A range of patients are at risk for tardive dyskinesia

Tardive dyskinesia (TD) can affect anyone taking or who has taken dopamine receptor blocking agents (DRBAs).1,2 Patients often don’t proactively bring up signs of TD,3 so it’s important to identify those at risk.

A face with tardive dyskinesia (TD) speaks a thousand words. It’s time to listen.

Patient risk factors

While anyone taking or who has taken DRBAs can develop TD,1,2 the following have been associated with increased risk

  • Duration of exposure to DRBAs, including antipsychotics or metoclopramide2,4
  • Potency of DRBA5
  • Diagnosed with a mood disorder or family history of mood disorder in patients with schizophrenia6
  • Presence of another drug-induced movement disorder7
  • Aged 50 or older8
  • Postmenopausal women9
  • History of alcohol or drug abuse7
Image representing patients at higher risk for tardive dyskinesia (TD).
I’ve gotten so bad on occasion that I’ve bit my tongue and it started to bleed. I had to leave the library one time because I was bleeding so badly. Patient

DRBAs and tardive dyskinesia

Patients should be evaluated for dyskinesias before starting a DRBA, which may be used for both psychotic and nonpsychotic treatment.2,10

  • Psychiatric disorders
  • Anxiety disorder
  • Bipolar disorder
  • Major depressive disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Nonpsychiatric disorders
  • Gastrointestinal motility disorder
    • ‐ Gastroparesis
  • Nausea
  • Vomiting
The rates of new TD cases are more similar between atypical and typical antipsychotics than previously reported13* Chart that shows similar rates of new tardive dyskinesia (TD) cases between those taking atypical (3.9%) and typical (5.5%) antipsychotics.

*Annualized incidence rates of TD. Based on a meta-analysis of 12 studies published since 2004; 28,051 patients, mean age 39.7 years, 59.7% male, 70.9% white.13

While atypical (second generation) antipsychotics were thought to substantially lessen the risk for TD, recent studies may suggest this to not be the case.13

Take on TD: How does typical antipsychotic treatment duration affect TD?

Click each time point to see the risk for TD the longer a patient is exposed to typical antipsychotics.4

The risk for tardive dyskinesia (TD) is 32% after 5 years of taking dopamine receptor blocking agents (DRBAs). The risk for tardive dyskinesia (TD) is 57% after 15 years of taking dopamine receptor blocking agents (DRBAs). The risk for tardive dyskinesia (TD) is 68% after 25 years of taking dopamine receptor blocking agents (DRBAs).




Evaluate your patients for all TD risk factors.
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Estimated risk of TD is based on a long-term study of 362 outpatients who were free of TD at enrollment between July 1, 1985, and June 30, 1987, and reexamined at least once during follow-up. The mean baseline age was 42 years (range 19-73 years), 53% were women, and 25% were nonwhite. Net years of previous neuroleptic use without TD and additional years of neuroleptic use were used to determine the estimated risk for TD.4

Next: Mechanism of TD

TD is thought to be caused by dopamine receptor hypersensitivity resulting from exposure to DRBAs.14,15

See the mechanism
References: 1. American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013:712. 2. Kenney C, Hunter C, Davidson A, et al. Metoclopramide, an increasingly recognized cause of tardive dyskinesia. J Clin Pharmacol. 2008;48(3):379-384. 3. Macpherson R, Collis R. Tardive dyskinesia: patients' lack of awareness of movement disorder. Br J Psychiatry. 1992;160:110-112. 4. Glazer WM, Morgenstern H, Doucette JT. Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. J Clin Psychiatry. 1993;54(4):133-139. 5. Caroff SN, Hurford I, Lybrand J, Campbell EC. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurol Clin. 2011;29(1):127-148. 6. Wegner JT, Catalano F, Gibralter J, et al. Schizophrenics with tardive dyskinesia. Neuropsychological deficit and family psychopathology. Arch Gen Psychiatry. 1985;42(9):860-865. 7. Miller DD, McEvoy JP, Davis SM, et al. Clinical correlates of tardive dyskinesia in schizophrenia: baseline data from the CATIE schizophrenia trial. Schizo Res. 2005;80(1):33-43. 8. Woerner MG, Alvir JM, Saltz BL, et al. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155(11):1521-1528. 9. Seeman MV. Interaction of sex, age, and neuroleptic dose. Compr Psychiatry. 1983;24(2):125-128. 10. Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. American Psychiatric Association; Washington, DC; 1992. 11. National Institute of Mental Health. Mental health medications. http://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml. Updated January 2016. Accessed September 7, 2016. 12. National Institutes of Health. Metoclopramide. https://pubchem.ncbi.nlm.nih.gov/compound/metoclopramide#section=Top. Updated September 3, 2016. Accessed September 7, 2016. 13. Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008;21(2):151-156. 14. Stahl SM. Essential Psychopharmacology Online. Based on: Stahl SM. Stahl’s Essential Psychopharmacology. 4th ed. Cambridge, UK: Cambridge University Press; 2013. http://stahlonline.cambridge.org/essential_4th_chapter.jsf?page=chapter5_introduction.htm&name=Chapter%205&title=Conventional%20 antipsychotics#c02598-5-1. Accessed March 14, 2016. 15. Sayers AC, Bürki HR, Ruch W, et al. Neuroleptic-induced hypersensitivity of striatal dopamine receptors in the rat as a model of tardive dyskinesias: effects of clozapine, haloperidol, loxapine and chlorpromazine. Psychopharmacologia. 1975;41(2):97-104.

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