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. 1990 Nov;153(5):535–541.

Tardive dyskinesia.

D E Casey 1
PMCID: PMC1002605  PMID: 1979705

Abstract

Tardive dyskinesia is a potentially irreversible syndrome of involuntary hyperkinetic movements that occur in predisposed persons receiving extended neuroleptic (antipsychotic) drug therapy. 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. Although the mechanisms underlying the pathogenesis and pathophysiology of this disorder are unproven, altered dopaminergic functions will likely play a role in any explanation of it. Tardive dyskinesia develops in 20% of neuroleptic-treated patients, but high-risk groups such as the elderly have substantially higher rates. Risk factors 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. Total drug exposure is positively correlated with tardive dyskinesia risk. Management strategies include a careful evaluation of both the psychiatric and neurologic states, a broad differential diagnosis, and adjustment of neuroleptic agents to the lowest effective dose that controls psychosis and minimizes motor side effects. No drug therapy is uniformly safe and effective for treating this disorder. A favorable long-term outcome of improvement or resolution correlates with younger age, early detection, lower drug exposure, and duration of follow-up.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes T. R., Braude W. M. Akathisia variants and tardive dyskinesia. Arch Gen Psychiatry. 1985 Sep;42(9):874–878. doi: 10.1001/archpsyc.1985.01790320042006. [DOI] [PubMed] [Google Scholar]
  2. Barnes T. R., Kidger T., Gore S. M. Tardive dyskinesia: a 3-year follow-up study. Psychol Med. 1983 Feb;13(1):71–81. doi: 10.1017/s003329170005008x. [DOI] [PubMed] [Google Scholar]
  3. Burke R. E., Fahn S., Jankovic J., Marsden C. D., Lang A. E., Gollomp S., Ilson J. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. 1982 Dec;32(12):1335–1346. doi: 10.1212/wnl.32.12.1335. [DOI] [PubMed] [Google Scholar]
  4. Campbell M., Grega D. M., Green W. H., Bennett W. G. Neuroleptic-induced dyskinesias in children. Clin Neuropharmacol. 1983;6(3):207–222. doi: 10.1097/00002826-198309000-00003. [DOI] [PubMed] [Google Scholar]
  5. Casey D. E. Affective disorders and tardive dyskinesia. Encephale. 1988 Sep;14(Spec No):221–226. [PubMed] [Google Scholar]
  6. Casey D. E. Clozapine: neuroleptic-induced EPS and tardive dyskinesia. Psychopharmacology (Berl) 1989;99 (Suppl):S47–S53. doi: 10.1007/BF00442559. [DOI] [PubMed] [Google Scholar]
  7. Casey D. E., Denney D. Pharmacological characterization of tardive dyskinesia. Psychopharmacology (Berl) 1977 Aug 31;54(1):1–8. doi: 10.1007/BF00426532. [DOI] [PubMed] [Google Scholar]
  8. Casey D. E., Keepers G. A. Neuroleptic side effects: acute extrapyramidal syndromes and tardive dyskinesia. Psychopharmacol Ser. 1988;5:74–93. doi: 10.1007/978-3-642-73280-5_7. [DOI] [PubMed] [Google Scholar]
  9. Casey D. E. Spontaneous and tardive dyskinesias: clinical and laboratory studies. J Clin Psychiatry. 1985 Apr;46(4 Pt 2):42–47. [PubMed] [Google Scholar]
  10. Casey D. E. Tardive dyskinesia: reversible and irreversible. Psychopharmacology Suppl. 1985;2:88–97. doi: 10.1007/978-3-642-70140-5_11. [DOI] [PubMed] [Google Scholar]
  11. Casey D. E. The differential diagnosis of tardive dyskinesia. Acta Psychiatr Scand Suppl. 1981;291:71–87. doi: 10.1111/j.1600-0447.1981.tb02460.x. [DOI] [PubMed] [Google Scholar]
  12. Crane G. E., Smeets R. A. Tardive dyskinesia and drug therapy in geriatric patients. Arch Gen Psychiatry. 1974 Mar;30(3):341–343. doi: 10.1001/archpsyc.1974.01760090055009. [DOI] [PubMed] [Google Scholar]
  13. FAURBYE A., RASCH P. J., PETERSEN P. B., BRANDBORG G., PAKKENBERG H. NEUROLOGICAL SYMPTOMS IN PHARMACOTHERAPY OF PSYCHOSES. Acta Psychiatr Scand. 1964;40:10–27. doi: 10.1111/j.1600-0447.1964.tb05731.x. [DOI] [PubMed] [Google Scholar]
  14. Fairbairn A. F., Rowell F. J., Hui S. M., Hassanyeh F., Robinson A. J., Eccleston D. Serum concentration of depot neuroleptics in tardive dyskinesia. Br J Psychiatry. 1983 Jun;142:579–583. doi: 10.1192/bjp.142.6.579. [DOI] [PubMed] [Google Scholar]
  15. Famuyiwa O. O., Eccleston D., Donaldson A. A., Garside R. F. Tardive dyskinesia and dementia. Br J Psychiatry. 1979 Dec;135:500–504. doi: 10.1192/bjp.135.6.500. [DOI] [PubMed] [Google Scholar]
  16. Fisher W. J. Electroshock and what it stands for. Can Psychiatr Assoc J. 1972 Feb;17(1):69–70. doi: 10.1177/070674377201700112. [DOI] [PubMed] [Google Scholar]
  17. Gardos G., Cole J. O., Haskell D., Marby D., Paine S. S., Moore P. The natural history of tardive dyskinesia. J Clin Psychopharmacol. 1988 Aug;8(4 Suppl):31S–37S. [PubMed] [Google Scholar]
  18. Gerlach J., Reisby N., Randrup A. Dopaminergic hypersensitivity and cholinergic hypofunction in the pathophysiology of tardive dyskinesia. Psychopharmacologia. 1974 Jan 9;34(1):21–35. doi: 10.1007/BF00421217. [DOI] [PubMed] [Google Scholar]
  19. Gualtieri C. T., Quade D., Hicks R. E., Mayo J. P., Schroeder S. R. Tardive dyskinesia and other clinical consequences of neuroleptic treatment in children and adolescents. Am J Psychiatry. 1984 Jan;141(1):20–23. doi: 10.1176/ajp.141.1.20. [DOI] [PubMed] [Google Scholar]
  20. Hoffman W. F., Labs S. M., Casey D. E. Neuroleptic-induced parkinsonism in older schizophrenics. Biol Psychiatry. 1987 Apr;22(4):427–439. doi: 10.1016/0006-3223(87)90165-x. [DOI] [PubMed] [Google Scholar]
  21. Jankovic J., Ford J. Blepharospasm and orofacial-cervical dystonia: clinical and pharmacological findings in 100 patients. Ann Neurol. 1983 Apr;13(4):402–411. doi: 10.1002/ana.410130406. [DOI] [PubMed] [Google Scholar]
  22. Jeste D. V., DeLisi L. E., Zalcman S., Wise C. D., Phelps B. H., Rosenblatt J. E., Potkin S. G., Bridge T. P., Wyatt R. J. A biochemical study of tardive dyskinesia in young male patients. Psychiatry Res. 1981 Jun;4(3):327–331. doi: 10.1016/0165-1781(81)90034-2. [DOI] [PubMed] [Google Scholar]
  23. Jeste D. V., Potkin S. G., Sinha S., Feder S., Wyatt R. J. Tardive dyskinesia--reversible and persistent. Arch Gen Psychiatry. 1979 May;36(5):585–590. doi: 10.1001/archpsyc.1979.01780050095012. [DOI] [PubMed] [Google Scholar]
  24. Jeste D. V., Wyatt R. J. Therapeutic strategies against tardive dyskinesia. Two decades of experience. Arch Gen Psychiatry. 1982 Jul;39(7):803–816. doi: 10.1001/archpsyc.1982.04290070037008. [DOI] [PubMed] [Google Scholar]
  25. Kane J. M., Smith J. M. Tardive dyskinesia: prevalence and risk factors, 1959 to 1979. Arch Gen Psychiatry. 1982 Apr;39(4):473–481. doi: 10.1001/archpsyc.1982.04290040069010. [DOI] [PubMed] [Google Scholar]
  26. Kane J. M., Woerner M., Weinhold P., Wegner J., Kinon B., Borenstein M. Incidence of tardive dyskinesia: five-year data from a prospective study. Psychopharmacol Bull. 1984 Summer;20(3):387–389. [PubMed] [Google Scholar]
  27. Keepers G. A., Clappison V. J., Casey D. E. Initial anticholinergic prophylaxis for neuroleptic-induced extrapyramidal syndromes. Arch Gen Psychiatry. 1983 Oct;40(10):1113–1117. doi: 10.1001/archpsyc.1983.01790090075012. [DOI] [PubMed] [Google Scholar]
  28. Lieberman J., Kane J. M., Woerner M., Weinhold P. Prevalence of tardive dyskinesia in elderly samples. Psychopharmacol Bull. 1984 Winter;20(1):22–26. [PubMed] [Google Scholar]
  29. Richardson M. A., Craig T. J. The coexistence of parkinsonism-like symptoms and tardive dyskinesia. Am J Psychiatry. 1982 Mar;139(3):341–343. doi: 10.1176/ajp.139.3.341. [DOI] [PubMed] [Google Scholar]
  30. SIGWALD J., BOUTTIER D., RAYMONDEAUD C., PIOT C. [4 Cases of facio-bucco-linguo-masticatory dyskinesis of prolonged development following treatment with neuroleptics]. Rev Neurol (Paris) 1959 Jun;100:751–755. [PubMed] [Google Scholar]
  31. STOLZE R., ULE G. Die Bedeutung der Trigeminusdegeneration für die Sprachstörung bei der hereditären Ataxie. Nervenarzt. 1957 Jan 20;28(1):35–36. [PubMed] [Google Scholar]
  32. Schooler N. R., Kane J. M. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982 Apr;39(4):486–487. doi: 10.1001/archpsyc.1982.04290040080014. [DOI] [PubMed] [Google Scholar]
  33. Smith J. M., Baldessarini R. J. Changes in prevalence, severity, and recovery in tardive dyskinesia with age. Arch Gen Psychiatry. 1980 Dec;37(12):1368–1373. doi: 10.1001/archpsyc.1980.01780250054006. [DOI] [PubMed] [Google Scholar]

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