Pharmacopsychiatry
Original Paper Neuropsychobiology 1992;25:149-152
Department of Neuropsychiatry, Kanazawa University School of Medicine, Kanazawa, Japan
The Rabbit Syndrome and Antiparkinsonian Medication in Schizophrenic Patients
Key Words
Abstract
Rabbit syndrome Extrapyramidal side effects Antiparkinsonian drugs Schizophrenia Antipsychotic medication
Effects of antiparkinsonian medication on the rabbit syndrome (RS) and accompanying parkinsonian symptoms were studied in 5 schizophrenic inpa tients receiving long-term antipsychotic medication. All patients showed early improvement of RS following additional treatment with trihexyphenidyl or biperiden, with a significant reduction in the RS score also observed. The improvement of RS paralleled improvement of the parkinsonian symptoms, with the score of the Simpson-Angus rating scale significantly reduced. Our data provide further evidence that the underlying mechanism of RS is similar to that of acute forms of drug-induced parkinsonism.
Introduction
The rabbit syndrome (RS), a term coined by Villeneuvc [ 1], is an extrapyramidal side effect induced by pro longed exposure to antipsychotic drugs. This syndrome is characterized by rhythmic involuntary movements at a frequency of about 5 Hz of the perioral musculature mim icking the masticatory movement of a rabbit [1,2], Sev eral studies have shown the favorable responses of RS to anticholinergic agents [1-6], and have suggested that the pathophysiology of RS is similar to that of drug-induced parkinsonism. To our knowledge, however, no studies have systematically investigated the relationship between the drug responses of RS and parkinsonian symptoms. In the present study we examined the effects of antiparkin sonian (AP) drugs on both disorders in schizophrenic patients receiving long-term antipsychotic medication.
Patients and Methods This open trial was carried out in 5 schizophrenic inpatients (4 women and 1 man), ranging in age from 44 to 67 years, who mani fested RS for at least 3 months before the study. All patients gave informed consent. They had been on antipsychotic medication for 11-32 years, and all patients except one (patient 4) had received combined antipsychotic and AP drugs continuously for more than one year. Individual patient data are listed in table 1. In the present study we added trihexyphenidyl (6 mg/day, t.i.d.) to the existing drug regimen in 3 patients (patients 1. 2 and 5). and biperiden (3 mg/day. t.i.d.) in 2 patients (patients 3 and 4). The doses of antipsychotic drugs were kept constant throughout the study. Each patient was rated on the scale at baseline, and weekly thereafter for 4 weeks. To evaluate the severity of RS, patients were observed during a 10-min examination that included sitting, standing, walking, and distraction by conversation. Evaluation was made at approximately the same time of day. Since motor performance and concentration of attention have been shown to influence RS [ 1, 7], the finger tapping technique was employed to elicit RS. RS was rated on the following scale of
Yuji Wada. MD Department of Neuropsychiatry Kanazawa University School of Medicine 13-1 Takara-Machi. Kanazawa 920 (Japan)
© 1992 S. Karger AG, Basel 0302-282X/92/0253-0149 $2.75/0
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
Yuji Wada Nariyoshi Yamaguchi
Table 1. Characteristics Patient
i 2 3 4 5
Sex
F F F F M
Age years
63 63 44 48 58
of'5 patients with RS Duration of previous antipsychotic treatment, years
Treatment before study antipsychotic drugs, mg/day
AP drugs mg/day
baseline
week 4
baseline
week 4
n
FIPD 8. LP 50. Li 600 PC 50. CCP 100 HPD 5, PC 60, SP 1.200 HPD 5. L.P 150. SP 1.200 BPL 20. SP 600
BPD 5 BPD 3 PMZ 100
3 3 3 3 2
2 0 0 2 0
5 6 2 3 6
3 3 1 2 1
32 13 31 11
RS score
-
BPD 3
Simpson-Angus score
M = male: F = female; HPD = haloperidol: LP = ievomepromazine: Li = lithium: SP = sulpiride: CCP = clocapramine; PC = propericiazine; BPL = brontperidol: BPD = biperiden: PMZ « promethazine.
a
CE
Fig. 1 . Changes in the RS score (•) and the total score of the Simpson-Angus scale (o) during the 4-wcek study period. Values indicate mean ± SEM (n = 5). * p < 0.05; ** p < 0.01 compared with pre study values.
150
Wada/Yamaguchi
Results
Four of the 5 patients had almost continuous RS in the prestudy evaluation, and their RS score was rated 3. The RS score of the remaining patient was rated 2 (table 1). Following additional treatment with AP drugs, improve ment of RS was seen in all patients, and the RS score was significantly reduced at the 2.3 and 4 weeks' evaluation as compared with the prestudy score (fig. 1). Three patients improved dramatically, with RS completely disappearing at the final evaluation. We observed RS improvement early during the trial (< 2 weeks), and this was sustained until the end of the 4-week study period. The improve ment of the accompanying parkinsonian symptoms paral
Rabbit Syndrome
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
0-3: A score of 0 indicated RS was absent even during finger tapping: 1 indicated RS was evident only during finger tapping: 2 indicated RS was present for less than half of the examination time, and 3 that RS was present for more than half of the examination time. Parkinso nian symptoms were rated with the Simpson-Angus 5-point scale [8] that comprised 10 items: gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, tremor, salivation, and glabella tap. The glabella tap was excluded from the items of the present study because it was found to operate inconsis tently and was considered unreliable. Two nonspecific items related to akathisia (restless and creeping sensation of the body), anticholin ergic side effects and tardive dyskinesia symptoms were also assessed in this study. Friedman analysis of variance was employed to detect overall sig nificance. followed by Dunnett’s multiple comparisons procedure. A value of p < 0.05 was considered to be significant.
4 weeks
pre
Discussion
It has been reported that RS responds well to treatment with AP drugs such as benztropine [1-4. 10] and trihexy phenidyl [1 1, 12]. Sovnerand DiMascio [3] demonstrated that benztropine suppressed RS with an exacerbation of tardive dyskinesia in a patient simultaneously afflicted with both disorders. Based on their observation that physostigmine exacerbated RS but improved tardive dyskine sia. Weiss et al. [10] suggested that this agent is a useful diagnostic tool to differentiate RS from tardive dyskine sia. In addition, it has been shown that RS persists during stage I non-REM sleep while tardive dyskinesia does not [13-15], These findings suggest that RS is a distinct druginduced extrapyramidal symptom in the spectrum of par kinsonism, and not just a form of tardive dyskinesia. Kachi and Ando [11] suggested, however, that RS is a transitional form from drug-induced parkinsonism to tar dive dyskinesia because the intravenous administration of haloperidol had a suppressive effect on RS. The present study confirms that AP drugs are highly effective in con trolling RS. Furthermore, our patients had RS and par kinsonian symptoms simultaneoulsy before the study, and the improvement of RS occurred in association with improvement of the accompanying parkinsonian symp toms. These findings provide further evidence that the pathophysiology of RS is similar to that of acute forms of drug-induced parkinsonism. RS is usually seen after prolonged exposure to antipsy chotic drugs in middle-aged and elderly patients [1], Our patients had received antipsychotic medication for 11-32 years with an average of 19.6. and their ages ranged from 44 to 67 years with an average of 55.2. Four of the subjects
in the present study were women. Our search of the litera ture revealed a total of 41 patients with RS, 27 of whom were women, suggesting that like drug-induced parkin sonism [16], RS may also occur more often in women. Yassa and Lai [5] conducted a prevalence study of RS, and reported that 6 of 266 inpatients (2.3%) had RS. In their study, all of the patients with RS were receiving antipsychotics alone, whereas none of the patients receiv ing concomitant AP drugs manifested RS. In contrast, all but one of our patients had received long-term medica tion with combined antipsychotic and AP drugs before the study. This discrepancy is difficult to explain because of differences in the type or dose of antipsychotics used as well as in the duration of treatment. Since Asian patients have been reported to be more vulnerable to druginduced parkinsonism than Black or White patients [ 17], racial differences may be one of the factors that account for the differences found between our study and theirs. It has been reported that there is a significant inverse corre lation between serum concentrations of AP drugs and the presence of drug-induced extrapyramidal symptoms [18, 19]. In the present study additional AP medication re sulted in improvement of RS and parkinsonian symp toms. It seems likely therefore that the original dose or serum level of AP drugs was too low to counteract the extrapyramidal side effects of our patients. In the previous studies RS was evaluated in the absence of a tight definition for grading its severity. In the present study we devised a 4-point rating scale for RS, which seems to be very useful in documenting the severity of RS and its serial changes. Concentration of attention and motor performance (e.g.. retracing a complicated labyrinth) have been described to increase the amplitude of RS and muscle tone [1, 7], We applied finger tapping to our rating scale, and this was found to be a reliable tech nique to uncover RS. Although caution must be exercised in drawing any conclusion from the small number of patients in this non blind trial, the present findings suggest that the mecha nism of RS is similar to that of acute forms of druginduced parkinsonism. Since the previous studies were also open and involved a small number of patients, a pla cebo-controlled, double-blind study is necessary to in crease our knowledge of the treatment and underlying mechanism of this syndrome.
151
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
leled that of RS, and the total score of the Simpson-Angus rating scale was significantly reduced at the 3 and 4 weeks’ evaluation as compared with the prestudy score (fig. 1). Two patients showed mild worsening of anticholinergic symptoms: constipation (patient 3) and dryness of mouth (patient 4). There was no change in the items of akathisia. Only I patient (patient 2) had symptoms of tardive dyski nesia simultaneously before the study (a total score of 4, according to the abnormal involuntary movements scale, AIMS [9]). and her AIMS score did not change during the study period. All patients were observed for an additional month while they continued to receive the same medica tion as in the present study, and there was no change in their RS status.
1 Villeneuve A: The rabbit syndrome. A peculiar extrapyramidal reaction. Can Psychiatr Assoc J 1972; 17(suppl):69-72. 2 Jus K. Jus A. Gautier J, Villeneuve A. Pires P, Pineau R. Villeneuve R: Studies on the action of certain pharmacological agents on tardive dyskinesia and on the rabbit syndrome. Int J Clin Pharmacol 1974:9:138—145. 3 Sovner R, DiMascio A: The effect of benztropine mesylate in the rabbit syndrome and tar dive dyskinesia. Am J Psychiatry 1977; 134: 1301-1302. 4 Todd R. Lippmann S. Maushadi M. Chang A: Recognition and treatment of rabbit syndrome, an uncommon complication of neuroleptic therapies. Am J Psychiatry 1983; 140; 1519— 1520. 5 Yassa R, Lai S: Prevalence of the rabbit syn drome. Am J Psychiatry 1986;143:656-657. 6 Deshmukh DK. Joshi VS. Agarwal MR: Rabbit syndrome - a rare complication of long-term neuroleptic medication. Br J Psychiatry 1990; 157:293.
7 Jus K. Jus A, Vilieneuve A, Villeneuve R: Influence of concentration and motor perfor mance on tardive dyskinesia and rabbit syn drome. Polygraphic studies. Can Psychiatr As soc J 1973;18:327-330. 8 Simpson GM. Angus JWS: A rating scale for extrapyramidal effects. Acta Psychiatr Scand I970;212(suppl):l 1-19. 9 Guy W: HCDEU Assessment Manual for Psy chopharmacology. Publication ADM 76-338, Washington, US Department of Health, Edu cation and Welfare, 1976, pp 534-537. 10 Weiss KJ. Ciraulo DA, Shader Rl: Physostigmine test in the rabbit syndrome and tardive dyskinesia. Am J Psychiatry 1980:137:627— 628. 11 Kachi T, Ando K: The rabbit syndrome: A clin ical study of three cases. Neurol Med (Tokyo) 1981;14:253-259. 12 Kakigi R. Kuroda Y. Shibasaki H: The rabbit syndrome induced by sulpiride: A case report. Clin Neurol (Tokyo)"l982:22:557-562.
13 Jus K, Villeneuve A. Jus A: Tardive dyskinesia and the rabbit syndrome during wakefulness and sleep. Am J Psychiatry 1972:129:143. 14 Jus K. Jus A. Villeneuve A: Polygraphic profile of oral tardive dyskinesia and of rabbit syn drome: for quantitative and qualitative evalua tion. Dis Nerv Syst 1973:34:27-32. 15 Villeneuve A. Jus K. Jus A: Polygraphic studies of tardive dyskinesia and of rabbit syndrome during different stages of sleep. Biol Psychiatry 1973;6:259-274. 16 Ayd FJ J r A survey of drug-induced extrapy ramidal reactions. JAMA 1961:175:1054— 1060 17 Binder RL, Levy R: Extrapyramidal reactions in Asian. Am J Psychiatry 1981; 138:1243— 1244. 18 T une L, Coyle JT : Scrum levels of anticholiner gic drugs in treatment of acute extrapyramidal side effects. Arch Gen Psychiatry 1980:37: 293-297. 19 Tune L. Coyle JT: Acute extrapyramidal side effects: serum levels of neuroleptics and anti cholinergics. Psychopharmacology 1981;75:9— 15.
152
Wada/Yamaguchi
Rabbit Syndrome
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
References
Original Paper Neuropsychobiology 1992;25:149-152
Department of Neuropsychiatry, Kanazawa University School of Medicine, Kanazawa, Japan
The Rabbit Syndrome and Antiparkinsonian Medication in Schizophrenic Patients
Key Words
Abstract
Rabbit syndrome Extrapyramidal side effects Antiparkinsonian drugs Schizophrenia Antipsychotic medication
Effects of antiparkinsonian medication on the rabbit syndrome (RS) and accompanying parkinsonian symptoms were studied in 5 schizophrenic inpa tients receiving long-term antipsychotic medication. All patients showed early improvement of RS following additional treatment with trihexyphenidyl or biperiden, with a significant reduction in the RS score also observed. The improvement of RS paralleled improvement of the parkinsonian symptoms, with the score of the Simpson-Angus rating scale significantly reduced. Our data provide further evidence that the underlying mechanism of RS is similar to that of acute forms of drug-induced parkinsonism.
Introduction
The rabbit syndrome (RS), a term coined by Villeneuvc [ 1], is an extrapyramidal side effect induced by pro longed exposure to antipsychotic drugs. This syndrome is characterized by rhythmic involuntary movements at a frequency of about 5 Hz of the perioral musculature mim icking the masticatory movement of a rabbit [1,2], Sev eral studies have shown the favorable responses of RS to anticholinergic agents [1-6], and have suggested that the pathophysiology of RS is similar to that of drug-induced parkinsonism. To our knowledge, however, no studies have systematically investigated the relationship between the drug responses of RS and parkinsonian symptoms. In the present study we examined the effects of antiparkin sonian (AP) drugs on both disorders in schizophrenic patients receiving long-term antipsychotic medication.
Patients and Methods This open trial was carried out in 5 schizophrenic inpatients (4 women and 1 man), ranging in age from 44 to 67 years, who mani fested RS for at least 3 months before the study. All patients gave informed consent. They had been on antipsychotic medication for 11-32 years, and all patients except one (patient 4) had received combined antipsychotic and AP drugs continuously for more than one year. Individual patient data are listed in table 1. In the present study we added trihexyphenidyl (6 mg/day, t.i.d.) to the existing drug regimen in 3 patients (patients 1. 2 and 5). and biperiden (3 mg/day. t.i.d.) in 2 patients (patients 3 and 4). The doses of antipsychotic drugs were kept constant throughout the study. Each patient was rated on the scale at baseline, and weekly thereafter for 4 weeks. To evaluate the severity of RS, patients were observed during a 10-min examination that included sitting, standing, walking, and distraction by conversation. Evaluation was made at approximately the same time of day. Since motor performance and concentration of attention have been shown to influence RS [ 1, 7], the finger tapping technique was employed to elicit RS. RS was rated on the following scale of
Yuji Wada. MD Department of Neuropsychiatry Kanazawa University School of Medicine 13-1 Takara-Machi. Kanazawa 920 (Japan)
© 1992 S. Karger AG, Basel 0302-282X/92/0253-0149 $2.75/0
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
Yuji Wada Nariyoshi Yamaguchi
Table 1. Characteristics Patient
i 2 3 4 5
Sex
F F F F M
Age years
63 63 44 48 58
of'5 patients with RS Duration of previous antipsychotic treatment, years
Treatment before study antipsychotic drugs, mg/day
AP drugs mg/day
baseline
week 4
baseline
week 4
n
FIPD 8. LP 50. Li 600 PC 50. CCP 100 HPD 5, PC 60, SP 1.200 HPD 5. L.P 150. SP 1.200 BPL 20. SP 600
BPD 5 BPD 3 PMZ 100
3 3 3 3 2
2 0 0 2 0
5 6 2 3 6
3 3 1 2 1
32 13 31 11
RS score
-
BPD 3
Simpson-Angus score
M = male: F = female; HPD = haloperidol: LP = ievomepromazine: Li = lithium: SP = sulpiride: CCP = clocapramine; PC = propericiazine; BPL = brontperidol: BPD = biperiden: PMZ « promethazine.
a
CE
Fig. 1 . Changes in the RS score (•) and the total score of the Simpson-Angus scale (o) during the 4-wcek study period. Values indicate mean ± SEM (n = 5). * p < 0.05; ** p < 0.01 compared with pre study values.
150
Wada/Yamaguchi
Results
Four of the 5 patients had almost continuous RS in the prestudy evaluation, and their RS score was rated 3. The RS score of the remaining patient was rated 2 (table 1). Following additional treatment with AP drugs, improve ment of RS was seen in all patients, and the RS score was significantly reduced at the 2.3 and 4 weeks' evaluation as compared with the prestudy score (fig. 1). Three patients improved dramatically, with RS completely disappearing at the final evaluation. We observed RS improvement early during the trial (< 2 weeks), and this was sustained until the end of the 4-week study period. The improve ment of the accompanying parkinsonian symptoms paral
Rabbit Syndrome
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
0-3: A score of 0 indicated RS was absent even during finger tapping: 1 indicated RS was evident only during finger tapping: 2 indicated RS was present for less than half of the examination time, and 3 that RS was present for more than half of the examination time. Parkinso nian symptoms were rated with the Simpson-Angus 5-point scale [8] that comprised 10 items: gait, arm dropping, shoulder shaking, elbow rigidity, wrist rigidity, leg pendulousness, head dropping, tremor, salivation, and glabella tap. The glabella tap was excluded from the items of the present study because it was found to operate inconsis tently and was considered unreliable. Two nonspecific items related to akathisia (restless and creeping sensation of the body), anticholin ergic side effects and tardive dyskinesia symptoms were also assessed in this study. Friedman analysis of variance was employed to detect overall sig nificance. followed by Dunnett’s multiple comparisons procedure. A value of p < 0.05 was considered to be significant.
4 weeks
pre
Discussion
It has been reported that RS responds well to treatment with AP drugs such as benztropine [1-4. 10] and trihexy phenidyl [1 1, 12]. Sovnerand DiMascio [3] demonstrated that benztropine suppressed RS with an exacerbation of tardive dyskinesia in a patient simultaneously afflicted with both disorders. Based on their observation that physostigmine exacerbated RS but improved tardive dyskine sia. Weiss et al. [10] suggested that this agent is a useful diagnostic tool to differentiate RS from tardive dyskine sia. In addition, it has been shown that RS persists during stage I non-REM sleep while tardive dyskinesia does not [13-15], These findings suggest that RS is a distinct druginduced extrapyramidal symptom in the spectrum of par kinsonism, and not just a form of tardive dyskinesia. Kachi and Ando [11] suggested, however, that RS is a transitional form from drug-induced parkinsonism to tar dive dyskinesia because the intravenous administration of haloperidol had a suppressive effect on RS. The present study confirms that AP drugs are highly effective in con trolling RS. Furthermore, our patients had RS and par kinsonian symptoms simultaneoulsy before the study, and the improvement of RS occurred in association with improvement of the accompanying parkinsonian symp toms. These findings provide further evidence that the pathophysiology of RS is similar to that of acute forms of drug-induced parkinsonism. RS is usually seen after prolonged exposure to antipsy chotic drugs in middle-aged and elderly patients [1], Our patients had received antipsychotic medication for 11-32 years with an average of 19.6. and their ages ranged from 44 to 67 years with an average of 55.2. Four of the subjects
in the present study were women. Our search of the litera ture revealed a total of 41 patients with RS, 27 of whom were women, suggesting that like drug-induced parkin sonism [16], RS may also occur more often in women. Yassa and Lai [5] conducted a prevalence study of RS, and reported that 6 of 266 inpatients (2.3%) had RS. In their study, all of the patients with RS were receiving antipsychotics alone, whereas none of the patients receiv ing concomitant AP drugs manifested RS. In contrast, all but one of our patients had received long-term medica tion with combined antipsychotic and AP drugs before the study. This discrepancy is difficult to explain because of differences in the type or dose of antipsychotics used as well as in the duration of treatment. Since Asian patients have been reported to be more vulnerable to druginduced parkinsonism than Black or White patients [ 17], racial differences may be one of the factors that account for the differences found between our study and theirs. It has been reported that there is a significant inverse corre lation between serum concentrations of AP drugs and the presence of drug-induced extrapyramidal symptoms [18, 19]. In the present study additional AP medication re sulted in improvement of RS and parkinsonian symp toms. It seems likely therefore that the original dose or serum level of AP drugs was too low to counteract the extrapyramidal side effects of our patients. In the previous studies RS was evaluated in the absence of a tight definition for grading its severity. In the present study we devised a 4-point rating scale for RS, which seems to be very useful in documenting the severity of RS and its serial changes. Concentration of attention and motor performance (e.g.. retracing a complicated labyrinth) have been described to increase the amplitude of RS and muscle tone [1, 7], We applied finger tapping to our rating scale, and this was found to be a reliable tech nique to uncover RS. Although caution must be exercised in drawing any conclusion from the small number of patients in this non blind trial, the present findings suggest that the mecha nism of RS is similar to that of acute forms of druginduced parkinsonism. Since the previous studies were also open and involved a small number of patients, a pla cebo-controlled, double-blind study is necessary to in crease our knowledge of the treatment and underlying mechanism of this syndrome.
151
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
leled that of RS, and the total score of the Simpson-Angus rating scale was significantly reduced at the 3 and 4 weeks’ evaluation as compared with the prestudy score (fig. 1). Two patients showed mild worsening of anticholinergic symptoms: constipation (patient 3) and dryness of mouth (patient 4). There was no change in the items of akathisia. Only I patient (patient 2) had symptoms of tardive dyski nesia simultaneously before the study (a total score of 4, according to the abnormal involuntary movements scale, AIMS [9]). and her AIMS score did not change during the study period. All patients were observed for an additional month while they continued to receive the same medica tion as in the present study, and there was no change in their RS status.
1 Villeneuve A: The rabbit syndrome. A peculiar extrapyramidal reaction. Can Psychiatr Assoc J 1972; 17(suppl):69-72. 2 Jus K. Jus A. Gautier J, Villeneuve A. Pires P, Pineau R. Villeneuve R: Studies on the action of certain pharmacological agents on tardive dyskinesia and on the rabbit syndrome. Int J Clin Pharmacol 1974:9:138—145. 3 Sovner R, DiMascio A: The effect of benztropine mesylate in the rabbit syndrome and tar dive dyskinesia. Am J Psychiatry 1977; 134: 1301-1302. 4 Todd R. Lippmann S. Maushadi M. Chang A: Recognition and treatment of rabbit syndrome, an uncommon complication of neuroleptic therapies. Am J Psychiatry 1983; 140; 1519— 1520. 5 Yassa R, Lai S: Prevalence of the rabbit syn drome. Am J Psychiatry 1986;143:656-657. 6 Deshmukh DK. Joshi VS. Agarwal MR: Rabbit syndrome - a rare complication of long-term neuroleptic medication. Br J Psychiatry 1990; 157:293.
7 Jus K. Jus A, Vilieneuve A, Villeneuve R: Influence of concentration and motor perfor mance on tardive dyskinesia and rabbit syn drome. Polygraphic studies. Can Psychiatr As soc J 1973;18:327-330. 8 Simpson GM. Angus JWS: A rating scale for extrapyramidal effects. Acta Psychiatr Scand I970;212(suppl):l 1-19. 9 Guy W: HCDEU Assessment Manual for Psy chopharmacology. Publication ADM 76-338, Washington, US Department of Health, Edu cation and Welfare, 1976, pp 534-537. 10 Weiss KJ. Ciraulo DA, Shader Rl: Physostigmine test in the rabbit syndrome and tardive dyskinesia. Am J Psychiatry 1980:137:627— 628. 11 Kachi T, Ando K: The rabbit syndrome: A clin ical study of three cases. Neurol Med (Tokyo) 1981;14:253-259. 12 Kakigi R. Kuroda Y. Shibasaki H: The rabbit syndrome induced by sulpiride: A case report. Clin Neurol (Tokyo)"l982:22:557-562.
13 Jus K, Villeneuve A. Jus A: Tardive dyskinesia and the rabbit syndrome during wakefulness and sleep. Am J Psychiatry 1972:129:143. 14 Jus K. Jus A. Villeneuve A: Polygraphic profile of oral tardive dyskinesia and of rabbit syn drome: for quantitative and qualitative evalua tion. Dis Nerv Syst 1973:34:27-32. 15 Villeneuve A. Jus K. Jus A: Polygraphic studies of tardive dyskinesia and of rabbit syndrome during different stages of sleep. Biol Psychiatry 1973;6:259-274. 16 Ayd FJ J r A survey of drug-induced extrapy ramidal reactions. JAMA 1961:175:1054— 1060 17 Binder RL, Levy R: Extrapyramidal reactions in Asian. Am J Psychiatry 1981; 138:1243— 1244. 18 T une L, Coyle JT : Scrum levels of anticholiner gic drugs in treatment of acute extrapyramidal side effects. Arch Gen Psychiatry 1980:37: 293-297. 19 Tune L. Coyle JT: Acute extrapyramidal side effects: serum levels of neuroleptics and anti cholinergics. Psychopharmacology 1981;75:9— 15.
152
Wada/Yamaguchi
Rabbit Syndrome
Downloaded by: King's College London 137.73.144.138 - 1/26/2019 12:04:49 AM
References
