tardive dyskinesia


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Related to tardive dyskinesia: neuroleptic malignant syndrome, tardive dystonia

Tardive Dyskinesia

 

Definition

Tardive dyskinesia is a mostly irreversible neurological disorder of involuntary movements caused by long-term use of antipsychotic or neuroleptic drugs.

Description

Antipsychotic or neuroleptic drugs are powerful tranquilizers generally prescribed for serious psychiatric disorders, as well as neurological and gastrointestinal disorders. Some common antipsychotics are: chlorpromazine HCl (Thorazine), thioridazine HCl (Mellaril), haloperidol (Haldol), perphenazine (Trilafon), thiothixene (Navane), trifluoperazine HCl (Stelazine), and fluphenazine HCl (Permitil, Prolixin).
When these drugs are used long term, tardive dyskinesia (TD) can result. About 20 percent of people taking antipsychotic drugs for more then one year become affected by TD. The prevalence of TD tends to be highest among elderly patients and among women.

Causes and symptoms

TD usually appears after years of antipsychotic drug use, and seems to be related to the total lifetime dose of medication. The symptoms include the following:
  • tongue protrusion
  • grimacing
  • rapid eye blinking
  • lip smacking, pursing, or puckering
  • rapid movement of the arms or legs
  • other involuntary movements of the head, face, neck and tongue muscles

Diagnosis

The diagnosis of TD is suspected upon observation of involuntary movements of the head, neck, face, and tongue in individuals who have a history of antipsychotic drug prescription.

Treatment

There is no standard treatment for TD. The primary approach is to discontinue or minimize the use of antipsychotic drugs while attempting to treat some of the symptoms. The treatment must be individualized to the patient, because discontinuation of the antipsychotic drug(s) may not be advisable, depending on the patient's condition. In some cases, substituting another drug for the antipsychotic drug may be beneficial.

Prognosis

Once TD appears in full—blown form, it can be permanent. With careful management, some symptoms may improve and even disappear with time. In less severe cases, some patients may recover from TD within three months of discontinuing the use of antipsychotic medication. Studies report that at least half of patients experience remission of major symptoms within 12 to 18 months following discontinuation of antipsychotic drugs. In some patients, however, decreasing the dose of the antipsychotic drug actually increases the symptoms of TD, while increasing the dose sometimes offers a temporary remission of the symptoms.

Prevention

TD can be prevented by early recognition and discontinuation of the antipsychotic medication if this is clinically possible. The use of antipsychotic drugs should in any case be kept to a minimum in all patients. Patients should be followed carefully to determine when the dose of the drug can be tapered off as the psychiatric condition improves. In all cases, the benefits of taking the antipsychotic medication should outweigh the risk of developing TD.
A study has shown that elderly institutionalized patients with dementia that were treated with risperidone had a low incidence of TD. Although further study is needed, this study shows that non-conventional neuroleptic drugs should be considered to avoid the risk of tardive dyskinesia, particularly in elderly patients.

Resources

Books

Tierney, Lawrence, et al. Current Medical Diagnosis and Treatment. Los Altos: Lange Medical Publications, 2001.

Periodicals

"Risperidone May Lower Incidence of TD." Brown University geroPsych Report August 2000: 2.

Organizations

National Institute for Mental Health. 6001 Executive Blvd., Room 8184, MSC 9663, Bethesda, MD 20892-9663. http://www.nimh.nih.gov.
Tardive Dyskinesia/Tardive Dystonia National Association. P.O. Box 45732, Seattle, WA 98145-0732. (206) 522-3166.

Key terms

Antipsychotics — Drugs used to treat psychotic conditions such as schizophrenia or psychosis. These medications are powerful tranquilizers that all have sedating and calming effects, but their major effect is to reduce psychotic thinking and behavior.
Neuroleptics — Any of a class of drugs used to treat psychotic conditions.
Psychosis — A condition where a person's ability to recognize reality and cope with everyday life is severely affected.

dyskinesia

 [dis-ki-ne´zhah]
impairment of the power of voluntary movement.
primary ciliary dyskinesia any of a group of hereditary syndromes characterized by delayed or absent mucociliary clearance from the airways; often there is also lack of motion of sperm. One variety is Kartagener's syndrome.
tardive dyskinesia an iatrogenic disorder produced by long-term administration of antipsychotic agents; it is characterized by oral-lingual-buccal dyskinesias that usually resemble continual chewing motions with intermittent darting movements of the tongue; there may also be choreoathetoid movements of the extremities. The disorder is more common in women than in men and in the elderly than in the young, and incidence is related to drug dosage and duration of treatment. In some patients symptoms disappear within several months after antipsychotic drugs are withdrawn; in others symptoms may persist indefinitely.

tar·dive dys·ki·ne·si·a

[MIM*272620]
involuntary movements of the facial muscles and tongue, often persistent, that develop as a late complication of some neuroleptic therapy, more likely with typical antipsychotic agents.

tardive dyskinesia

n.
A chronic disorder of the nervous system characterized by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually caused by prolonged treatment with antipsychotic drugs.

tardive dyskinesia

Neurology Slow involuntary sinuous rhythmic movements usually caused as a neurologic side effect of certain drugs–eg, tricyclic tranquilizers–phenothiazine and other tricyclics. See Abnormal Involuntary Movement Scale, 'Piano playing. ', Rabbit syndrome, Tricyclic antidepressant.

tar·dive dys·ki·ne·si·a

(tahr'div dis'ki-nē'zē-ă)
A neurologic disorder associated with involuntary repetitive movements of the facial muscles, tongue, limbs, and trunk; commonly associated with long-term treatment with antipsychotic medications such as phenothiazines.

tardive dyskinesia

Involuntary repetitive shaking movements induced by drugs, such as the phenothiazines, that persist or become worse after the drug is withdrawn. The condition usually affects elderly people after years of treatment with the drug.

tar·dive dys·ki·ne·si·a

(tahr'div dis'ki-nē'zē-ă) [MIM*272620]
Involuntary movements of facial muscles and tongue, often persistent, which develop as a late complication of some neuroleptic therapy.
References in periodicals archive ?
Deutetrabenazine for tardive dyskinesia: a systematic review of the efficacy and safety profile for this newly approved novel medication--What is the number needed to treat, number needed to harm and likelihood to be helped or harmed?
Non-therapeutic risk factors for onset of tardive dyskinesia in schizophrenia: a meta-analysis.
History and definition of tardive dyskinesia. Clin Neuropharmacol 1983;6(2):91-9.
Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications.
The development of tardive dyskinesia "is directly related to the length of time a patient is taking metoclopramide and the number of doses taken," the statement says.
The atypical or second-generation antipsychotic agents (SGAs) are often drugs of choice in the treatment of psychotic illness, based on evidence of their reduced risk for associated acute extrapyramidal side-effects and tardive dyskinesia, compared with the first-generation antipsychotics (FGAs).
Effectiveness of ivermectin in rats with haloperidol induced tardive dyskinesia
The neuroleptics we know pose the greater risk in terms of serious adverse events such as tardive dyskinesia and neuro-malignant syndrome (Jeste & Caligiurie, 1993).
It is clearly true that the newer medications are much more expensive than the older ones, but tardive dyskinesia (TD) rates have plummeted by about 99 percent with the advent of the modern antipsychotic medications.
But one of the serious problems associated with antipsychotic therapy is a neurologic condition called tardive dyskinesia. In the following article, based on an interview with William M.
In long-term studies, the prevalence of tardive dyskinesia often exceeds 50% of all treated patients.
Their use has fallen out of favor, particularly in children and adolescents, because of tardive dyskinesia and other debilitating side effects.