Tardive dyskinesia (TD) is a neurological syndrome caused by long-term use of drugs to treat psychiatric disorders, presenting as repetitive, involuntary movements. Symptoms include grimacing, tongue protrusion, lip smacking. TD can be confused with Parkinson's disease which presents as tremors, rigidity, and bradykinesia. Antipsychotic medications like haloperidol, risperidone, and olanzapine can cause TD by reducing dopamine levels in the brain. Treatment involves discontinuing the causative medication, using anti-Parkinson's drugs, or vitamin E to relieve symptoms.

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. 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. 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

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