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The genetics of drug-related movement disorders (DRMD), reply to comment: Antipsychotic-induced catatonia and neuroleptic malignant syndrome: The dark side of the moon

Molecular Psychiatry volume 26, page 6115 (2021)Cite this article

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We thank Dusan Hirjak et al. for their comments and compliments on our paper The genetics of drug-related movement disorders, an umbrella review of meta-analyses. They suggest that antipsychotic-related catatonic symptoms (ACS) and neuroleptic malignant syndrome (NMS) should have been included in the umbrella review (UR). We find their concern important and would like reply as follows.

Hirjak et al. state that in clinical practice it is often difficult to disentangle genuine catatonia from ACS, given some overlapping signs and symptoms. In our UR, we state that drug-related movement disorders (DRMD) may be involved in the pathophysiology of psychotic disorders. In that view antipsychotics are not the cause but a moderating factor and may increase the risk of motor dysfunctions. E.g. motor dysfunctions are found in a proportion of antipsychotic-naive patients, with first-episode schizophrenia and that subgroup is extra vulnerable for drug-induced movement disorders [1,2,3,4]. It could be that the same counts for catatonia, i.e. subclinical genuine catatonia may be involved in the pathophysiology of psychotic disorders (and other psychiatric disorders) and ACS could be, partly, an aggravated form of underlying genuine catatonia. Also, malignant catatonia is hard to distinguish from NMS. In both syndromes, antipsychotic treatment plays an important role but in different ways: antipsychotics initiate NMS but aggravate malignant catatonia [5].

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Authors and Affiliations

  1. Zon & Schild, GGZ Centraal, Amersfoort, The Netherlands

    Nadine C. van der Burg & Peter N. van Harten

  2. Scheldezoom Pharmacy, ‘s Gravenpolder, The Netherlands

    Asmar F. Y. Al Hadithy

  3. Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands

    Peter N. van Harten, Jim van Os & P. Roberto Bakker

  4. Department Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands

    Jim van Os & P. Roberto Bakker

  5. King’s College London, King’s Health Partners Department of Psychosis Studies, Institute of Psychiatry, London, UK

    Jim van Os

  6. Psychiatry at Arkin, Amsterdam, The Netherlands

    P. Roberto Bakker

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  1. Nadine C. van der Burg
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Correspondence to Nadine C. van der Burg.

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van der Burg, N.C., Al Hadithy, A.F.Y., van Harten, P.N. et al. The genetics of drug-related movement disorders (DRMD), reply to comment: Antipsychotic-induced catatonia and neuroleptic malignant syndrome: The dark side of the moon. Mol Psychiatry 26, 6115 (2021). https://doi.org/10.1038/s41380-021-01212-z

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