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Tardive Dyskinesia

(TD)

Definition

Tardive dyskinesia (TD) is a neurologic syndrome. It results from using neuroleptic drugs—also called antipsychotic drugs. This class of drugs is used to treat psychiatric conditions, like schizophrenia. TD consists of a group of symptoms including:

Causes

It is unclear exactly why Tardive dyskinesia develops. Long-term use of neuroleptic drugs can cause changes in the brain chemistry that lead to the symptoms. Nerve cells may also become overly sensitive to certain substances. Not everyone who takes these drugs develops TD.

Risk Factors

Tardive dyskinesia (TD) is more common in women and in people over the age of 54. Other factors that may increase your risk of TD include:

Symptoms

Tardive dyskinesia (TD) causes repetitive movements. Movements usually occur in the face, mouth, limbs, or trunk. The movements are involuntary and serve no purpose. They may occur occasionally or all of the time. They may or may not be noticeable. Symptoms may begin while on the drug or within weeks of stopping it.
Symptoms may include:
They can worsen with:
Symptoms may decrease with:

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Other disorders can cause symptoms similar to those of Tardive dyskinesia (TD). The doctor will rule out other disorders before making a diagnosis. There is no specific test for TD.
Tests to rule out other disorders may include:
CT Scan of the Head
CT Scan of the Head
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Treatment

To treat Tardive dyskinesia, your doctor may:
Symptoms may decrease over time even if you continue to take the neuroleptic drug. Younger people tend to do better.

Medication

Some medications may help decrease symptoms, such as:
  • Trihexyphenidyl
  • Reserpine
  • Propranolol
  • Clonidine
  • Baclofen
  • Sedatives
  • Antiseizure drugs
  • Antipsychotic drugs that may help with movement disorders
  • Melatonin
  • Diphenhydramine

Surgery

Deep Brain Stimulation (DBS) is being evaluated for the treatment of Tardive dyskinesia.

Prevention

If you need neuroleptic drugs to control a psychiatric disorder, consider these guidelines to help prevent Tardive dyskinesia (TD):

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.ontario.cmha.ca

Mental Health Canada http://www.mentalhealthcanada.com

References

Bai YM, Yu SC, et al. 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, et al. 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, et al. 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 website. Available at: http://www.ebscohost.com/dynamed. Updated November 23, 2011. Accessed July 29, 2013.

Thema B, Srivastava V, et al. Genetic underpinnings of tardive dyskinesias: passing the baton to pharmacogenetics. Pharmacogenomics. 2008;9(9):1285-1306.

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