Tardive syndromes are a group of delayed onset abnormal involuntary movement disorders induced by dopamine receptor blocking agents. Tardive dyskinesia (rhythmic involuntary movements of tongue, face, and jaw) is the best known and may occur even years after drug withdrawal. Tardive dystonia (usually of the face and neck), akathisia (which begins during neuroleptic treatment or within three months of discontinuation and persists for one month or more after drug discontinuation), tics (tardive Tourettism), myoclonus (of the neck or upper arms and particularly associated with high doses of neuroleptics), and tremor can also result from chronic antipsychotic use.5 These syndromes also occur with the newer atypical antipsychotics but the risk is lower. Informing and monitoring the patient may help to reduce malpractice claims that are common in the USA in this therapeutic area. Onset of tardive dyskinesia within three months of drug exposure is possible but uncommon. Some improvement after withdrawal of the offending drug occurs in a third of cases, but complete recovery is rare. If antipsychotic treatment cannot be discontinued, substituting with an atypical agent or adding tetrabenazine may help (tetrabenazine is dopamine depleting and blocks postsynaptic dopamine receptors).
Posted on: Sun, 09 Jun 2013 18:21:45 +0000
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