From the Guidelines
The Tardieu scale is not directly related to the provided evidence, which focuses on Tardive Dyskinesia, a condition associated with long-term neuroleptic use, characterized by involuntary movements, particularly in the orofacial region 1.
Definition and Assessment
Tardive Dyskinesia (TD) is an involuntary movement disorder that can affect any part of the body, but it typically involves athetoid or choreic movements in the orofacial region. The Abnormal Involuntary Movement Scale (AIMS) is a useful tool for monitoring and assessing TD, as recommended by the American Academy of Child and Adolescent Psychiatry 1.
Prevention and Management
Given that there is no specific treatment for TD other than discontinuing the offending medication, strategies for prevention and early detection are crucial. This includes obtaining adequate informed consent, recording baseline measures of abnormal movements, and regularly assessing for dyskinesias at least every 3 to 6 months 1.
- Prevention strategies are key because TD may persist even after the antipsychotic agent is discontinued.
- If TD occurs, the approach should be to continue the medication at the current dose only if the patient is in full remission and changing the dosage or agent might precipitate a relapse 1.
- Otherwise, attempts should be made to either lower the dose or switch to another medication, preferably an atypical antipsychotic, to mitigate the risk of TD while still managing the underlying condition effectively.
Clinical Implications
The concern over TD should not outweigh the potential benefits of antipsychotics for patients with schizophrenia, but it necessitates careful monitoring and management strategies to minimize its occurrence and impact on patients' quality of life 1.
- The potential for TD to develop in as many as 50% of youth receiving neuroleptics underscores the importance of vigilant assessment and proactive management strategies.
- Withdrawal dyskinesias, which can occur with the cessation of neuroleptic agents, almost always resolve over time, distinguishing them from TD, which may persist 1.
From the Research
Tardive Dyskinesia Scale
- Tardive dyskinesia is a movement disorder characterized by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication 2.
- The Abnormal Involuntary Movement Scale (AIMS) is used to measure the severity of tardive dyskinesia 3, 4.
Treatment Options
- Preventing tardive dyskinesia is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimising the duration of therapy 2.
- The first-line management of tardive dyskinesia is the withdrawal of antipsychotic medication if clinically feasible 2, 5.
- Switching from a first-generation to a second-generation antipsychotic with a lower D2 affinity, such as clozapine or quetiapine, may be effective in reducing tardive dyskinesia symptoms 2, 3, 4.
- The strongest evidence for a suitable co-intervention to treat tardive dyskinesia comes from tests with the new VMAT inhibitors, deutetrabenazine and valbenazine 2.
- Other treatment options include benzodiazepines, anticholinergic drugs, botulinum toxin injections, and tetrabenazine 5.
Management Strategies
- Emphasis is on prevention, prompt detection, and management of early and potentially reversible cases 5.
- Psychiatric reevaluation to consider alternative psychiatric diagnoses or treatments is strongly advised 5.
- The need for treatment of TD should be carefully assessed, and for mild dyskinesia, low doses of a benzodiazepine may reduce the amount of both dyskinesia and associated anxiety 5.
- Research to date supports switching to clozapine for the purpose of reducing tardive dyskinesia risk and/or treating existing tardive dyskinesia 3.