From the Guidelines
Tardive dyskinesia is an involuntary movement disorder typically associated with long-term use of neuroleptics, characterized by athetoid or choreic movements in the orofacial region, but can affect any part of the body.
Key Characteristics
- Involuntary movements, often in the orofacial region
- Associated with long-term use of neuroleptics
- Can affect any part of the body
- May persist even after discontinuation of the antipsychotic agent
Diagnosis and Treatment
- Diagnosis is based on clinical presentation and history of neuroleptic use
- The Abnormal Involuntary Movement Scale (AIMS) is a useful measure for monitoring tardive dyskinesia 1
- Treatment involves discontinuing the offending medication, or switching to an atypical antipsychotic
- In some cases, treatment with a reversible inhibitor of the vesicular monoamine transporter 2 (VMAT2) may be recommended 1
Prevention
- Strategies for prevention and early detection are crucial, as there is no specific treatment for tardive dyskinesia
- Baseline measures of abnormal movements should be recorded, and assessment for dyskinesias should occur at least every 3 to 6 months 1
- Atypical antipsychotics may have a lower risk of tardive dyskinesia compared to traditional neuroleptics, but can still cause extrapyramidal side effects 1
From the Research
Definition and Characteristics of Tardive Dyskinesia
- Tardive dyskinesia is a potentially irreversible syndrome of involuntary hyperkinetic movements that occur in predisposed persons receiving extended neuroleptic (antipsychotic) drug therapy 2.
- It is usually characterized by choreoathetoid dyskinesias in the orofacial, limb, and truncal regions, but subtypes of this syndrome may include tardive dystonia and tardive akathisia 2.
- Tardive dyskinesia is a potentially permanent movement disorder resulting from chronic use of dopamine receptor blocking agents (DRBA) 3.
Risk Factors and Prevalence
- Risk factors for tardive dyskinesia include age, female sex, affective disorders, and probably those without psychotic diagnoses, including patients receiving drugs with antidopaminergic activity for nausea or gastrointestinal dysfunction for extended periods 2.
- The type of antipsychotic agent, duration of illness, and cumulative dose of DRBA are also identified risk factors 3.
- Advanced age, female sex, and African and Caucasian ethnicity are additional potential risk factors 3.
- The mean prevalence of TD is estimated to be 25.3% in psychiatric patients taking antipsychotics 3.
Diagnosis and Treatment
- Accurate diagnosis of tardive dyskinesia is crucial, but can be challenging due to subtle and often fluctuating symptoms 4.
- Clinicians should use the lowest necessary doses of dopamine receptor blocking agents and try to avoid parkinsonian adverse effects and akathisia 5.
- Two vesicular monoamine transporter-2 (VMAT2) inhibitors, deutetrabenazine and valbenazine, are approved by the US Food and Drug Administration to treat TD 5.
- Non-neuroleptic agents such as tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba have shown positive results in small, early-phase, blinded trials 6.