Abstract
Background
Tardive dyskinesia (TD) is a severe condition that can affect almost 1 out of 4 patients
on current or previous antipsychotic treatment, including both first-generation antipsychotics
(FGAs) and second-generation antipsychotics (SGAs). While two novel vesicular monoamine
transporter inhibitors, deutetrabenazine and valbenazine, have shown acute efficacy
for TD, the majority of patients do not remit, and TD appears to recur once treatment
is withdrawn. Hence, prevention of TD remains a crucial goal.
Methods
We provide a clinically oriented overview of risk factors for TD, dividing them into
patient-, illness- and treatment-related variables, as well as nonmodifiable and modifiable
factors.
Results
Unmodifiable patient-related and illness-related risk factors for TD include older
age, female sex, white and African descent, longer illness duration, intellectual
disability and brain damage, negative symptoms in schizophrenia, mood disorders, cognitive
symptoms in mood disorders, and gene polymorphisms involving antipsychotic metabolism
and dopamine functioning. Modifiable comorbidity-related and treatment-related factors
include diabetes, smoking, and alcohol and substance abuse, FGA vs SGA treatment,
higher cumulative and current antipsychotic dose or antipsychotic plasma levels, early
parkinsonian side effects, anticholinergic co-treatment, akathisia, and emergent dyskinesia.
Discussion
Clinicians using dopamine antagonists need to consider risk factors for TD to minimize
TD and its consequences.
Keywords
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Article Info
Publication History
Published online: February 05, 2018
Accepted:
February 2,
2018
Received:
January 3,
2018
Footnotes
☆This article is part of the Special Issue Tardive Syndromes and Their Management edited by Robert A. Hauser and Daniel D. Truong.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
