1.18 - Tardive dyskinesia and other late-onset movement disorders  pp. 123-128

Tardive dyskinesia and other late-onset movement disorders

By David M. Gardner, Michael D. Teehan and Ross Baldessarini

Image View Previous Chapter Next Chapter


Long-term use of antipsychotics can lead to delayed-onset movement disorders. Tardive dyskinesia (TD) is an involuntary movement disorder characterized by a variable mixture of dyskinetic movements typically involving the face, mouth, and tongue. Also common are tics, grimacing, truncal and axial muscle involvement, chorea, athetosis, and dystonias. Speech and respiration can be affected in severe cases. Also possible are tardive or chronic akathisia (a persistent sense of inner restlessness) and tardive dystonia (recurring, rapid-onset, often sustained muscle contractions causing abnormal twisting, contorting, and postures, e.g. torticollis, blepharospasm, oculogyric crisis, and spasms of the jaw, trunk, and extremities).

Determining that these movement disorders are related to antipsychotic treatment can be challenging in the absence of a documented pre-treatment assessment, as a variety of neuro-medical conditions can present with similar features. It has also been observed that untreated patients with schizophrenia have a higher incidence of abnormal movement disorders.

However, the evidence implicating some antipsychotic agents as the primary cause of TD is beyond challenge. Most long-term studies of first-generation antipsychotics indicate that the rate of TD appears to be dependent on dosage and duration of treatment. Tardive dyskinesia can be irreversible. However, this risk is reduced when treatment is stopped or switched to an antipsychotic with low TD liability as soon as symptoms present.

Prevention and a rapid response to emerging signs of TD are vital in minimizing this side effect, as effective treatment modalities are lacking.

Abbasian C , Power P . A case of aripiprazole and tardive dyskinesia. J Psychopharmacol 2009;23(2):214–15.
Adityanjee , Aderibigbe YA , Jampala VC , Mathews T . The current status of tardive dystonia. Biol Psychiatry 1999;45(6):715–30.
American Psychiatric Association . Tardive Dyskinesia: a Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
Anonymous . Aripiprazole improves neuroleptic-associated tardive dyskinesia, but it does not meliorate psychotic symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2008;32(5):1342–3.
Bristol-Myers Squibb , Otsuka America Pharmaceutical . Abilify (Aripiprazole) U.S. Full Prescribing Information. Tokyo, Japan: Otsuka Pharmaceutical Co., Ltd.; 2008.
Caykoylu A , Ekinci O , Yilmaz E . Resolution of risperidone-induced tardive dyskinesia with a switch to aripiprazole monotherapy. Prog Neuropsychopharmacol Biol Psychiatry 2009;33(3):571–2.
Correll CU , Leucht S , Kane JM . Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. Am J Psychiatry 2004;161(3):414–25.
Correll CU , Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry 2008;21(2):151–6.
Duggal HS. Aripiprazole-induced improvement in tardive dyskinesia. Can J Psychiatry 2003;48(11):771–2.
Evcimen YA , Evcimen H , Holland J . Aripiprazole-induced tardive dyskinesia: the role of tamoxifen. Am J Psychiatry 2007;164(9):1436–7.
Gardos G , Cole JO. Severe tardive dyskinesia. In Young RR , Joseph AB , eds., Movement Disorders in Neurology and Neuropsychiatry, 3rd edn. Malden, MA: Blackwell Science, Inc.; 1999.
Grant MJ , Baldessarini RJ . Possible improvement of neuroleptic-associated tardive dyskinesia during treatment with aripiprazole. Ann Pharmacother 2005;39(11):1953.
Jenner P , Marsden CD. Neuroleptic-induced tardive dyskinesia. Acta Psychiatr Belg 1987;87(5):566–98.
Jeste DV , Okamoto A , Napolitano J , Kane JM , Martinez RA . Low incidence of persistent tardive dyskinesia in elderly patients with dementia treated with risperidone. Am J Psychiatry 2000;157(7):1150–5.
Jeste DV. Tardive dyskinesia rates with atypical antipsychotics in older adults. J Clin Psychiatry 2004;65 Suppl. 9:21–4.
Kane JM. Tardive dyskinesia. In Young RR , Joseph AB , eds., Movement Disorders in Neurology and Neuropsychiatry, 3rd edn. Malden, MA: Blackwell Science, Inc.; 1999.
Kantrowitz JT , Srihari VH , Tek C . Resolution of tardive dyskinesia after addition of aripiprazole to haloperidol depot. J Clin Psychopharmacol 2007;27(5):525–6.
Kinon B , Jeste DV , Stauffer V , et al. Olanzapine improves tardive dyskinesia in patients with schizophrenia (abstract). In 155th Annual Meeting of the American Psychiatric Association, May 18–23, 2002; Philadelphia, PA.
Lungu C , Aia PG , Shih LC , Esper CD , Factor SA , Tarsy D . Tardive dyskinesia due to aripiprazole: report of 2 cases. J Clin Psychopharmacol 2009;29(2):185–6.
Lykouras L , Rizos E , Gournellis R . Aripiprazole in the treatment of tardive dyskinesia induced by other atypical antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry 2007;31(7):1535–6.
Miller del D , Caroff SN , Davis SM , et al. Extrapyramidal side-effects of antipsychotics in a randomised trial. Br J Psychiatry 2008;193(4):279–88.
Novick D , Haro JM , Perrin E , Suarez D , Texeira JM . Tolerability of outpatient antipsychotic treatment: 36-month results from the European Schizophrenia Outpatient Health Outcomes (SOHO) study. Eur Neuropsychopharmacol 2009;19(8):542–50.
Oosthuizen PP , Emsley RA , Maritz JS , Turner JA , Keyter N . Incidence of tardive dyskinesia in first-episode psychosis patients treated with low-dose haloperidol. J Clin Psychiatry 2003;64(9):1075–80.
Owens DG , Johnstone EC , Frith CD . Spontaneous involuntary disorders of movement: their prevalence, severity, and distribution in chronic schizophrenics with and without treatment with neuroleptics. Arch Gen Psychiatry 1982;39(4):452–61.
Rajarethinam R , Dziuba J , Manji S , Pizzuti A , Lachover L , Keshavan M . Use of aripiprazole in tardive dyskinesia: an open label study of six cases. World J Biol Psychiatry 2009;10:416–19.
Sharma A , Ramaswamy S , Dewan VK . Resolution of ziprasidone-related tardive dyskinesia with a switch to aripiprazole. Prim Care Companion J Clin Psychiatry 2005;7(1):36.
Spivak B , Mester R , Abesgaus J , et al. Clozapine treatment for neuroleptic-induced tardive dyskinesia, parkinsonism, and chronic akathisia in schizophrenic patients. J Clin Psychiatry 1997;58(7):318–22.
Tamminga CA , Thaker GK , Moran M , Kakigi T , Gao XM. Clozapine in tardive dyskinesia: observations from human and animal model studies. J Clin Psychiatry 1994;55 Suppl. B:102–6.
Tarsy D . Akathisia . In Young RR , Joseph AB , eds., Movement Disorders in Neurology and Neuropsychiatry, 3rd edn. Malden, MA: Blackwell Science, Inc.; 1999.
Tollefson GD , Birkett MA , Kiesler GM , Wood AJ , Lilly Resistant Schizophrenia Study Group . Double-blind comparison of olanzapine versus clozapine in schizophrenic patients clinically eligible for treatment with clozapine. Biol Psychiatry 2001;49(1):52–63.
Wang LJ , Ree SC , Chen CK . Courses of aripiprazole-associated tardive dyskinesia: report of two cases. Prog Neuropsychopharmacol Biol Psychiatry 2009;33(4):743–4.
Witschy JK , Winter AS. Improvement in tardive dyskinesia with aripiprazole use. Can J Psychiatry 2005;50(3):188.