Tardive dyskinesia irreversibility

Phenothiazines may cause sedation, orthostatic hypotension, and extrapyramidal symptoms (EPS) such as dystonia (involuntary muscle contractions), tardive dyskinesia (irreversible and permanent involuntary movements), and akathisia (motor restlessness or anxiety).1,21,22 Chronic phenothiazine use has been associated with EPS, but single doses have also caused these effects.23... 

Because there is no known treatment for tardive dyskinesia and because it is irreversible in some patients the nurse must immediately report symptoms These indude rhythmic, involuntary movements of the tongue, face, mouth, jaw, or the extremities... 

The major adverse effects of first-generation drugs for schizophrenia are involuntary movement disorders. Symptoms include tremor, rigidity, restlessness, and slowness of movement, strongly reminiscent of the movement disorders in parkinsonism, about which more follows later. The worst of these movement disorders is tardive dyskinesia, an irreversible movement disorder. 

Antipsychotics also have a troublesome side effect burden that includes an often-irreversible movement disorder known as tardive dyskinesia (TD). Other side effects include so-called parkinsonism, dystonic reactions (i.e., abrupt onset of muscle spasms), akathisia (an uncomfortable sense of motoric restlessness), sedation, weight gain, dizziness, dry mouth, and constipation among others. These side effects, in particular the risk for TD, limit the usefulness of antipsychotics in the treatment of ADHD, and at this time the typical antipsychotics cannot be considered a reasonable monotherapy in uncomplicated ADHD. 

There are, of course, risks with long-term use of conventional antipsychotics. The most concerning is an irreversible movement disorder known as tardive dyskinesia. Nevertheless, some particularly fragile patients with BPD may require long-term antipsychotic treatment. If so, atypical antipsychotics are recommended. 

Tardive Dyskinesia (TD). As mentioned previously, TD is a potential side effect of long-term treatment with typical antipsychotics it is believed to be very rare but possible after atypical antipsychotic treatment. Although we now know that TD is not irreversible in all patients, about half will recover after discontinuation of the antipsychotic and the passage of several months time, others will exhibit the symp-... 

Tardive dyskinesia Tardive dyskinesia, a syndrome consisting of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with neuroleptics (eg, antipsychotics). Amoxapine is not an antipsychotic, but it has substantive neuroleptic activity. 

Nonpsychotic anxiety - 1 or 2 mg twice daily. Do not administer more than 6 mg/day or for longer than 12 weeks because trifluoperazine use at higher doses or for longer intervals may cause persistent tardive dyskinesia that may prove irreversible. 

Tardive dyskinesia, including tongue protrusion, puffing of the cheeks, and puckering of the mouth, is a rare reaction that maybe irreversible. 

Observe the patient for fine tongue movement, which may be the first sign of irreversible tardive dyskinesia... 

Tardive dyskinesia is a potentially irreversible movement disorder characterized by choreoathetoid movements. The possibility of a primary neurological disorder should be considered when a patient being treated with an antipsychotic develops involuntary movements. It should also be noted that patients might develop transient withdrawal dyskinesias as the dosage of neuroleptics is lowered or discontinued (Campbell et ah, 1999). It appears that withdrawal dyskinesias are more common in children than adults. 

Because tardive dyskinesia developing in adults is usually irreversible and has no satisfactory treatment, care must be taken to reduce the likelihood of its occurrence. Antipsychotic medication should be prescribed only when necessary and should be withheld periodically to assess the need for continued treatment and to unmask incipient dyskinesia. Thioridazine, a phenothiazine with a piperidine side chain, is an effective antipsychotic that seems less likely than most to cause extrapyramidal reactions, perhaps because it has little effect on dopamine receptors in the striatal system. Finally, antimuscarinic drugs should not be prescribed routinely in patients receiving... 

Severe and Potentially Irreversible Neurological Syndromes (Tardive Dyskinesia and Neuroleptic Malignant Syndrome) Caused by Neuroleptics... 

In 1980 the APA produced a detailed analysis of the iatrogenic disease in its Task Force Report Tardive Dyskinesia. The task force made it clear that TD is a serious, usually irreversible, largely untreatable, and highly prevalent disease resulting from therapy with neuroleptics. The task force estimated the prevalence rate for TD in routine treatment (several months to 2 years) as at least 10% to 20% for more than minimal disease. For long-term exposure to neuroleptics, the rate was at least 40% for more than minimal disease. 

Tardive or withdrawal dyskinesias, some transient but others irreversible, seen in 8%-51% of antipsychotic-treated children and adolescents, mandate caution regarding casual use of these drugs. Tardive dyskinesia has been documented in children and adolescents after as brief a period of treatment as 5 months and may appear even during periods of constant medication dose. Cases of tardive dyskinesia have been reported in youths treated with risperidone, indicating that atypical antipsychotics may also cause this serious adverse reaction. 

SSRIs cause a wide range of neurological impairments. Spigset (1999) found the following neurological reports in order of frequency parethesias, headache, dizziness, tremor, seizures, acute dystonia, dyskinesia, muscle cramps, muscle weakness, parkinsonism, muscle stiffness, akathisia, myoclonus, extrapyramidal reactions, increased muscle tone, and migraine. There have been reports of irreversible tardive dyskinesia caused by SSRIs (see subsequent section). 

Gerber and Lund (1998) reviewed the literature and located 127 case reports of SSRI-induced abnormal movements. These included akathisia (agitation with hyperactivity), tardive dyskinesia, parkinsonism, dystonia (muscle spasms), bruxism (tooth grinding), and related disorders. They found many additional case reports from the drug manufacturers, including 516 cases of parkinsonism and 76 cases of tardive dyskinesia. The term tardive dyskinesia is usually reserved for cases that are irreversible. 

The rate of reversibility of tardive dyskinesia after drug withdrawal is 0-90% (269). Since patients with tardive dyskinesia rarely have subjective complaints (304), periodic assessment of dyskinetic movements is essential in making an early diagnosis and can increase the chance of reversing the disorder. Some reports are relatively encouraging regarding reversibility (305,306) the characteristics of reversible and irreversible forms have been reviewed, but no firm conclusion can be drawn (307). However, the prognosis of tardive dyskinesia was better in patients treated for a shorter duration and in those treated with lower doses (308). 

Chouinard G, Bradwejn J. Reversible and irreversible tardive dyskinesia a case report. Am J Psychiatry 1982 139(3) 360-2. 

Motor side effects deserve particular mention. Some can occur as early as a few hours after administration of the first dose (acute dystonia), whereas others (like tardive dyskinesia, a usually irreversible condition) may not appear until after many years of treatment (although... 

Some side effects may be irreversible (e.g. tardive dyskinesia)... 

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