Tardive dyskinesia

Definition
Tardive dyskinesia is a mostly irreversible neurological disorder of involuntary
movements caused by longterm 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 than 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.

GALE ENCYCLOPEDIA OF MEDICINE

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.

GALE ENCYCLOPEDIA OF MEDICINE