SummaryTwo psychiatric patients developed moderate or severe oro-facial dyskinesia, and limb dyskinesia, at a relatively young age and within a year of starting antipsychotic drug-treatment. This early appearance of tardive dyskinesia was preceded by akathisia that had developed at the beginning of drug therapy and persisted, despite the reduction of their drug doses to maintenance levels. The possibility that persistent akathisia may herald the early onset of tardive dyskinesia, is discussed.KEY WORDS: schizophrenia, parkinsonism.
IntroductionTardive dyskinesia is a movement disorder associated with the administration of antipsychotic (dopamine antagonist) drugs and, as its name suggests, has been considered as a side-effect of late-onset. It is characterized by oro-facial and limb dyskinesia. Akathisia is a syndrome of motor restlessness also related to antipsychotic medication and usually described as an acute, dose-related phenomenon. In our recent study (Braude, Barnes and Gore, 1983) of akathisia developing during the in-patient treatment of acute psychiatric patients, the condition was invariably ameliorated by a reduction in drug dose. This finding is in accord with the clinical literature on akathisia which suggests that dosage reduction is the only consistently effective treatment strategy (Hodge, 1959;Raskin, 1972;Van Putten, 1974). In the two patients described here, akathisia persisted despite a reduction in the dose of their antipsychotic medication, from high doses of oral drugs during hospital admission to maintenance doses of depot preparations. This persistent akathisia heralded the early appearance of tardive dyskinesia.