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Reprint of: Clinical management of tardive dyskinesia: Five steps to success

Published:February 27, 2018DOI:https://doi.org/10.1016/j.jns.2018.02.037

      Highlights

      • Tardive dyskinesia (TD) remains relatively common, despite the use of second-generation antipsychotics.
      • The Abnormal Involuntary Movement Scale offers a well-accepted solution to assessing dyskinetic movements.
      • There are now two medications approved by regulatory authorities for the treatment of TD: deutetrabenazine and valbenazine.
      • Deutetrabenazine and valbenazine are reversible VMAT2 inhibitors that modulate dopamine signaling by reducing dopamine output, hence reducing the symptoms of TD.

      Abstract

      Tardive dyskinesia (TD) has long been thought to be a generally irreversible consequence of the use of dopamine receptor blocking agents. There is now an opportunity to successfully manage this condition with agents approved by the US Food and Drug Administration. This is important because TD has not been eliminated with the use of second-generation antipsychotics, and the expansion of antipsychotics to treat conditions other than schizophrenia has resulted in millions of additional individuals at risk for developing TD. Recognition of TD requires careful observation; a structured approach using the Abnormal Involuntary Movement Scale is encouraged. Harm reduction can be achieved by using antipsychotics judiciously when possible and by paying attention to other modifiable risk factors such as drug-induced parkinsonian symptoms and the use of anticholinergic medication. Once TD has emerged and is associated with dysfunction or distress, treatment with a VMAT2 inhibitor such as deutetrabenazine or valbenazine is well supported by several controlled clinical trials.

      Keywords

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      • Clinical management of tardive dyskinesia: Five steps to success
        Journal of the Neurological SciencesVol. 383
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          Tardive dyskinesia (TD) has long been thought to be a generally irreversible consequence of the use of dopamine receptor blocking agents. There is now an opportunity to successfully manage this condition with agents approved by the US Food and Drug Administration. This is important because TD has not been eliminated with the use of second-generation antipsychotics, and the expansion of antipsychotics to treat conditions other than schizophrenia has resulted in millions of additional individuals at risk for developing TD.
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