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Clinical risk factors for the development of tardive dyskinesia

  • Marco Solmi
    Affiliations
    University of Padua, Neuroscience Department, Psychiatry Unit, Padua, Italy

    University Hospital of Padua, Azienda Ospedaliera di Padova, Psychiatry Unit, Padua, Italy
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  • Giorgio Pigato
    Affiliations
    University Hospital of Padua, Azienda Ospedaliera di Padova, Psychiatry Unit, Padua, Italy
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  • John M. Kane
    Affiliations
    The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA

    Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA
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  • Christoph U. Correll
    Correspondence
    Corresponding author at: Division of Psychiatry Research, The Zucker Hillside Hospital, 75-59 263rd Street, Glen Oaks, NY 11004, USA.
    Affiliations
    The Zucker Hillside Hospital, Department of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA

    Hofstra Northwell School of Medicine, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA

    Charité Universitätsmedizin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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Published:February 05, 2018DOI:https://doi.org/10.1016/j.jns.2018.02.012

      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have shown acute efficacy for TD, the majority of patients do not remit, and TD appears to recur once treatment is withdrawn.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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