Makindo Medical Notes.com

Newer antipsychotics such as olanzapine and risperidone appear to have less risk

About

• Occurs months to years after drug treatment and so-called tardive dyskinesia
• Advanced age is a major risk factor for TD

Aetiology

• Long term treatment with Dopamine blocker drugs
• Usually in those treated with antipsychotics e.g. schizophrenia
• May be a genetic component

Clinical

• Involuntary Movements: The hallmark of TD is the presence of involuntary, repetitive movements, which can include:
• Facial Movements: Grimacing, lip-smacking, chewing motions, and rapid eye blinking.
• Tongue Movements: Protrusion, thrusting, or rolling of the tongue.
• Limb Movements: Less commonly, patients may experience movements of the fingers, arms, legs, or trunk, such as tapping, jerking, or writhing.
• Chronic Condition: TD is often persistent and can be difficult to manage, even after the offending drug is discontinued.
• Onset: TD typically develops after months or years of antipsychotic medication use. It may also appear after the medication is reduced or stopped, a phenomenon known as "withdrawal dyskinesia."

Causes

• Antipsychotic Medications:
• Typical Antipsychotics: haloperidol, chlorpromazine, and fluphenazine are strongly associated with TD.
• Atypical Antipsychotics: While less common, newer antipsychotics like risperidone, olanzapine, and aripiprazole can also cause TD, especially at high doses or with long-term use.
• Other Medications: Some other medications, such as metoclopramide (used for nausea) and certain antidepressants, can also cause or contribute to the development of TD.

Investigations

• Exclude Wilson's disease: serum copper, serum ceruloplasmin

Management

• Medication Adjustment: Reducing or discontinuing the offending drug may help, though symptoms can sometimes persist.
• Medications for TD: Specific treatments like valbenazine or deutetrabenazine may help reduce symptoms.
• Supportive Therapies: Speech and physical therapy can help manage symptoms and improve quality of life.
• Variable Outcomes: Some individuals may experience partial or full resolution of symptoms after discontinuing the offending medication, while others may have persistent symptoms.
• Chronic Condition: For many, TD can be a long-term condition that requires ongoing management.

References