Spectrum of tardive syndromes: clinical recognition and management

Abstract

Tardive syndrome (TS) refers to a group of delayed onset disorders characterised by abnormal movements and caused by dopamine receptor blocking agents (DRBAs). Classical tardive dyskinesia is a specific type of oro-buccal-lingual dyskinesia. However, TS may exist in other forms--for example, stereotypy, dystonia, and akathisia--and frequently occur in combination. The onset typically is insidious and after reaching its maximum severity it often stabilises. Frequently reported risk factors are age, dose and duration of neuroleptic exposure, the use of conventional DRBAs, and co-existing mood disorders. This review highlights the broad spectrum of TS, not limited to classical tardive dyskinesia, as well as the clues for its recognition. Despite challenges in the treatment of TS, dictated by the different phenomenology, severity of TS and the need for ongoing neuroleptic treatment, the authors provide evidence based recommendations for patient management, which is not restricted to only withdrawal of the offending neuroleptics or the selection of an alternative medication, such as clozapine. In a minority of cases with significant functional disability, symptomatic or suppressive treatments should be considered. Recently, there has been a resurgence of stereotactic pallidal surgery for the treatment of TS. Although the efficacy of both pallidotomy and pallidal deep brain stimulation in dystonia has been encouraging, the evidence is still limited.

Tardive dyskinesia in long term hospitalized patients with schizophrenia

“…Although results in the literature about the relationship between gender and TD prevalence were different; in recent years a high risk was reported in postmenopausal women (14). Besides, age and gender, additional neurological disease, high dose antipsychotics, mood disorders, negative symptoms, alcohol and drug use and diabetes are other risk factors for TD (15,16). Another risk factor for TD is prolonged use of antipsychotics.…”

Antipsychotic-Induced Tardive Syndromes: Clinical Features and Treatment Approaches

“…Tercih edilen tedavi, antipsikotik dozajını düşürmektir veya kesmektir. 5 Ancak, bu strateji birçok hasta için klinik olarak gerçekçi değildir. Antikolinerjik ajanların eklenmesi yararlı olmaz.…”

“…Bunlar, geç diskinezinin klasik formu dışında distoni, akatizi, parkinsonizm, tremor, miyoklonus, tik bozukluğu gibi fenomenolojik ve deskriptif olarak farklı tablolardır. 4,5 …”

Antipsychotikainduzierte tardive Syndrome

“…Dies könnte darauf zurückzuführen sein, dass NGA eine im Vergleich zu Dopamin stär-kere Serotoninrezeptorblockade aufweisen und diese starken serotonergen Blockaden mit weniger EPMS assoziiert sind [20]. Darüber hinaus werden auch Zusammenhänge zwischen TD, afroamerikanischer Herkunft, dem Vorliegen affektiver sowie organischpsychiatrischer Störungen, Diabetes sowie Alkoholund Kokainkonsum in der Anamnese beschrieben [21].…”