Tardive dyskinesia

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Obesity, Sleep & Internal medicine
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Tardive dyskinesia
Dopamine
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Involuntary movements, especially of the lower face
Complications	Social stigma, impaired quality of life
Onset	Months to years after starting antipsychotic medication
Duration	Often chronic
Types	Tardive dystonia, Tardive akathisia
Causes	Long-term use of dopamine receptor blocking agents
Risks	Use of antipsychotics, older age, female gender
Diagnosis	Clinical evaluation
Differential diagnosis	Parkinson's disease, Huntington's disease, Tourette syndrome
Prevention	Use of lowest effective dose of antipsychotics, regular monitoring
Treatment	Discontinuation or reduction of causative agent, use of VMAT2 inhibitors
Medication	Valbenazine, Deutetrabenazine
Prognosis	Variable; some cases improve, others persist
Frequency	20-30% of patients on long-term antipsychotics
Deaths	N/A

Tardive dyskinesia is a neurological disorder characterized by involuntary, repetitive body movements. These movements can include grimacing, tongue movements, lip smacking, and rapid eye blinking. The condition is often associated with long-term use of antipsychotic medications, particularly the older, first-generation antipsychotics.

Pathophysiology

Tardive dyskinesia is believed to result from the long-term blockade of dopamine receptors in the brain. Antipsychotic medications, which are used to treat conditions such as schizophrenia and bipolar disorder, often target dopamine receptors to reduce symptoms of psychosis. However, chronic use of these medications can lead to an imbalance in the dopaminergic system, resulting in the development of tardive dyskinesia.

Symptoms

The symptoms of tardive dyskinesia can vary in severity and may include:

• Involuntary movements of the face, such as grimacing and lip smacking.
• Rapid eye blinking.
• Tongue movements, including protrusion and rolling.
• Involuntary movements of the limbs and trunk.

Diagnosis

Diagnosis of tardive dyskinesia is primarily clinical, based on the observation of characteristic involuntary movements. A thorough medical history and review of medication use are essential to differentiate tardive dyskinesia from other movement disorders.

Treatment

Treatment of tardive dyskinesia involves discontinuing or reducing the dose of the offending antipsychotic medication, if possible. Switching to a newer, atypical antipsychotic with a lower risk of causing tardive dyskinesia may also be beneficial. In some cases, medications such as tetrabenazine or valbenazine may be used to manage symptoms.

Prevention

Preventing tardive dyskinesia involves careful monitoring of patients on antipsychotic medications, using the lowest effective dose, and regularly assessing the need for continued treatment. Early detection of symptoms can help mitigate the progression of the disorder.

See also

• Antipsychotic
• Dopamine
• Schizophrenia
• Bipolar disorder