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Tardive Dyskinesia

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Topic presentation delivered to nursing home staff in Julesburg, CO

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Tardive Dyskinesia

  1. 1. TARDIVE DYSKINESIA What is Tardive Dyskinesia (TD)? o Neurological syndrome caused by long-term use of drugs to treat psychiatric disorders o Presents as repetitive, involuntary, and purposeless movements o Symptoms include: o Grimacing o Tongue protrusion o Lip smacking o Puckering or Pursing of the lips o Rapid eye blinking o Rapid movements of the arms o Rapid leg movement o Finger movements Parkinson’s Disease Symptoms o Often TD symptoms can be confused for parkinsonian movement disorders o Present as: o Resting tremors o Rigidity o Postural Instability o Bradykinesia
  2. 2. Psycosis o Dysfunction of the mesolimbic system caused by too much dopamine in the brain according to the dopaminergic hyperactivity theory o Medications for the treatment mental conditions block dopamine receptors o Blocking dopamine results in reduced amounts of dopamine or malfunctioning of receptors and causes extrapyramidal side effects o End result is decreased dopamine in mesocorticolimbic pathway and nigrostriatal pathway of the brain Parkinson’s Disease o Dysfunction in the nigrostriatal pathway caused by too little dopamine working in the body o For treatment, medications are used that provide extra dopamine o Side effects of the medication can cause psycosis from the increased dopamine in the mesocorticolimbic pathway in the brain
  3. 3. What medications cause TD? o Metoclopramide (Reglan®) o Trifluoperazine (Stelazine®) o Prochlorperazine (Compazine®) o Perphenazine (Trilafon®) o Promethazine (Phenergan®) o Fluphenazine (Prolixin®) o Chlorpromazine (Thorazine®) o Thiothixene (Navane®) o Haloperidol (Haldol®) o Thioridazine (Mellaril®)  Olanzapine (Zyprexa®)  Quetiapine (Seroquel®)  Risperidone (Risperdal®)  Amisulpride (Solian®) Selectivity of Psychiatric Medications o First Generation Antipsychotics o Known as DOPAMINE ANTAGONISTS o Bind and block multiple receptors in the brain including D1, D2, D4, and serotinergic receptors o When 60% of the D2 receptors are blocked, efficacy is reached. At 80% D2 receptor blockade, extrapyramidal side effects can be seen o Atypical Antipsychotics (Second Generation) o Known as SEROTONIN-DOPAMINE ANTAGONISTS o Have higher affinities for 5-HT2, D1 and D4 rather than D2 o Cause fewer extrapyramidal side effects o More specific for mesolimbic pathway o Thought to have faster dissociation from D2 receptors Treatment of TD: o Three basic approaches o Prevention o Diagnosis o Management o Discontinue medication or reduce dose o Change to different antipsychotic o Initiating benzodiazepine or vitamin E may relieve some of the patient’s symptoms o Benztropine may be used to treat extrapyramidal symptoms Distinguishing TD from other Movement disorders: o Youtube video demonstrates the symptoms of Parkinson’s disease http://www.youtube.com/watch?v=xuVY7wS25rc&feature=related o Youtube video demonstrates various TD symptoms and how to score them http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related o Using forms and scoring techniques, it is easier to document symptoms patients have and track progression o Remember that people with Parkinson’s Disease have difficulty moving, while those with tardive dyskinesia have difficulty not moving
  4. 4. References: "Bjeaaan213 - Parkinson's." Bjeaaan213 - Home. Web. 13 July 2010. <http://bjeaaan213.wikispaces.com/parkinson's>. Hsiung, Robert. "Abnormal Involuntary Movement Scale." The Dr. Bob Home Page. Web. 13 July 2010. <http://www.dr-bob.org/tips/aims.html>. "Neuroleptics - Tardive Dyskinesia Causes." Tardive Dyskinesia & Reglan - Symptoms, Side Effects & Treatments. 14 May 2010. Web. 13 July 2010. <http://www.tardivedyskinesia.com/causes/neuroleptics.php>. "Nutritional Treatment of Tardive Dyskinesia." Pharmaceuticals Anonymous. Web. 13 July 2010. <http://pharmaceuticalsanonymous.blogspot.com/2008/03/nutritional- treatment-of-tardive.html>. "Parkinson's Disease - Homepage." BIO349, CSB/EEB/BIOTA, University of Toronto. 13 Mar. 2009. Web. 13 July 2010. <http://bio349.biota.utoronto.ca/20089/20089bio349graham/parkinsons/index.ht ml>. Rang, H. P. Rang and Dale's Pharmacology. 6th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2007. Print. Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. 10th ed. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print. "Tardive Dyskinesia: EMedicine Neurology." EMedicine - Medical Reference. Web. 13 July 2010. <http://emedicine.medscape.com/article/1151826-overview>. "Tardive Dyskinesia Information Page." National Institute of Neurological Disorders and Stroke (NINDS). 14 Feb. 2007. Web. 10 July 2010. <http://www.ninds.nih.gov/disorders/tardive/tardive.htm>. "YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast Yourself. Web. 10 July 2010. <http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related>. "YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast Yourself. Web. 13 July 2010. <http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=player_embedded>.

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