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Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia.
Materials and methods
A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004.
Results
The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics.
Conclusion
There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.
Los datos indican que los antipsicóticos clásicos pueden agravar la catatonía no maligna (CNM) y la catatonía maligna (CM). Los antipsicóticos atípicos tienen menos posibilidades de causar trastornos del movimiento que los antipsicóticos clásicos, y se prescriben con frecuencia en los trastornos que se pueden asociar con la catatonía. Por tanto, la pregunta importante que se plantea es si los antipsicóticos atípicos tienen un papel que desempeñar en el tratamiento de la catatonía.
Materiales y métodos
Se realizó una búsqueda en Medline para localizar artículos sobre el uso de antipsicóticos atípicos en la catatonia publicados entre 1970 y el 31 de diciembre de 2004.
Resultados
Las publicaciones sobre el uso de antipsicóticos atipicos en la catatonía consisten en informes clínicos y estudios retrospectivos. En la mayoría de los casos de CNM se informa de una reducción de los síntomas catatónicos con el tratamiento con antipsicóticos atípicos. Los casos de CM se relacionan sobre todo con el síndrome neuroléptico maligno (SNM), que se considera como una variante estuporosa yatrógena de CM causada por los antipsicóticos.
Conclusión
Hay indicaciones de que los antipsicóticos atípicos pueden ser útiles en la CNM. Como consecuencia, deberíamos centramos no sólo en los posibles efectos secundarios extrapiramidales y neurovegetativos de estos farmacos, sino también en los posibles efectos beneficiosos en ciertas funciones cerebrales y en los síntomas catatónicos. Sin embargo, se necesitan ensayos controlados distribuidos al azar para evaluar el efecto de estos medicamentos, y la prudencia es aconsejable, ya que se ha asociado casos de SNM con el tratamiento con antipsicóticos atípicos. No hay datos para prescribir antipsicóticos atípicos en la CM.
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