Tardive Dyskinesia in the Era of Typical and Atypical Antipsychotics. Part 2: Incidence and Management Strategies in Patients with Schizophrenia

Abstract

Objective: Tardive dyskinesia (TD), the principal adverse effect of long-term conventional antipsychotic treatment, can be debilitating and, in many cases, persistent. We sought to explore the incidence and management of TD in the era of atypical antipsychotics because it remains an important iatrogenic adverse effect. Methods:We conducted a review of TD incidence and management literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, management, therapy, neuroleptics, antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. Additional articles were obtained by searching the bibliographies of relevant references. We considered articles that contributed to the current understanding of both the incidence of TD with atypical antipsychotics and management strategies for TD. Results:The incidence of TD is significantly lower with atypical, compared with typical, antipsychotics, but cases of de novo TD have been identified. Evidence suggests that atypical antipsychotic therapy ameliorates long-standing TD. This paper outlines management strategies for TD in patients with schizophrenia.

Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy

“…This also remains a challenge for long-term studies on TD. Despite validated methods to diagnose TD based on similarities with L -DOPA-induced dyskinesia, the existence of TD was contested [1,210,211]. TD was once considered to be a manifestation of schizophrenic motor mannerisms existing before FGAs.…”

Atypical Antipsychotics: CATIE Study, Drug-Induced Movement Disorder and Resulting Iatrogenic Psychiatric-Like Symptoms, Supersensitivity Rebound Psychosis and Withdrawal Discontinuation Syndromes

“…Considered as the most significant side effect of classical antipsychotics, TD has been associated with antipsychotics and gastrointestinal neuroleptics, and usually occurs after several years of treatment. Persistent TD can also occur after short-term exposure to classical antipsychotics and gastrointestinal neuroleptics even at low doses and for as few as 2 months [8,21,22,23], while reversible and withdrawal dyskinesias share properties with levodopa-induced dyskinesia [24]. We conducted several epidemiological studies of TD [4,25,26,27] and in 1975, using the National Institute of Mental Health (NIMH) psychopharmacology criteria, we found a 31% prevalence of TD in 261 outpatients with schizophrenia [25].…”

S33138 [N-[4-[2-[(3aS,9bR)-8-cyano-1,3a,4,9b-tetrahydro[1]-benzopyrano[3,4-c]pyrrol-2(3H)-yl)-ethyl]phenylacetamide], A Preferential Dopamine D3versus D2Receptor Antagonist and Potential Antipsychotic Agent: I. Receptor-Binding Profile and Functional Actions at G-Protein-Coupled Receptors

“…However, some 20 to 30% of patients are resistant, and efficacy against negative and cognitive symptoms is limited. Furthermore, there is only a modest therapeutic window to doses provoking extrapyramidal motor symptoms (EPSs), and long-term utilization may be associated with the development of irreversible tardive dyskinesia (Dean and Scarr, 2004;Lieberman et al, 2005;Margolese et al, 2005). The "atypical" antipsychotic, clozapine, which potently interacts with several classes of monoaminergic receptor, is active in certain neuroleptic-refractory patients, does not elicit EPS, and is more effective than haloperidol against negative symptoms (Dean and Scarr, 2004;Meltzer, 2004;Lieberman et al, 2005).…”

“…A number of other multireceptorial antipsychotics have been introduced with similar, although not identical, broad-based receptorbinding profiles: notably, olanzapine and risperidone (Millan et al, 2000a;Dean and Scarr, 2004;Lieberman et al, 2005;McCue et al, 2006). However, despite their undeniable utility, they do not fully reproduce the clinical benefits of clozapine, and therapeutic indexes to doses eliciting undesirable actions are limited; in particular, EPS for risperidone and obesity for olanzapine (Dean and Scarr, 2004;Lieberman et al, 2005;Margolese et al, 2005). Moreover, although the more recently launched partial dopaminergic agonist, aripiprazole, is well tolerated, its efficacy is not superior to that of other agents (Abi-Dargham and Laruelle, 2005;Burstein et al, 2005;McCue et al, 2006;Urban et al, 2007b).…”