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Tardive Dyskinesia: Reversible and Irreversible

  • Conference paper
Dyskinesia

Part of the book series: Psychopharmacology Supplementum ((PSYCHOPHARM,volume 2))

Abstract

The long-term prognosis of tardive dyskinesia (TD) has been insufficiently studied. Symptoms are reversible in many patients, but an irreversible course is widely believed to be the expected outcome. This pessimistic view has led to the assumption that neuroleptics should not be used in patients with TD because these drugs will produce an inevitable aggravation of TD. To clarify this issue, 27 patients were serially evaluated over 5 years for changes in neuroleptic treatment, TD, and mental status. Ten patients were able to discontinue medications; 15 required continued low-dose neuroleptic therapy [average 223 mg/day chlorpromazine (CPZ) equivalents], and two needed high doses (1000–2000 mg/day CPZ equivalents) to control psychosis. The majority of patients improved by more than 50% in both treated and untreated groups. In 8 of 27 patients (29.6%) TD resolved; in 1 patient TD increased by 25%. Younger patients improved the most. Prognosis was most favorable if neuroleptics were discontinued, but improvement was still possible with low to moderate doses (less than 600 mg/day CPZ equivalents). The large majority of patients with schizophrenia or schizoaffective illness relapsed, and required continued drug treatment. TD must be evaluated over several years to monitor the resolving/persisting course. Control of psychosis and improvement of TD during low-dose neuroleptic treatment suggest the antipsychotic and neurological effects of neuroleptics may involve different thresholds or mechanisms of action.

This research was supported in part by funds from the Veterans Administration Career Development Award and Merit Review Program, and NIMH Grant no 36657

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Authors and Affiliations

  1. Psychiatric Service, VA Medical Center, Portland, OR, 97207, USA

    D. E. Casey

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  1. D. E. Casey
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Editor information

Editors and Affiliations

  1. Medical Research, Psychiatry and Neurology Services at the Veterans Administration Medical Center, USA

    Daniel E. Casey MD (Clinical Investigator, Associate Professor, Collaborative Scientist) (Clinical Investigator, Associate Professor, Collaborative Scientist)

  2. Departments of Psychiatry and Neurology at the Oregon Health Sciences University, 97207, Portland, OR, USA

    Daniel E. Casey MD (Clinical Investigator, Associate Professor, Collaborative Scientist) (Clinical Investigator, Associate Professor, Collaborative Scientist)

  3. Oregon Regional Primate Research Center, 97006, Beaverton, OR, USA

    Daniel E. Casey MD (Clinical Investigator, Associate Professor, Collaborative Scientist) (Clinical Investigator, Associate Professor, Collaborative Scientist)

  4. Intramural Research Program, National Institute of Neurological and Communicative Disorders and Stroke, Department of Health and Human Services, National Institute of Health, 20205, Bethesda, MD, USA

    Thomas N. Chase MD (Director) (Director)

  5. H. Lundbeck A/S, Ottiliavej 7-9, DK-2500, Copenhagen-Valby, Denmark

    Anne Vibeke Christensen MSc Pharm, DSc (Vice-President, Director of Research) (Vice-President, Director of Research)

  6. Department AEH, Sct. Hans Mental Hospital, DK-4000, Roskilde, Denmark

    Jes Gerlach MD

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© 1985 Springer-Verlag Berlin Heidelberg

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Casey, D.E. (1985). Tardive Dyskinesia: Reversible and Irreversible. In: Casey, D.E., Chase, T.N., Christensen, A.V., Gerlach, J. (eds) Dyskinesia. Psychopharmacology Supplementum, vol 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-70140-5_11

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  • DOI: https://doi.org/10.1007/978-3-642-70140-5_11

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-70142-9

  • Online ISBN: 978-3-642-70140-5

  • eBook Packages: Springer Book Archive

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