++
++
A syndrome of abnormal 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
Years of treatment
Cigarette smoking
Diabetes mellitus
Atypical antipsychotics appear to incur a lower risk than typical or first-generation antipsychotic therapy; clozapine is unique in that it can treat antipsychotic-induced tardive dyskinesia.
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
++
Early signs
Fine worm-like tongue movements at rest
Difficulty sticking out the tongue
Facial tics
Increased blink frequency
Jaw movements
Later signs
Bucco-linguo-masticatory movements
Lip smacking
Chewing motions
Mouth opening and closing
Disturbed gag reflex
Puffing of the cheeks
Respiratory distress
Disrupted speech
Choreoathetoid movements (more prevalent in younger patients)
Dyskinesias do not occur during sleep; can be voluntarily suppressed for short periods
++
Differentiate early signs of tardive dyskinesia from similar symptoms produced by ill-fitting dentures or reversible side effects of nonantipsychotic 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 of side effects by using lowest effective dose of the antipsychotic medication
Gradually discontinue antipsychotic medication, if clinical feasible
Keep patient off the medications until reemergent psychotic symptoms dictate their resumption; restart in low doses and gradually increase until there is clinical improvement
Clozapine and olanzapine appear to offer less risk of recurrence
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