clin Psychiatry 2010;71:463-74.
of atypical antipsychotics: cause for con- cern? CNS Drugs 2012;26:383-90.
of 266 outpatients. Arch Gen Psychiatry hyperkinetic movement disorders. Am J Geriatr Pharmacother 2010;8:331-73.
Bhidayasiri R, Fahn S, Weiner WJ, et al.
prevalence and risk factors, 1959 to 1979.
adults with antipsychotics. Arch Gen Arch Gen Psychiatry 1982;39:473-81.
Crystal S, Olfson M, Huang C, et al.
dyskinesia. Int Rev Neurobiol 2011;98: chotics: safety, effectiveness, and policy Miller DD, McEvoy JP, Davis SM, et al.
Clinical correlates of tardive dyskinesia min E supplementation? Crit Rev Food CATIE schizophrenia trial. Schizophr Res Caroff SN, Davis VG, Miller DD, et al.
chotics: rethinking “off-label”. Psychiatr nia. J Clin Psychiatry 2011;72:295-303.
schizophrenia. Acta Psychiatr Scand view. CNS Drugs 2005;19(Suppl 1):1-93.
recognition and management. Postgrad dyskinesia: clinical presentation and treat- J Psychiatry Neurosci 2014;39(1)


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