TARDIVE DYSKINESIA What is Tardive Dyskinesia (TD)?

o Neurological syndrome caused by long-term use of drugs to treat psychiatric

disorders o Presents as repetitive, involuntary, and purposeless movements

o Symptoms include:

o Grimacing o Tongue protrusion o Lip smacking o Puckering or Pursing of the lips

o Rapid eye blinking o Rapid movements of the arms o Rapid leg movement o Finger movements

Parkinson’s Disease Symptoms

o Often TD symptoms can be confused for parkinsonian movement disorders

o Present as:

o Resting tremors

o Rigidity

o Postural Instability

o Bradykinesia

Psycosis

o Dysfunction of the mesolimbic system caused by too much

dopamine in the brain according to the dopaminergic

hyperactivity theory o Medications for the treatment

mental conditions block dopamine receptors

o Blocking dopamine results in reduced amounts of dopamine

or malfunctioning of receptors and causes extrapyramidal

side effects

o End result is decreased dopamine in

mesocorticolimbic pathway and nigrostriatal pathway of

the brain

Parkinson’s Disease o Dysfunction in the nigrostriatal

pathway caused by too little dopamine working in the body

o For treatment, medications are used that provide extra

dopamine o Side effects of the medication

can cause psycosis from the increased dopamine in the

mesocorticolimbic pathway in the brain

What medications cause TD?

o Metoclopramide (Reglan®) o Trifluoperazine (Stelazine®)

o Prochlorperazine (Compazine®) o Perphenazine (Trilafon®)

o Promethazine (Phenergan®) o Fluphenazine (Prolixin®)

o Chlorpromazine (Thorazine®) o Thiothixene (Navane®)

o Haloperidol (Haldol®) o Thioridazine (Mellaril®)

Olanzapine (Zyprexa®) Quetiapine (Seroquel®)

Risperidone (Risperdal®) Amisulpride (Solian®)

Selectivity of Psychiatric Medications o First Generation Antipsychotics

o Known as DOPAMINE ANTAGONISTS

o Bind and block multiple receptors in the brain including D1, D2, D4, and serotinergic receptors

o When 60% of the D2 receptors are blocked, efficacy is reached. At 80% D2 receptor blockade, extrapyramidal side effects can be seen

o Atypical Antipsychotics (Second Generation) o Known as SEROTONIN-DOPAMINE ANTAGONISTS

o Have higher affinities for 5-HT2, D1 and D4 rather than D2 o Cause fewer extrapyramidal side effects

o More specific for mesolimbic pathway o Thought to have faster dissociation from D2 receptors

Treatment of TD:

o Three basic approaches o Prevention

o Diagnosis

o Management o Discontinue medication or reduce dose

o Change to different antipsychotic o Initiating benzodiazepine or vitamin E may relieve some of the

patient’s symptoms o Benztropine may be used to treat extrapyramidal symptoms

Distinguishing TD from other Movement disorders: o Youtube video demonstrates the symptoms of Parkinson’s disease

http://www.youtube.com/watch?v=xuVY7wS25rc&feature=related o Youtube video demonstrates various TD symptoms and how to score them

http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related

o Using forms and scoring techniques, it is easier to document symptoms patients

have and track progression o Remember that people with Parkinson’s Disease have difficulty moving, while

those with tardive dyskinesia have difficulty not moving

References:

"Bjeaaan213 - Parkinson's." Bjeaaan213 - Home. Web. 13 July 2010. <http://bjeaaan213.wikispaces.com/parkinson's>.

Hsiung, Robert. "Abnormal Involuntary Movement Scale." The Dr. Bob Home Page. Web.

13 July 2010. <http://www.dr-bob.org/tips/aims.html>.

"Neuroleptics - Tardive Dyskinesia Causes." Tardive Dyskinesia & Reglan - Symptoms, Side Effects & Treatments. 14 May 2010. Web. 13 July 2010.

<http://www.tardivedyskinesia.com/causes/neuroleptics.php>.

"Nutritional Treatment of Tardive Dyskinesia." Pharmaceuticals Anonymous. Web. 13 July 2010. <http://pharmaceuticalsanonymous.blogspot.com/2008/03/nutritional-

treatment-of-tardive.html>.

"Parkinson's Disease - Homepage." BIO349, CSB/EEB/BIOTA, University of Toronto. 13

Mar. 2009. Web. 13 July 2010. <http://bio349.biota.utoronto.ca/20089/20089bio349graham/parkinsons/index.ht

ml>.

Rang, H. P. Rang and Dale's Pharmacology. 6th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2007. Print.

Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's

Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. 10th ed. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.

"Tardive Dyskinesia: EMedicine Neurology." EMedicine - Medical Reference. Web. 13 July

2010. <http://emedicine.medscape.com/article/1151826-overview>.

"Tardive Dyskinesia Information Page." National Institute of Neurological Disorders and

Stroke (NINDS). 14 Feb. 2007. Web. 10 July 2010. <http://www.ninds.nih.gov/disorders/tardive/tardive.htm>.

"YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast

Yourself. Web. 10 July 2010. <http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related>.

"YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast

Yourself. Web. 13 July 2010. <http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=player_embedded>.