Tardive dyskinesia is characterized by repetitive, involuntary, potentially irreversible movements of the tongue, jaw, lips, trunk or limbs.
- choreiform – rapid, jerky, non repetitive
- athetoid – slow, sinuous, continual
- rhythmic - stereotypic
It is a serious side effect of long term use of drugs that block dopamine receptors particularly D2- receptors.
: 2-4% per year of exposure.
: 20% in patients receiving a typical anti psychotic for more than 3 months; it is most common in women, elderly and those on high doses. Less common in patients receiving atypical anti psychotics such as resperidone.
: worm – like movements of the tongue; inability to protrude tongue for more than a few seconds.
Responds poorly to treatment with drugs; withdrawal of the causal agent leads to resolution in 30% in 3 months and a further 40% in 5 years.
Some drugs to consider:
- Tetrabenazine: 12.5 mg to 25 mg q 8 h; increase the dose slowly to avoid troublesome hypotension.
- Levodopa may produce long-term benefit after causing initial deterioration.
Reus VI. Mental Disorders. Longo DL, Fauci AS, Kasper DL (Ed). Harrison’s Principles of Internal Medicine. 18th Edition, Volume 1, McGraw Hill, 2012, pp.3529-3545.