Tardive dyskinesia

Background

  • Orofacial involuntary movements
    • Described as grimacing, writhing and choreathetoid
    • Grimacing, Tongue movements, Lip smacking, Excessive eye blinking
  • Often occurs after years of treatment with neuroleptic agents
  • Risk factors:
    • Longer duration of neuroleptic treatment
    • Concomitant mood disorder
    • Patient age, particularly elderly females

Evaluation

  • Clinical diagnosis

Differential Diagnosis

Management

  • Mild Symptoms: Cessation of the neuroleptic drug or decreasing the dose, which rarely reverses symptoms
  • Moderate to Severe Symptoms: Reserpine and tetrabenazine
  • New drug approved 2017
    • Austedo (deutetrabenazine), previously approved for chorea due to Huntington's disease
    • 12-48 mg/day PO divided BID, starting at 6 mg BID, increased by 6 mg/day qwk

See Also

References

  • Hockberger RS, Richards JR: Thought Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 110: p 1460-1466