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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 incur a lower risk

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

  • Symptoms do not occur during sleep and can be voluntarily suppressed for short periods

  • Stress and movements in other parts of the body aggravate the condition

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

    • Mouth opening and closing

    • Disturbed gag reflex

    • Puffing of the cheeks

    • Respiratory distress

    • Disrupted speech

    • Choreoathetoid movements


  • Differentiate early signs of tardive dyskinesia from reversible side effects of medications (eg, tricyclic antidepressants and antiparkinsonism agents)

  • Other neurologic conditions such as Huntington chorea can be differentiated by history and examination


  • Emphasis should be on prevention by using lowest effective dose of the antipsychotic medication

  • Gradually discontinue antipsychotic medication, if clinical feasible

  • Clozapine and vesicular monoamine transporter 2 (VMAT2) inhibitors, such as valbenazine and deutetetrabenazine, have some usefulness in treating antipsychotic-induced tardive dyskinesia

  • Adjunctive agents such as benzodiazepines or lithium may allow control of psychotic symptoms with a low dosage of antipsychotics

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