Tardive dyskinesia (TD) is a delayed movement disorder resulting from treatment with dopamine receptor–blocking medications, Dr Karen Anderson of Georgetown University School of Medicine explains. TD is most commonly associated with long-term use of antipsychotic drugs.
TD is characterized by involuntary, jerking movements of the tongue, lips, face, trunk, extremities, or the whole body. Although its characteristic movements are sometimes viewed as cosmetic, TD can interfere with patients’ quality of life and add to the stigma of mental illness.
The sooner TD is diagnosed, the more likely it is for patients to achieve remission spontaneously and without treatment. To that end, patients who are prescribed antipsychotic medication should be evaluated at baseline and regularly thereafter using the Abnormal Involuntary Movement Scale (AIMS), which rates abnormal movements.
The optimal first step in TD management is to stop the dopamine receptor–blocking medication, but this option may not be possible in patients with chronic conditions, such as manic depression and schizophrenia. In these patients, dose reduction or switching to a newer antipsychotic may provide relief.
Two vesicular monoamine transporter 2 (VMAT2) inhibitors are approved to treat TD and have been found to not worsen patients’ underlying psychiatric condition. Dr Anderson cautions that patients treated with a VMAT2 inhibitor will require monitoring because side effects of these agents include suicidal ideation.
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Karen Anderson, MD, Professor, Department of Psychiatry and Neurology, Georgetown University School of Medicine; Washington, DC
Karen Anderson, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Neurocrine; Teva