Atypical Neuroleptics Cause TD in Adults

All the neuroleptics (see the appendix) can cause TD, including the atypical neuroleptics such as clozapine (Weller et al., 1993), olanzapine (Her-ran, 1999), and risperidone (Addington et al., 1995 Buzan, 1996 Kumar et al., 2000 Kwon, 2004). Aripiprazole (Abilify) has been considered one of the safer atypicals, but there are already reports of tardive dyskinesia (Maytal et al., 2006 Oommen et al., 2006). Given that the atypicals, 

As already noted, in the clinical antipsychotic trials of intervention effectiveness among adults exposed to older neuroleptics and several atypicals (Nasrallah, 2007), no difference was found between the older antipsychotic drugs and the newer ones in regard to producing extrapy-ramidal effects, movement disorders, or akathisia. 

One variant of TD called rabbit syndrome is characterized by fine, rapid, rhythmic movements along the vertical axis of the mouth. A recent review found 11 cases associated with atypicals, mostly risperidone (Dell Osso et al., 2007). All of the FDA-approved atypical neuroleptic labels carry the same class warning as the older neuroleptics. 

Furthermore, at the times they were being evaluated, the patients continued to take the olanzapine, which, like all neuroleptics, suppresses the appearance of TD symptoms while at the same time causing or worsening the underlying disorder (see subsequent section). Therefore, the only way to determine an accurate rate of TD is to withdraw the patients from the offending drug before the final evaluation. In this study, the actual rate of TD would have been much higher than 3% per year if the patients had been withdrawn from the olanzapine before the final TD evaluation. 

As of May 2006, two of the more knowledgeable TD experts, Daniel Tarsy and Ross Baldessarini, concluded that the risk of TD with atypicals had not been clearly established to be less than that with the classic neuroleptics and that patients should be treated with atypicals with the usual caution concerning neuroleptic treatment. 

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