A large-scale, prospective study of tardive dyskinesia (TD) was performed in 11 psychiatric facilities in Japan. A total of 1595 psychiatric patients were enrolled in this study in 1987. The progress of these patients, with the exception of 490 dropouts, has now been followed up to 1988. The prevalence of TD at study entry was 7.6%, the annual incidence rate was 3.7% and the annual remission rate was 28.7%. Newly developed TD patients tended to be older, to have undergone more psychosurgery, and to have had lower neuroleptic doses than the patients who had not developed TD, whereas no specific variable could be detected as a factor associated with remission of TD. The results suggest that the incidence of TD is lower in Japan than that in Europe and North America.

Involuntary movement disorders were investigated in a psychiatric hospital in Japan. The prevalence of tardive dyskinesia was 9.9% and four clinical variants of tardive dyskinesia could be classified. Of the 716 patients, tardive dystonia was identified in 15 cases, tardive akathisia in one, respiratory dyskinesia in two and rabbit syndrome in 17. The existence of tardive forms for acute dystonic reactions and akathisia suggests that any type of acute extrapyramidal symptoms can have a tardive form.

An open clinical trial of caerulein diethylamine, a cholecystokinin analogue, was performed in a total of 58 chronic schizophrenic patients maintained on drugs such as antipsychotic agents without dosage modification. The neuro peptide medication by intramuscular route produced a clinical improvement in 20 cases and was eventually assessed to have been of therapeutic value in 23 cases. Clinical responses to the medication observed in the present series in cluded: subjective changes in mood mostly to become feeling "fine" or "re freshed in the head", improvement in contact, increased spontaneity and objective behavioral changes such as restlessness and excitement. These features of clinical responses observed in respect of mental condition seem to indicate that the drug affects emotion and exerts an analeptic effect as its principal clinical effects. The clinical effects were remarkably long sustained for 1-2 weeks after a single i.m. dose in most responders. Feeling of facial warmth and lassitude as well as symptoms of the gastrointestinal system were encountered as attendant symptoms in 6 cases.

The authors applied a statistical method to subclassify tardive dyskinesia (TD) in 71 psychiatric patients. Based on two-step statistical procedures and findings reported previously, TD is considered to consist of 2 subgroups: a classical dyskinesic group and a dystonic group. Symptoms manifested in the former group are seen most frequently in the oral region while the latter group, which is usually called tardive dystonia, is manifested by movement disorders in the trunk and extremities, predominantly. Abnormal movements occurring in the facial region characterize a population whose members may belong to either group.

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