Tardive Dyskinesia

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

• Gradually discontinue antipsychotic medications, if clinical feasible

• 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