Find information on thousands of medical conditions and prescription drugs.

Tardive dyskinesia

Tardive dyskinesia is a serious neurological disorder caused by the long-term and/or high-dose use of dopamine antagonists, usually antipsychotics and among them especially the typical antipsychotics. These neuroleptic drugs are generally prescribed for serious psychiatric disorders. The older typical antipsychotics, which appear to cause tardive dyskinesia somewhat more often than the newer atypical antipsychotics, are being prescribed less frequently. There are some new uses, however, such as year-long implants that are being developed using the older typicals, e.g. more...

Home
Diseases
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
Candidiasis
Tachycardia
Taeniasis
Talipes equinovarus
TAR syndrome
Tardive dyskinesia
Tarsal tunnel syndrome
Tay syndrome ichthyosis
Tay-Sachs disease
Telangiectasia
Telangiectasia,...
TEN
Teratoma
Teratophobia
Testotoxicosis
Tetanus
Tetraploidy
Thalassemia
Thalassemia major
Thalassemia minor
Thalassophobia
Thanatophobia
Thoracic outlet syndrome
Thrombocytopenia
Thrombocytosis
Thrombotic...
Thymoma
Thyroid cancer
Tick paralysis
Tick-borne encephalitis
Tietz syndrome
Tinnitus
Todd's paralysis
Topophobia
Torticollis
Touraine-Solente-Golé...
Tourette syndrome
Toxic shock syndrome
Toxocariasis
Toxoplasmosis
Tracheoesophageal fistula
Trachoma
Transient...
Transient Global Amnesia
Transposition of great...
Transverse myelitis
Traumatophobia
Treacher Collins syndrome
Tremor hereditary essential
Trichinellosis
Trichinosis
Trichomoniasis
Trichotillomania
Tricuspid atresia
Trigeminal neuralgia
Trigger thumb
Trimethylaminuria
Triplo X Syndrome
Triploidy
Trisomy
Tropical sprue
Tropophobia
Trypanophobia
Tuberculosis
Tuberous Sclerosis
Tularemia
Tungiasis
Turcot syndrome
Turner's syndrome
Typhoid
Typhus
Tyrosinemia
U
V
W
X
Y
Z
Medicines

, Haldol®, one of the worst offenders when it comes to tardive dyskinesia. Other dopamine antagonists that can cause tardive dyskinesia are drugs for gastrointestinal disorders (for example metoclopramide) and neurological disorders. Some drugs that are not intended to affect dopamine, such as SSRI antidepressants, may also cause tardive dyskinesia. The new generation of atypical antipsychotics appears to cause tardive dyskinesia somewhat less frequently (though they may cause serious metabolic disorders, e.g., diabetes, frequently enough to make them equally dangerous).

The term tardive dyskinesia was introduced in 1964. Dyskinesia means "abnormal movement" and tardive means "late", signifying that the dyskinesia only occurs after some time has elapsed following initial administration of the neuroleptic drug.

Features

Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano. Many of the symptoms of tardive dyskinesia appear similar to Parkinson's disease.

Cause

The cause of tardive dyskinesia appears to be related to damage — due to the use of antipsychotic medications — to the system that uses and processes the neurotransmitter dopamine. It is thought that postsynaptic dopaminergic receptors become supersensitive to stimulation during neuroleptic treatment and that this supersensitivity causes the symptoms of tardive dyskinesia. The available research seems to suggest that the concurrent prophylactical use of a neuroleptic and an antiparkinsonian drug is useless to avoid early extrapyramidal side-effects and may render the patient more sensitive to tardive dyskinesia.

Treatment

Primary prevention of tardive dyskinesia is achieved by using the lowest effective dose of a neuroleptic for the shortest time. If tardive dyskinesia is diagnosed, the causative drug should be reduced or discontinued if possible. Tardive dyskinesia may persist after withdrawal of the 'offending neuroleptic' for months, years, or even permanently. There is no known cure for tardive dyskinesia, but preliminary research suggests that the atypical neuroleptic Clozaril (Clozapine®) may improve the state of the patient. Improvements are also seen in some cases, if the high potency benzodiazepines - lorazepam (Ativan®), diazepam (Valium®), or clonazepam (Klonopin®)—are used. The findings about the effects of natural substances, such as vitamin E (Alpha-Tocopherol) or melatonin, are inconclusive. Treatment with adrenergic blocking agents and dopamine agonists like bromocriptin also remains somewhat controversial. There have been some reports of promising effects from the drug tetrabenazine (a different kind of neuroleptic). On the contrary, most antiparkinsonian drugs worsen the state of the patient.

Read more at Wikipedia.org


[List your site here Free!]


New report offers antipsychotic guidelines - American Psychiatric Association task force report on tardive dyskinesia, the movement disorder caused by
From Science News, 5/11/91 by Bruce Bower

Lawsuits filed by patients who develop a severe movement disorder during anti-psychotic-drug treatment greatly increased over the past decade. A specially convened American Psychiatric Association (APA) task force has just completed a report stressing clinical vigilance and caution as keys to preventing and treating tardive dyskinesia, the potentially debilitating disorder that can accompany use of neuroleptics, a class of drugs that often quell psychotic symptoms.

Physicians prescribe neuroleptics for as many as 3 million people in the United States each year. Many of their patients suffer from schizophrenia, although a substantial minority includes individuals with mental retardation, severe depression, organic brain disorders and autism. Neuroleptics often quell aggressive and assaultive behavior as well.

No effective treatment currently exists for the tardive dyskinesia that often develops after several months of neuroleptic treatment. Rapid, involuntary twitching or jerking of the mouth, lips, tongue, limbs or trunk characterizes this condition, whose symptoms often appear most clearly when drug use stops. Neuroleptic drugs may also trigger tardive dystonia, a slower twisting and writhing of the head, neck and other body parts.

Lawyers involved in litigation over the development of tardive dyskinesia look forward to seeing the new psychiatric task force report, slated for fall publication by the American Psychiatric Press in Washington, D.C. Most doubt, however, that the report's recommendations will adequately protect patients from developing tardive dyskinesia or provide an enforceable standard of practice for prescribing the drugs that are responsible, says Irwin Birnbaum. The Syracuse, N.Y.-based lawyer co-chairs the Association of Trial Lawyers of America tardive-dyskinesia-litigation group.

"Physicians are caught in a dilemma," says APA task force chairman John M. Kane of Long Island Jewish Medical Center in Glen Oaks, N.Y. "There's a high risk of relapse among schizophrenic patients treated with neuroleptics and then taken off medication, but there's the risk of tardive dyskinesia for those who continue to take the drugs."

SCIENCE NEWS obtained a summary of APA's new tardive-dyskinesia recommendations, contained in a nearly 400-page follow-up to a 1980 task force report on the same subject. The new report notes that roughly 20 percent of patients taking neuroleptics develop some tardive dyskinesia, with about 10 percent of those suffering moderate to severe symptoms. Among prolonged users of the drugs, tardive dyskinesia incidence rises about 4 percent annually, according to an ongoing study directed by Kane.

Psychiatrists should inform neuroleptic-treated patients and their families about the risk of tardive dyskinesia "as soon as clinically feasible," and look for early signs of the disorder every three to six months, the report states. Where symptoms occur, and clinicians have ruled out non-neuroleptic causes, the report recommends that physicians discuss benefits and risks of further drug use with patients -- and, if necessary, their families -- to gain consent for continuing or halting drug treatment. And at every step in the process, the task force urges psychiatrists to write down their communications with patients and families, "at least in outline form."

Reduced doses or intermittent neuroleptic use may also lessen tardive dyskinesia (TD) symptoms, the report says, but researchers have yet to identify which patients respond to this best. Where symptoms worsen, the report suggests that physicians consider prescribing another neuroleptic recently approved for use in this country. Called clozapine, this drug poses little tardive dyskinesia risk, although about 1 percent of patients treated with it develop a potentially fatal immune disorder. Though psychiatrists have touted clozapine's benefits for schizophrenia sufferers who do not improve on other neuroleptics, the drug remains too expensive for many of the patients who need it most (SN: 5/26/90, p.334).

"If physicians follow these recommendations, there will be less TD, but the task force report doesn't go far enough," Birnbaum charges. Clinicians should also explore "drug holidays" for patients to see if tardive dyskinesia has developed and curtail chronic neuroleptic use, he argues. Moreover, drug firms should train psychiatrists in neuroleptic use and include inserts in all prescriptions warning patients that neuroleptics may cause a potentially irreversible neurological disorder, he asserts.

Kane opposes neuroleptic warning labels, emphasizing instead the need for consistent communication between clinicians and patients. "Neuroleptic benefits outweigh the risks in most instances," he contends.

COPYRIGHT 1991 Science Service, Inc.
COPYRIGHT 2004 Gale Group

Return to Tardive dyskinesia
Home Contact Resources Exchange Links ebay