Tardive Dyskinesia--Diagnostic Issues, Subsyndromes, and Concurrent Movement Disorders: A Study of State Hospital Inpatients Referred to a Movement Disorder Consultation Service

Abstract

Of 49 state hospital patients referred for movement disorder consultation for tardive dyskinesia (TD), 11 (23.9%) of 46 meeting inclusion criteria had movement disorders other than TD. These other disorders led to a false diagnosis of TD in 6 subjects (12.2%). Between-day dyskinesia variability affected TD ascertainment in only 3.2 percent of subjects. Prevalences of other neurological conditions in the 30 patients identified with definite TD were parkinsonism (90%), dystonia (25%), akathisia (16%), cerebellar signs (40%), dysmetria (23%), cerebellar tremor (17%), tardive dystonia (3.3%), and tardive akathisia (3.3%). Concurrence rates of parkinsonism with TD varied significantly according to which clinical signs were used to define parkinsonism. Using a rating score threshold of at least mild, rigidity occurred in 79.3 percent, bradykinesia in 55.2 percent, and resting tremor in 41.4 percent of subjects with TD; more significant rigidity occurred in 41.4 percent, bradykinesia in 31.0 percent, and resting tremor in 20.7 percent. Concurrence rates of neurological conditions with TD subsyndromes were distributed rather evenly according to condition prevalences, except for an association of cervicotruncal TD with bradykinesia (perhaps because of ventromedial striatal presynaptic and postsynaptic D2 blockade, respectively). These findings, as well as the occurrence of equal gender ratio and relative under-representation of bipolar and alcohol disorders in subjects with definite TD, are discussed.

Diagnostic Challenges Revealed from a Neuropsychiatry Movement Disorders Clinic

“…essential tremor and Parkinson's disease) increases with age 14 . The age of our patient sample is consistent with Lauterbach, et al 2 .…”

“…and 26% had DIP of which the residents only correctly identified TD in 12% and DIP in 11% of the sample. Additionally, Lauterbach, et al reported that of 49 hospitalized patients with TD seen for movement disorder consultation, 23.9% had movement disorders other than TD 2 . Collectively these studies demonstrate that there are issues with consistency in diagnosing movement disorders in a psychiatric population.…”

Instrument measurement of lingual force variability reflects tardive tongue dyskinesia

“…Neurological soft signs (and by inference cerebellar dysfunction) [31] are present in schizophrenia and mood disorders [32,33] and correlate with dyskinesia [34,35]. The relationship between drug-induced parkinsonism (including resting tremor) and TD remains unclear, since positive [36] as well as negative [37] associations have been reported. However, TD is measured in the 0-3 Hz frequency range and therefore unaffected by a resting tremor, which is measured in the 4-6 Hz frequency range [19,30].…”

Olanzapine/fluoxetine combination for bipolar depression

“…Discontinuation of a typical agent can 'unmask' pre-existing TD, and also may result in a transient withdrawal-type dyskinesia, which may be misinterpreted [38]. In addition, persons with schizophrenia have a small but finite rate of dyskinetic symptoms that are unrelated to drug exposure [39]. Rates of TD in neuroleptic-naive patients (which includes most persons with bipolar disorder), appear to be very low [40].…”