***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Animal data suggest that a D1 antagonistic component in neuroleptic drugs counteracts development of dopamine supersensitivity and of tolerance to cataleptic effect . This has led to the hypothesis that neuroleptics with D1 antagonistic activity should cause a better suppression of tardive dyskinesia ( TD ) and less rebound aggravation after withdrawal than pure D2 antagonists . In this study the effect of zuclopenthixol ( mixed D1/D2 antagonist ) and haloperidol ( D2 antagonist ) was evaluated in chronic psychotic patients with TD . Fifteen patients completed a r and omized crossover study with blind evaluation of TD and parkinsonism . The test medications , haloperidol and zuclopenthixol , caused a significant suppression of TD and a significant increase of parkinsonism . No significant differences between haloperidol and zuclopenthixol were observed . No TD aggravation was seen . The lack of differences between the mixed D1/D2 antagonist and a D2 antagonist suggest that tolerance and DA supersensitivity play no or a minor role for development of TD Eleven patients with tardive dyskinesia were treated with lithium carbonate in a placebo-controlled double-blind crossover study . No significant effect of lithium on either tardive dyskinesia or blood prolactin concentrations was demonstrated , but 5 patients developed pseudo-Parkinsonian features In a double-blind , placebo-controlled study , ten chronic schizophrenic patients with pronounced symptoms of tardive dyskinesia ( TD ) were withdrawn from anticholinergic medication . All patients had previously been under long-term treatment with neuroleptics and anticholinergics for at least two years . The rating-scales used were the AIMS , our own TD Scale , and the Simpson-Angus scale for extra-pyramidal side-effects . The severity of TD decreased significantly in nine patients with in two weeks ; this improvement , most pronounced in the oral region ( P less than .001 ) , persisted during a six-week placebo period . There was a slight increase in parkinsonian symptoms ( P less than .05 ) , which was not a prerequisite for improvement in TD . Hence , discontinuation of anticholinergic medication is a possible therapeutic approach in patients with TD A study was conducted to investigate a novel approach to the prophylaxis of  schizophrenic relapse .  The treatment strategy comprised brief intermittent courses of neuroleptic agents begun as soon as non-psychotic symptoms believed to be early signs of relapse appeared . Fifty four stable , remitted out patients meeting the American Psychiatric Association 's DSM-III criteria for schizophrenia were r and omised double blind to receive brief intermittent treatment with either active or placebo depot neuroleptic injections . Only three patients given placebo injections  and two controls were admitted to hospital during one year of follow up . Eight ( 30 % ) of the patients given placebo injections and only 2 ( 7 % ) of the controls , however , had a recurrence of schizophrenic symptoms . Patients given placebo injections experienced fewer extrapyramidal side effects and showed a trend towards a reduction in tardive dyskinesia . Dysphoric and neurotic symptoms were identified before eight out of 11 relapses , and these symptoms were more frequent in patients given placebo depot injections . These results suggest a viable but not necessarily better alternative to continuous oral or depot treatment for less ill , chronic , stabilised schizophrenics based on the early treatment of putative prodromal symptoms of relapse BACKGROUND While the atypical antipsychotics should ultimately reduce the prevalence of tardive dyskinesia , it is likely to remain a significant clinical problem for a long time to come . No strategy has clearly emerged as the treatment of choice for tardive dyskinesia .  Atypical antipsychotics have reduced propensities for producing acute extrapyramidal symptoms ( EPS ) and possibly tardive dyskinesia and may be effective in treating patients with established tardive dyskinesia . METHOD This 12-month , r and omized , investigator-blinded study compared the efficacy of quetiapine  ( N = 22 ) and haloperidol  ( N = 23 ) in treating patients with DSM-IV schizophrenia or schizoaffective disorder and established tardive dyskinesia .  Dyskinesia was assessed using the Extrapyramidal Symptom Rating Scale ( ESRS ) dyskinesia subscale scores and the Clinical Global Impression ( CGI ) dyskinesia scores . Other EPS , weight , serum prolactin level , and glycosylated hemoglobin level were also assessed . Subjects were enrolled in the study between April 2000 and March 2002 . RESULTS Mean endpoint doses were 400 mg/day of quetiapine and 8.5 mg/day of haloperidol . Compared with the haloperidol group , the quetiapine group showed significantly greater improvements in ESRS dyskinesia ( 6 and 9 months [ p < or=.01 ] ) and CGI dyskinesia ( from 6 months onward [ p < .05 ] and with repeated- measures analysis [ p = .002 ] ) . Response rate ( > or= 50 % symptom reduction ) was greater with quetiapine than haloperidol ( 64 % [ 9/14 ] and 37 % [ 6/16 ] at 6 months ; 55 % [ 6/11 ] and 28 % [ 4/14 ] at 12 months ) . Other EPS decreased significantly with quetiapine at 3 ( p = .01 ) , 6 ( p = .01 ) , and 9 ( p = .002 ) months . Serum prolactin levels decreased with quetiapine but increased with haloperidol , differing significantly between the groups at endpoint ( p = .005 ) . No significant changes in weight or glucose metabolism were recorded in either group . CONCLUSION Quetiapine effectively reduces the severity of tardive dyskinesia and is well tolerated in patients with established tardive dyskinesia Clozapine has long been considered a useful treatment in patients who have schizophrenia with the neuroleptic-induced delayed-onset side effect tardive dyskinesia . We present data in support of the clinical impression using both an animal model of the disorder and dyskinetic patients themselves . Clozapine produces a lower rate of oral dyskinesia in laboratory rats after 6 months of chronic treatment than does haloperidol ( 8.6 + /- 1.3 vs. 13.6 + /- 1.4 vacuous chewing movements every 5 minutes , respectively ) , suggesting a lower propensity to cause tardive dyskinesia . In the human , when clozapine was compared with haloperidol in the treatment of patients with tardive dyskinesia , clozapine produced significantly greater benefit for motor symptoms after 12 months of treatment than did haloperidol ( p < .001 ) . Moreover , the dyskinesia rebound , which occurred equally in both drug groups at the beginning of the study , was sustained in the haloperidol group but lost in the clozapine-treated patients . These data suggest that dyskinetic patients lose their symptoms of tardive dyskinesia , along with dopaminergic hypersensitivity , with long-term clozapine treatment A comparison of the features of persistent oral dyskinesia and functional oral movements is made . The literature on the drug control of oral dyskinesia is review ed . In a double-blind interrupted cross-over trial in two established cases of oral dyskinesia , thiopropazate dihydrochloride was found to be highly effective An experimental method was utilized to compare the masking effects of two neuroleptic agents -- molindone and haloperidol -- on 18 neuroleptic-treated schizophrenic patients exhibiting operationally defined withdrawal-exacerbated tardive dyskinesia . After a week on one of these two medications at preestablished doses equivalent to that of the pre- study neuroleptic , molindone-masked total AIMS scores by significantly less ( 12 % ) than haloperidol ( 27 % ) . Similarly , during a second week when the dose of these neuroleptics was equivalent to 200 % that of the pre- study dose , molindone masked the total AIMS score significantly less ( 23 % ) as compared to haloperidol ( 53 % ) . Several interpretations of this finding are considered . This study demonstrates the feasibility of a method that may offer a model for underst and ing pharmacological differences among neuroleptic medications The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas Fluperlapine , a new clozapine-like neuroleptic drug with weak affinity for dopamine receptors , was evaluated in a blind , placebo controlled trial in 11 patients with stable hyperkinesia ( ten with tardive dyskinesia ( TD ) and one with spontaneous dyskinesia ) . Drug effects during active treatment ( 200–600 mg/day ) and during pre- and post-treatment placebo periods were determined by scoring r and omly sequenced videotapes of TD and parkinsonian symptoms recorded weekly during st and ardized examinations . TD score was unchanged , while parkinsonism slightly decreased ( P<0.05 ) and eye-blinking rates increased ( P<0.05 ) . Psychiatric symptoms showed no significant changes , although positive psychotic symptoms diminished in four patients . Side effects included dizziness , sedation and constipation . The effects in movement disorders found in this study may imply that fluperlapine is less liable than traditional neuroleptics to induce acute extrapyramidal side effects and tardive dyskinesia and is particularly beneficial in the treatment of patients vulnerable to neurological side-effects We sought to determine whether such state-related factors as neuroleptic treatment and facio-oral tardive dyskinesia ( TD ) influence smooth-pursuit eye movement ( SPEM ) in chronic schizophrenics . The design involved 100 schizophrenics , 64 of whom showed " abnormal " eye tracking . Experimentally drug-withdrawn patients , some of whom were clinical ly relapsed , were compared with control patients who continued taking medication in prewithdrawal and postwithdrawal SPEM tests . All groups showed a slight worsening in eye-tracking performance on two postwithdrawal tests , but significant group-by-test session " interactions " were not demonstrable . We also determined that patients with TD tend to substitute large , nontracking saccades for SPEM to a significantly greater extent than nondyskinetic patients . Our findings strengthen the supposition that impaired SPEM is a trait in many schizophrenics but suggest that patients with TD be excluded in future studies of SPEM addressed to trait issues Clozapine , which has had limited clinical testing in the U.S.A. , was evaluated in 12 chronic schizophrenic patients with tardive dyskinesia .  Its antipsychotic activity was again demonstrated and it suppressed the symptoms of tardive dyskinesia with a marked rebound occurring in these symptoms when it was withdrawn ; there was no rigidity or other Parkinsonian symptoms . However , out of a total of 12 patients , neutropenia ( 800 and 1120 ) occurred in two patients , convulsions in one patient , marked withdrawal effects in three patients , and a hypotensive collapse with atrial fibrillation in one patient . If these adverse effects are confirmed in a larger sample size , then despite the novel desirable effects of clozapine it would seem unlikely that it will gain widespread or routine use1 BACKGROUND Amisulpride is a potent substituted benzamide antipsychotic drug cl aim ed to improve the negative symptoms of schizophrenia , particularly at low dosage . METHOD Sixty long-term in- patients with schizophrenia and selected for predominant negative symptoms were r and omised to receive either haloperidol or amisulpride . Over a year there was systematic dose reduction , as symptoms allowed . RESULTS There were no significant differences between the treatment groups in the proportion receiving low-dose treatment , the control of positive symptoms , or ratings of social behaviour , side-effects or tardive dyskinesia . For negative symptoms , there were consistent but non-significant trends in favour of amisulpride . The amisulpride patients required significantly less anticholinergic medication . CONCLUSIONS In chronically-hospitalised in- patients with schizophrenia characterised by persistent negative symptoms , amisulpride was a well-tolerated maintenance antipsychotic medication . The drug had only a limited effect in reducing negative symptoms , which were relatively stable , enduring phenomena in this sample , despite dosage reduction Eleven patients with Huntington 's disease and nine patients with tardive dyskinesia participated in a r and omised double-bl 
    Output:
    
AUTHORS ' CONCLUSIONS Limited data from small studies using neuroleptic reduction  or specific neuroleptic drugs  as treatments for TD did not provide any convincing evidence of the value of these approaches .