Tardive Dyskenisia:

• tardive dyskinesia (n.): a chronic disorder of the nervous system characterised by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually caused by prolonged treatment with antipsychotic drugs. ~ (American Heritage Dictionary).

• tardive dyskinesia (n.): nerve damage resulting in involuntary rolling of the tongue or twitching of facial or other small muscles, usually associated with long-term use of antipsychotic drugs. ~ (Webster’s College Dictionary).

• tardive dyskinesia (n.): involuntary rolling of the tongue and twitching of the face or trunk or limbs; often occurs in patients with Parkinsonism who are treated with phenothiazine; (synonym): dyskinesia (abnormality in performing voluntary muscle movements). ~ (Princeton’s WordNet 3.0).

• tardive dyskinesia (n.): an iatrogenic disorder produced by long-term administration of antipsychotic agents; it is characterised by oral-lingual-buccal dyskinesias that usually resemble continual chewing motions with intermittent darting movements of the tongue; there may also be choreoathetoid {choreoathetosis=involuntary movements} movements of the extremities. The disorder is more common in women than in men and in the elderly than in the young, and incidence is related to drug dosage and duration of treatment. In some patients symptoms disappear within several months after antipsychotic drugs are withdrawn; in others symptoms may persist indefinitely. ~ (Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health).

• tardive dyskinesia (n.): involuntary movements of the facial muscles and tongue, often persistent, that develop as a late complication of some neuroleptic therapy, more likely with typical antipsychotic agents; (synonyms): lingual-facial-buccal dyskinesia, tardive syndrome. ~ (Farlex Partner Medical Dictionary).

• tardive dyskinesia (n.): a chronic disorder of the nervous system characterised by involuntary jerky movements of the face, tongue, jaws, trunk, and limbs, usually caused by prolonged treatment with antipsychotic drugs. ~ (American Heritage Medical Dictionary).

• tardive dyskinesia (n.): slow involuntary sinuous rhythmic movements usually caused as a neurologic side effect of certain drugs–e.g., tricyclic tranquilisers–phenothiazine and other tricyclics. ~ (McGraw-Hill Concise Dictionary of Modern Medicine).

• tardive dyskinesia (n.): a neurologic disorder associated with involuntary repetitive movements of the facial muscles, tongue, limbs, and trunk; commonly associated with long-term treatment with antipsychotic medications such as phenothiazines. ~ (Farlex Medical Dictionary for the Health Professions and Nursing).

• tardive dyskinesia (n.): involuntary repetitive shaking movements induced by drugs, such as the phenothiazines, that persist or become worse after the drug is withdrawn. The condition usually affects elderly people after years of treatment with the drug. ~ (Collins Dictionary of Medicine).

• tardive dyskinesia (n.): involuntary movements of facial muscles and tongue, often persistent, which develop as a late complication of some neuroleptic therapy. ~ (Farlex Medical Dictionary for the Dental Professions).

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• tardive dyskinesia (n.): a mostly irreversible neurological disorder of involuntary movements caused by long-term use of antipsychotic or neuroleptic drugs.
Description: antipsychotic or neuroleptic drugs are powerful tranquilisers generally prescribed for serious psychiatric disorders, as well as neurological and gastrointestinal disorders. Some common antipsychotics are: *chlorpromazine HCl (Thorazine), thioridazine HCl (Mellaril), haloperidol (Haldol), perphenazine (Trilafon), thiothixene (Navane), trifluoperazine HCl (Stelazine), and fluphenazine HCl (Permitil, Prolixin)*. When these drugs are used long term, tardive dyskinesia (TD) can result. *About 20 percent of people taking antipsychotic drugs for more than one year become affected by tardive dyskinesia.* The prevalence of tardive dyskinesia tends to be highest among elderly patients and among women. Causes and symptoms: tardive dyskinesia usually appears after years of antipsychotic drug use, and seems to be related to the total lifetime dose of medication. [emphasis added].

The symptoms include the following:
1. tongue protrusion;
2. grimacing;
3. rapid eye blinking;
4. lip smacking, pursing, or puckering;
5. rapid movement of the arms or legs;
6. other involuntary movements of the head, face, neck and tongue muscles.

Diagnosis: the diagnosis of tardive dyskinesia is suspected upon observation of involuntary movements of the head, neck, face, and tongue in individuals who have a history of antipsychotic drug prescription. Treatment: there is no standard treatment for tardive dyskinesia. The primary approach is to discontinue or minimise the use of antipsychotic drugs while attempting to treat some of the symptoms. The treatment must be individualised to the patient, because discontinuation of the antipsychotic drug(s) may not be advisable, depending on the patient’s condition. In some cases, substituting another drug for the antipsychotic drug may be beneficial.

Prognosis: once tardive dyskinesia appears in full—blown form, it can be permanent. With careful management, some symptoms may improve and even disappear with time. In less severe cases, some patients may recover from tardive dyskinesia within three months of discontinuing the use of antipsychotic medication. Studies report that at least half of patients experience remission of major symptoms within 12 to 18 months following discontinuation of antipsychotic drugs. In some patients, however, decreasing the dose of the antipsychotic drug actually increases the symptoms of tardive dyskinesia, while increasing the dose sometimes offers a temporary remission of the symptoms.

Prevention: tardive dyskinesia can be prevented by early recognition and discontinuation of the antipsychotic medication if this is clinically possible. The use of antipsychotic drugs should in any case be kept to a minimum in all patients. Patients should be followed carefully to determine when the dose of the drug can be tapered off as the psychiatric condition improves. In all cases, the benefits of taking the antipsychotic medication should outweigh the risk of developing tardive dyskinesia.

A study has shown that elderly institutionalised patients with dementia that were treated with risperidone had {at first} a low incidence of tardive dyskinesia. Although further study is needed, this study shows that non-conventional neuroleptic drugs should be considered to avoid the risk of tardive dyskinesia, particularly in elderly patients.

Key terms: 1. antipsychotics—drugs used to treat psychotic conditions such as schizophrenia or psychosis. These medications are powerful tranquilisers that all have sedating and calming effects, but their major effect is to reduce psychotic thinking and behavior;
2. neuroleptics—any of a class of drugs used to treat psychotic conditions.
3. psychosis—a condition where a person’s ability to recognise reality and cope with everyday life is severely affected. [emphases and curly bracket insert added]. ~ (Gale Encyclopedia of Medicine).

 

For reference see “A Short History of Tardive Dyskinesia: 65 Years of Drug-Induced Brain Damage That Rolls On and On” by Robert Whitaker, November 22 2020