Tardive Dyskinesia

(TD)

Definition

Tardive dyskinesia (TD) is a movement disorder. It results from using medicines used to treat psychiatric problems, like schizophrenia.

TD causes repeating movements you can’t control. They may affect the face, limbs, or trunk.

Causes    TOP

TD is caused by chronic use of certain antipsychotic medicines.

It is not known why TD happens. Not all people who take these drugs get TD.

Risk Factors    TOP

TD is more common in women. It is also more common in older adults. Other things that may raise your risk are:

  • Use of antipsychotics, especially if the drugs:
    • Are taken in high doses for longer than six months
    • Are first-generation drugs, which are the first drugs made to treat a condition
  • Symptoms that begin or get worse after you reduce or stop the medicine

Symptoms    TOP

Movements may be once and a while or all of the time. They may or may not be noticed by others. Symptoms may start while on the medicine or within weeks of stopping it.

You may have:

  • Facial movements:
    • Chewing
    • Smacking, pursing, or puckering your lips
    • Frowning
    • Sticking out or twisting your tongue
  • Limb movements:
    • Flexing and extending the thighs
    • Foot tapping while sitting
    • Moving fingers as if playing the piano
    • Rubbing your hands together
  • Trunk movements:
    • Swaying the body
    • Pelvic thrusts

Diagnosis    TOP

The doctor will ask about your symptoms and health history. A physical exam will be done. There is no specific test for TD. It is suspected if you are taking these medicines and have movements you can’t control.

Tests to rule out other disorders may include:

CT Scan of the Head

CT Scan of the Head
Copyright © Nucleus Medical Media, Inc.

Treatment    TOP

To treat TD, your doctor may:

  • Stop the medicine that is causing it
  • Lower the dose
  • Switch you to a another medicine
  • Recommend vitamin B6 or vitamin E, which may lower the risk of problems

Symptoms may get better over time even if you keep taking the medicine. Younger people tend to do better.

Medication

Some medicines may help lower symptoms, such as:

  • Tetrabenazine
  • Reserpine
  • Clonidine
  • Antipsychotic drugs that may help with movement problems
  • Melatonin

Surgery

Deep Brain Stimulation (DBS) may be used on people who do not respond to medicine.

Prevention    TOP

To help reduce your chances of TD from an antipsychotic drug:

  • Talk with your doctor about:
    • Risks and benefits of the medicine
    • Whether the dose is right for you and how well the drug is working
    • Other medicines you can try that have less risk of TD
    • Whether you can take a drug holiday to take a break from using the medicine
    • For even a small symptom of TD that you have—early treatment works best
  • Do not stop taking your medicine without first talking to your doctor. it may set off TD.
  • See your doctor on a regular basis as advised.

RESOURCES:

National Alliance on Mental Illness
http://www.nami.org
National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.cmha.ca

References:

Bai YM, Yu SC, Linn CC. Risperidone for severe tardive dyskinesia: A 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2003;64(11):1342-1348.
Damier P. Drug-induced dyskinesias. Curr Opin Neurol. 2009;22(4):394-399.
Kinon BJ, Jeste DV, Kollack-Walker S, Stauffer V, Liu-Seifert H. Olanzapine treatment for tardive dyskinesia in schizophrenia patients: a prospective clinical trial with patients randomized to blinded dose reduction periods. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28(6):985-996.
McGrath JJ, Soares KV. Neuroleptic reduction and/or cessation and neuroleptics as specific treatments for tardive dyskinesia. Cochrane Database Syst Rev. 2006;(1):CD000459.
Meco G, Fabrizio E, Epifanio A. Levetiracetam in tardive dyskinesia. Clin Neuropharmacol. 2006;29(5):265-268.
Pham DQ, Plakogiannis R. Vitamin E supplementation in Alzheimer’s disease, Parkinson’s disease, tardive dyskinesia, and cataract: Part 2. Ann Pharmacother. 2005;39(12):2065-2072.
Sachdev PS. The current status of tardive dyskinesia. Australian and New Zealand Journal of Psychiatry. 2000;34(3):355-369.
Soares KV, McGrath JJ. The treatment of tardive dyskinesia: A systematic review and meta-analysis. Izophr Res. 1999;39(1):1-16.
Tardive dyskinesia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T113751/Tardive-dyskinesia. Updated May 31, 2018. Accessed June 13, 2018.
Thema B, Srivastava V, Tiwari AK. Genetic underpinnings of tardive dyskinesias: passing the baton to pharmacogenetics. Pharmacogenomics. 2008;9(9):1285-1306.
Last reviewed June 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 6/13/2018

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