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Managing the risk of tardive dyskinesia.

Article Excerpt
BASED ON AN INTERVIEW WITH WILLIAM M. GLAZER, MD

Modern mental healthcare wouldn't exist without antipsychotics. These drugs led to a revolution in treatment delivery: Many patients with severe mental illnesses were able to throw off the chains of rudimentary treatments (sometimes literally) and become functioning members of society. But one of the serious problems associated with antipsychotic therapy is a neurologic condition called tardive dyskinesia. In the following article, based on an interview with William M. Glazer, MD, associate clinical professor of psychiatry at Harvard Medical School, how to best manage tardive dyskinesia in patients on antipsychotic therapy is explained.

There are two generations of antipsychotics: The typicals are the older drugs, which were followed by a new breed in the late 1980s and early 1990s called the atypicals. A possible major side effect of antipsychotic therapy is tardive dyskinesia (TD), a neurologic syndrome caused by the long-term use of neuroleptic drugs such as antipsychotics. TD is characterized by repetitive, involuntary, purposeless movements. Orofacial features may include grimacing, tongue thrusting, jaw rolling, lip smacking, puckering and pursing, and rapid eye blinking. Rapid movements of the arms, legs, and trunk also may occur. Involuntary movements of the fingers may appear as though the patient is playing an invisible guitar or piano. (1) Symptoms range from mild (only visible to trained examiners) to severe and easily diagnosed. The movements can be embarrassing and even debilitating, affecting eating, breathing, and walking. People with TD might not only face the stigma of having a mental illness, they might also face the stigma of having a movement disorder. This can lead to serious quality-of-life issues.

Etiology

Antipsychotics work by blocking dopamine in the brain, which often causes immediate side effects called extra-pyramidal...

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