Tardive dyskinesia in geriatric patients

Abstract

Tardive (late-onset) dyskinesia (abnormal involuntary movement) is a debilitating and potentially irreversible hyperkinetic abnormal involuntary movement disorder caused by sustained exposure to antipsychotic medication. Tardive dyskinesia can affect any body region and possible associated features include unintelligible speech, respiratory distress and falls, as well as guilt, anger and depression. The diagnosis of tardive dyskinesia is one of exclusion, requiring complete physical and neurological examination and laboratory testing. Tardive dyskinesia rates with conventional antipsychotics vary from 2.9–29%. In older patients the incidence is much higher and increases with duration of exposure. Tardive dyskinesia risk appears to be substantially reduced with the atypical antipsychotics. Patient factors associated with tardive dyskinesia risk include increased age, psychiatric diagnosis, female sex, diabetes, organic brain damage, development of other neurological side effects (e.g., extrapyramidal), and the presence of negative symptoms of schizophrenia. The management of tardive dyskinesia includes discontinuing anticholinergic therapy and switching to an atypical antipsychotic; switching to clozapine; initiating suppressive therapy; and/or adding of one of the more experimental treatments.