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For further information, see CMDT Part 25-11: Schizophrenia Spectrum Disorders

Key Features

  • A syndrome of involuntary stereotyped movements of the face, mouth, tongue, trunk, limbs

  • Occurs after months or (typically) years of antipsychotic treatment in 20–35% of patients

  • Predisposing factors

    • Older age

    • Cigarette smoking

    • Diabetes mellitus

  • Atypical antipsychotics appear to be lower risk

  • Symptoms do not necessarily worsen and may improve even when antipsychotics are continued

Clinical Findings

  • Early signs

    • Fine worm-like tongue movements

    • Difficulty sticking out the tongue

    • Facial tics

    • Increased blink frequency

    • Jaw movements

  • Late signs

    • Lip smacking

    • Chewing motions

    • Disturbed gag reflex

    • Puffing of the cheeks

    • Respiratory distress

    • Disturbed speech

    • Choreoathetoid movements

Diagnosis

  • Differentiate early signs of tardive dyskinesia from reversible side effects of medicines, such as tricyclic antidepressants and antiparkinsonism agents

Treatment

  • Emphasis should be on prevention by using lowest effective dose

  • Stop anticholinergic drugs and gradually discontinue antipsychotic dose

  • Clozapine is has been found to treat antipsychotic-induced tardive dyskinesia

  • Benzodiazepines, buspirone, phosphatidylcholine, clonidine, calcium channel blockers, vitamin E, omega-3 fatty acids, and propranolol are of limited usefulness in treating dyskinetic side effects

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