Tardive dyskinesia is a serious neurological disorder caused by the long-term and/or high-dose use of dopamine antagonists, usually antipsychotics and among them especially the typical antipsychotics. These neuroleptic drugs are generally prescribed for serious psychiatric disorders. The older typical antipsychotics, which appear to cause tardive dyskinesia somewhat more often than the newer atypical antipsychotics, are being prescribed less frequently. There are some new uses, however, such as year-long implants that are being developed using the older typicals, e.g., Haldol®, one of the worst offenders when it comes to tardive dyskinesia. Other dopamine antagonists that can cause tardive dyskinesia are drugs for gastrointestinal disorders (for example metoclopramide) and neurological disorders. Some drugs that are not intended to affect dopamine, such as SSRI antidepressants, may also cause tardive dyskinesia. Newer atypical antipsychotics such as olanzapine and risperidone appear to cause tardive dyskinesia somewhat less frequently. The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Diseases Database is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Neurology is a branch of medicine dealing with disorders of the central and peripheral nervous systems. ... A dopamine antagonist is a drug which blocks dopamine receptors (of which there are five types in the human body; they are found in the brain, peripheral nervous system, blood vessels, and the kidney). ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Typical antipsychotics (sometimes referred to as conventional antipsychotics or conventional neuroleptics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia), and are generally being replaced by atypical antipsychotic drugs. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... Typical antipsychotics (sometimes referred to as conventional antipsychotics or conventional neuroleptics) are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis (in particular, schizophrenia), and are generally being replaced by atypical antipsychotic drugs. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ... Haloperidol (sold as Aloperidin®, Bioperidolo®, Brotopon®, Dozic®, Einalon S®, Eukystol®, Haldol®, Halosten®, Keselan®, Linton®, Peluces®, Serenace®, Serenase®, Sigaperidol®) is a conventional butyrophenone antipsychotic drug. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Metoclopramide (INN) (IPA: ) is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. ... Neurology is a branch of medicine dealing with disorders of the central and peripheral nervous systems. ... SSRI is an acronym that stands for several things: It is a class of antidepressants called selective serotonin reuptake inhibitor SSRI also is used as the stock symbol for Silver Standard Resources Inc. ... The atypical antipsychotics (also known as second generation antipsychotics) are a class of prescription medications used to treat psychiatric conditions. ...

The term tardive dyskinesia was introduced in 1964. Dyskinesia refers to an impairment of voluntary movement. The resultant tics and other movements are often referred to as dyskinesias. Dyskinesia is sometimes caused by long-term use of anti-psychotic drugs or other dopamine antagonists like the antiemetic metoclopramide. The effect of these drugs can be tardive, meaning the dyskinesia continues or appears even after the drugs are no longer taken. 1964 (MCMLXIV) was a leap year starting on Wednesday (the link is to a full 1964 calendar). ... A tic is a repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic). ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ... A dopamine antagonist is a drug which blocks dopamine receptors (of which there are five types in the human body; they are found in the brain, peripheral nervous system, blood vessels, and the kidney). ... An antiemetic is a drug that is effective against vomiting and nausea. ... Metoclopramide (INN) (IPA: ) is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. ...

In context of Parkinson's disease, dyskinesias are often the result of chronic levodopa (L-dopa) therapy. These motor fluctuations occur in more than half of PD patients after 5 to 10 years of levodopa therapy, with the percentage of affected patients increasing over time.^[1]

Dyskinesias most commonly occur at the time of peak L-dopa plasma concentrations and are thus referred to as peak-dose dyskinesias. As patients advance, they may evidence diphasic dyskinesias, which occur when the drug concentration rises or falls.

The use of MDMA (ecstasy) has been shown to enhance the effects of L-Dopa while reducing the associated dyskinesia in primates with simulated Parkinson's disease.^[2]

Features

Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano. Tardive dyskinesia, like Tourette Syndrome, can be considered an 'opposite' of Parkinson's disease. Patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficulty not moving. Tourette syndrome (also called Tourettes syndrome, Tourettes disorder, Gilles de la Tourette syndrome, GTS or the more common Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these...

Other closely related neurological disorders have been recognized as variants of tardive dyskinesia. Tardive akathisia involves painful feelings of inner tension and anxiety and a compulsive drive to move the body. In the extreme, the individual undergoes internal torture and can no longer sit still. Tardive tourettism is a tic disorder that can closely mimic Tourette Syndrome, sometimes to the point where the two can only be distinguished by the details of their onsets. Akathisia (or acathisia) is an often extremely unpleasant subjective sensation of inner restlessness that manifests itself with an inability to sit still or remain motionless, hence the origin of its name: Greek a (without) + kathesis (sitting). ... Tourettism refers to tics associated with conditions other than Tourette syndrome. ... A tic is a repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic). ... Tourette syndrome (also called Tourettes syndrome, Tourettes disorder, Gilles de la Tourette syndrome, GTS or the more common Tourettes or TS) is an inherited neurological disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these...

Cause

The cause of tardive dyskinesia appears to be related to damage to the system that uses and processes the neurotransmitter dopamine. It is thought that postsynaptic dopaminergic receptors become supersensitive to stimulation as a result of the use of neuroleptic drugs and that this supersensitivity causes the symptoms of tardive dyskinesia. The available research seems to suggest that the concurrent prophylactic use of a neuroleptic and an antiparkinsonian drug is useless to avoid early extrapyramidal side-effects and may render the patient more sensitive to tardive dyskinesia. Since 1973 the use of these drugs have been found to be associated with the development of tardive dyskinesia (Crane, 1973). Since some of the symptoms of tardive dyskinesia can be interpreted as schizophrenia by doctors, they may prescribe additional neuroleptic drugs to treat it, leading to increased risk of more prevalent tardive dyskinesia. Several studies have indicated that long-term neuroleptic use is associated with both cognitive deterioration and atrophy of the brain (Breggin, 1990; Gualtieri and Barnhill, 1988). [1] Chemical structure of D-Aspartic Acid, a common Amino Acid neurotransmitter. ... This article or section is in need of attention from an expert on the subject. ... In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. ...

Treatment

Primary prevention of tardive dyskinesia is achieved by using the lowest effective dose of a neuroleptic for the shortest time. If tardive dyskinesia is diagnosed, the causative drug should be reduced or discontinued if possible. Tardive dyskinesia may persist after withdrawal of the drug for months, years, or even permanently. There is no known cure for tardive dyskinesia, but preliminary research suggests that the atypical neuroleptic clozapine (Clozaril®) may improve the state of the patient. Improvements are also seen in some cases, if the high potency benzodiazepines - lorazepam (Ativan®), diazepam (Valium®), or clonazepam (Klonopin®)--are used. The findings about the effects of natural substances, such as vitamin E (Alpha-Tocopherol) or melatonin, are inconclusive. Treatment with adrenergic blocking agents and dopamine agonists like bromocriptine also remains somewhat controversial. There have been some reports of promising effects from the drug tetrabenazine (a different kind of neuroleptic). On the contrary, most antiparkinsonian drugs worsen the state of the patient. Clozapine (sold as Clozaril®, Leponex®, Fazaclo®) was the first of the atypical antipsychotics to be developed. ... Benzodiazepine tablets The benzodiazepines are a class of drugs with hypnotic, anxiolytic, anticonvulsant, amnestic and muscle relaxant properties. ... Lorazepam (marketed under the brand names Ativan®, Temesta®, Tavor®) is a drug which is a benzodiazepine derivative. ... Diazepam (IPA: ), marketed under brand names Valium, Stesolid, Diazemuls, Seduxen, Bosaurin, Diapam, Antenex and Apozepam)[1] is a drug which is a benzodiazepine derivative. ... Clonazepam (marketed by Roche under the trade-name Klonopin® in the United States and Rivotril® in Europe, Brazil and Canada) is a drug which is a benzodiazepine derivative. ... Tocopherol, or Vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... Bromocriptine is an ergoline derivative dopamine agonist that is used in the treatment of pituitary tumors and Parkinsons disease. ... Tetrabenazine (marketed under the trade names Nitoman® in Canada and Xenazine® in New Zeland and some parts of Europe - also available in the USA as an orphan drug) is a dopamine-depleting drug that is closely related to the antipsychotics and works similarly, though its action is subtly different and...

Caveats

Natural remedies are unproven, since they are seldom tested in a controlled setting such as a drug trial. Preliminary research indicates that alternating rest, and regular exercise also negate the symptoms of tardive dyskinesia, necessary for all mental health outpatients who must maintain anti-psychotic neuroleptic drug regimes, for on-going 'wellness'. Switching to a newer drug with less side-effects, might be an option - in a controlled / monitored environment. the lost cause!!!!!!!!!!!!

Epidemiology

Tardive dyskinesia most commonly occurs in patients with psychiatric conditions who are treated with antipsychotic medications for many years. Some estimates suggest that it occurs in 15-30% of patients receiving treatment with antipsychotic neuroleptic medications for 3 months or longer. Other estimates suggest that with each year of neuroleptic use, 5% of the patients will show signs of tardive dyskinesia, i.e., 5% after one year, 10% after two years, 15% after three years with no clear upper limit. Eventually, according to these estimates, if on the drugs long enough, the majority of patients will develop the disorder.[2] The incidence of tardive dyskinesia varies with the type of neuroleptic (e.g., haloperidol (Haldol®) more often than perphenazine (Trilafon®)), daily dose and duration of treatment (the higher the daily dose and the longer the duration of treatment, the higher the risk). The term antipsychotic is applied to a group of drugs used to treat psychosis. ... Haloperidol (sold as Aloperidin®, Bioperidolo®, Brotopon®, Dozic®, Einalon S®, Eukystol®, Haldol®, Halosten®, Keselan®, Linton®, Peluces®, Serenace®, Serenase®, Sigaperidol®) is a conventional butyrophenone antipsychotic drug. ... This article needs to be cleaned up to conform to a higher standard of quality. ...

The elderly and female patients are more prone to develop tardive dyskinesia. Cigarette smokers also have a higher prevalence of tardive dyskinesia. Children and adolescents are much more sensitive to the early and late extrapyramidal side-effects of neuroleptics than adults. Because of this, treatment of youngsters with neuroleptics may be contraindicated, and many authorities believe that they should be initiated only as a last resort, using the lowest dose regime possible and the shortest duration of treatment in accordance with good patient management.

Tardive dyskinesia can become a thoroughly debilitating social handicap. Some believe the devastating impact of tardive dyskinesia illustrates why patients and/or their families (guardians and/or caregivers/nurses) should receive full information about the neuroleptic before starting treatment (informed consent). Informed consent is a legal condition whereby a person can be said to have given consent based upon an appreciation and understanding of the facts and implications of an action. ...

My uncle once had Tardive dyskinesia and we found it wonderful to get him to sand wood as the fine shakes would give a smooth finish like no other, sometimes I wish the old bloke was still with us, holding hands and walking into the sunset [citation needed].

See also

• Primary ciliary dyskinesia
• Athetosis
• Asterixis

Primary ciliary dyskinesia (PCD), also known as immotile ciliary syndrome, is a rare autosomal recessive genetic disorder caused by a defect in the action of cilia lining the respiratory tract. ... Athetosis is a continuous stream of slow, sinuous, writhing movements, typically of the hands and feet. ... Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy (damage to brain cells due to toxins not cleared from the blood by the liver). ...

References

1. ^ Obeso JA, et al. The evolution and origin of motor complications in Parkinson's disease. Neurology. 2000;55(suppl 4):S13-S20.
2. ^ Iravani, M., Jackson, M., Kuoppaaki, M., Smith, L. & Jenner, P. (2003). 3,4-Methylenedioxymethamphetamine (Ecstasy) Inhibits Dyskinesia Expression and Normalizes Motor Activity in 1-Methyl-4-Phenyl-1,2,3,6-Tetrahydropyridine-Treated Primates, Journal of Neuroscience, 23, 9107–9115

• Crane, G. (1973) Clinical psychopharmacology in its 20th year. Science, 181,121 8
• Breggin, P. R. (1983) Psychiatric drugs. New York: Springer
• Hawkins, David R. (1986) The Prevention of Tardive Dyskinesia with High Dosage Vitamins: A Study of 58.000 Patients, Journal of Orthomolecular Medicine, 1:1,24-26
• Gualtieri, C. T. and Barnhill, L. J. (1988) Tardive dyskinesia in special populations. In M. E. Wolf and A. D. Mosnaim (eds) Tardive dyskinesia. Washington DC: American Psychiatric Press.
• Breggin, P. R. (1990) Brain damage, dementia and persistent cognitive dysfunction associated with neuroleptic drugs. Evidence, etiology, implications. Journal of Mind and Behavior, 11, 425 64
• Breggin, P. R. (1991) Toxic psychiatry. New York: St. Martin's Press
• American Psychiatric Association (1992) Task force on tardive dyskinesia. Washington DC: APA

External links

• NINDS tardive
• Psychiatrist and Psychiatry Critic, Peter Breggin, On Tardive Dyskinesia
• Jenelle's story report on a patient
• Tardive Dyskinesia Psyweb.com
• Photographs and Video of TD (critical view of psychiatry)
• Practical Gastroenterology article with Plain English description of all symptoms of EPS-TD and links to testing guidelines. reflux.org