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 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.

BOOKS

Tasman, Allan. Psychiatry. Philadelphia: W.B. Saunders Company, 1997.

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.