Advertisement

Dyskinesia pp 88-97 | Cite as

Tardive Dyskinesia: Reversible and Irreversible

  • D. E. Casey
Part of the Psychopharmacology Supplementum book series (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.

Keywords

Tardive Dyskinesia Neuroleptic Drug Neuroleptic Treatment Pessimistic View Chronic Psychosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Ayd FJ (1977) Ethical and legal dilemmas posed by tardive dyskinesia. Int Drug Ther Newsletter 12: 29–36Google Scholar
  2. Baldessarini RJ (1977) Chemotherapy in psychiatry. Harvard University Press, Cambridge, pp 12–56Google Scholar
  3. Baldessarini RJ, Cole JO, Davis JM, Simpson G, Tarsy D, Gardos G, Preskorn SH (1980) Tardive dyskinesia; a task force report. American Psychiatric Association, Washington DCGoogle Scholar
  4. Barnes TRE, Kidger T, Gore SM (1983) Tardive dyskinesia: a 3-year follow-up study. Psychol Med 13: 71–81PubMedCrossRefGoogle Scholar
  5. Barron ET, McCreadie RG (1983) One-year follow-up of tardive dyskinesia. Br J Psychiatry 143: 423–424PubMedGoogle Scholar
  6. Branchey MH, Branchey LB, Richardson MA (1981) Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients. Am J Psychiatry 138: 608–612PubMedGoogle Scholar
  7. Carpenter WT, Rey AC, Stephens JH (1980) Covert dyskinesia in ambulatory schizophrenia. Lancet 2: 212–213PubMedCrossRefGoogle Scholar
  8. Casey DE (1978) Managing tardive dyskinesia. J Clin Psychiatry 39: 748–753PubMedGoogle Scholar
  9. Casey DE (1984) Tardive dyskinesia and affective disorders. In: Gardos G, Casey DE (eds) Tardive dyskinesia and affective disorders. American Psychiatric Association, Washington DC, pp 1–20Google Scholar
  10. Casey DE, Gerlach J (1984) Tardive dyskinesia: management and new treatment. In: Stancer HC, Garfinkel PE, Rakoff VM (eds) Guidelines for the use of psychotropic drugs. Spectrum, New York, pp 183–203Google Scholar
  11. Chien CP, Cole JO (1973) Eighteen-months follow-up of tardive dyskinesia treated with various catecholamine-related agents. Psychopharmacol Bull 9: 38Google Scholar
  12. Crane GE (1971) Persistence of neurological symptoms due to neuroleptic drugs. Am J Psychiatry 127: 1407–1410PubMedGoogle Scholar
  13. Crow TJ, Cross AJ, Johnstone EC, Owen F, Owens DG, Waddington JL (1982) Abnormal involuntary movements in schizophrenia: are they related to the disease process or its treatment? Are they associated with changes in dopamine receptors? J Clin Psychopharmacol 2: 336–340PubMedCrossRefGoogle Scholar
  14. Gardos G, Cole JO (1976) Maintenance antipsychotic therapy: is the cure worse than the disease? Am J Psychiatry 133: 32–36PubMedGoogle Scholar
  15. Gardos G, Cole JO (1980) Overview: public health issues in tardive dyskinesia. Am J Psychiatry 137: 776–781PubMedGoogle Scholar
  16. Gardos G, Cole JO (1982) Early dyskinesia: course, outcome, and prognosis. Proc Ann Meet Am Psychiatr Assoc 68 D: 171Google Scholar
  17. Gardos G, Perenyi A, Cole JO, Samu I, Kallos M (1983) Tardive dyskinesia: changes after three years. J Clin Psychopharmacol 3: 315–318PubMedGoogle Scholar
  18. Gibson AC (1981) Incidence of tardive dyskinesia in patients receiving depot neuroleptic injection. Acta Psychiatr Scand [Suppl] 63: 111–116CrossRefGoogle Scholar
  19. Guy W (1976) ECDEU assessment manual for psychopharmacology. US department of health, education, and welfare. US Government Printing Office, Washington DC, pp 534–537Google Scholar
  20. Itoh H, Yagi G (1979) Reversibilitiy of tardive dyskinesia. Folia Psychiatr Neurol Jpn 33: 43–54PubMedGoogle Scholar
  21. Jeste DV, Potkin SG, Sinha S, Feder S, Wyatt RJ (1979) Tardive dyskinesia-reversible and persistent. Arch Gen Psychiatry 36: 585–590PubMedGoogle Scholar
  22. Jus A, Jus K, Fontaine P (1979) Long-term treatment of tardive dyskinesia. J Clin Psychiatry 40: 72–77PubMedGoogle Scholar
  23. Levine J, Schooler N, Severe J, Escobar J, Gelenberg A, Mandel M, Sovner R, Steinbook R (1980) Discontinuation of oral and depot fiuphenazine in schizophrenic patients after one year of continuous medication: a controlled study. In: Cattabeni F, Racagni G, Spano PF, Costa E (eds) Long-term effects of neuroleptics. Adv Biochem Psychopharmacol 24: 483–493Google Scholar
  24. Mehta D, Mehta S, Mathew P (1977) Tardive dyskinesia in psychogeriatric patients: a five-year follow-up. J Am Geriatr Soc 25: 545–547PubMedGoogle Scholar
  25. Moline RA (1975) Atypical tardive dyskinesia. Am J Psychiatry 132: 534–535PubMedGoogle Scholar
  26. Owens DGC, Johnstone EC, Frith CD (1982) Spontaneous involuntary disorders of movement. Arch Gen Psychiatry 39: 452–461PubMedGoogle Scholar
  27. Paulson GW (1968) “Permanent” or complex dyskinesias in the aged. Geriatrics 23:105–110Google Scholar
  28. Pyke J, Seeman MV (1981) Neuroleptic-free intervals in the treatment of schizophrenia. Am J Psychiatry 138: 1620–1621PubMedGoogle Scholar
  29. Quitkin F, Rifkin A, Gochfeld L, Klein DF (1977) Tardive dyskinesia: are first signs reversible? Am J Psychiatry 134: 84–87PubMedGoogle Scholar
  30. Schönecker M (1957) Ein eigentümliches Syndrom im oralen Bereich bei Megaphenapplikation. Nervenarzt 28: 35Google Scholar
  31. Schooler NR, Kane JM (1982) Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry 39: 486–487PubMedGoogle Scholar
  32. Seeman MV (1981) Tardive dyskinesia: two-year recovery. Compr Psychiatry 22: 189–192PubMedCrossRefGoogle Scholar
  33. Sigwald J, Bouttier D, Raymondeaud C (1959) Quatre cas de dyskinesie faciobuccolinguo- masticatrice a revolution prolongee secondaire a un traitement par les neuroleptiques. Rev Neurol 100: 751–755PubMedGoogle Scholar
  34. Smith JM, Baldessarini RJ (1980) Changes in prevalence, severity and recovery in tardive dyskinesia with age. Arch Gen Psychiatry 37: 1368–1373PubMedGoogle Scholar
  35. Smith JM, Burke MP, Moon CO (1981) Long-term changes in AIMS ratings and their relation to medication history. Psychopharmacol Bull 17: 120–121PubMedGoogle Scholar
  36. Uhrbrand L, Faurbye A (1960) Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine and electroconvulsive therapy. Psychopharmacologia 1: 408–418CrossRefGoogle Scholar
  37. Wegner JT, Kane JM (1982) Follow-up study on the reversibility of tardive dyskinesia. Am J Psychiatry 139: 368–369PubMedGoogle Scholar
  38. Yagi G, Ogita K, Ohtsuka N, Itoh H, Miura S (1976) Persistent dyskinesia after long-term treatment with neuroleptics in Japan. Keio J Med 25: 27–35PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1985

Authors and Affiliations

  • D. E. Casey
    • 1
  1. 1.Psychiatric ServiceVA Medical CenterPortlandUSA

Personalised recommendations