Tardive dyskinesia
Tardive dyskinesia typically affects the face (3/4 of affected individuals) but also affects the limbs (1/2 of affected) and the trunk (1/4 of affected).
The movements fluctuate over time, increase with emotional arousal, decrease with relaxation and disappear with sleep. They also decrease when affected muscles are used for voluntary tasks. Distracting tasks such as mental arithmetic also worsen the movements.
The movements have a variable response to medication. Increasing the dose of neuroleptics tends to lessen the problem (temporarily) and the use of anticholinergics tends to worsen the movements. It is believed to be due to postsynaptic D2 receptor hypersensitivity in the nigrostriatal pathway.
Tardive dyskinesia normally develops when a person has been on neuroleptics for months to years. This time period can be as short as one month in the elderly. It can also develop in patient who have never received treatment suggesting it may be a feature of schizophrenia. It tends to follow a fluctuating course with some spontaneous remissions.
Risk factors include:-
Treatment involves stopping the antipsychotic or switching to an atypical. Anticholinergics should also be stopped.
The current status of tardive dyskinesia Australian and New Zealand Journal of Psychiatry 2000; 34:355-369
The movements fluctuate over time, increase with emotional arousal, decrease with relaxation and disappear with sleep. They also decrease when affected muscles are used for voluntary tasks. Distracting tasks such as mental arithmetic also worsen the movements.
The movements have a variable response to medication. Increasing the dose of neuroleptics tends to lessen the problem (temporarily) and the use of anticholinergics tends to worsen the movements. It is believed to be due to postsynaptic D2 receptor hypersensitivity in the nigrostriatal pathway.
Tardive dyskinesia normally develops when a person has been on neuroleptics for months to years. This time period can be as short as one month in the elderly. It can also develop in patient who have never received treatment suggesting it may be a feature of schizophrenia. It tends to follow a fluctuating course with some spontaneous remissions.
Risk factors include:-
- Advancing age
- Gender - Earlier studies suggested TD was more common in women but this has not been a consistent finding (College questions may not be up to date on this)
- Ethnicity - Rates are higher in African Americans
- Psychiatric disorder - Some studies have suggested higher rates in people with affective disorder but this has not been a universal finding
- Antipsychotic use - First generation antipsychotics appear to present a higher risk than second generation drugs
- Mental retardation - Individuals who are mentally handicapped or who suffer from some sort of organic brain dysfunction or atrophy are more likely to develop the disorder than those with healthy brains
- Substance abuse People with a history of alcoholism or drug abuse seem to be more apt to develop the disorder when prescribed the drugs associated with TD.
Treatment involves stopping the antipsychotic or switching to an atypical. Anticholinergics should also be stopped.
The current status of tardive dyskinesia Australian and New Zealand Journal of Psychiatry 2000; 34:355-369
