Tardive Dyskinesia

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

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

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

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