Antipsychotic-induced tardive syndromes: Clinical features and treatment approaches

Abstract

Tardive syndromes (TS) are a group of delayed-onset abnormal involuntary movement disorders induced by a dopamine receptor blocking agent. Tardive syndromes remains a relevant clinical problem despite the increasing use of new-generation antipsychotics. Antipsychotic- induced tardive syndromes are difficult to treat and have a low tendency of remission. Their onset is usually insidious and they can be clinically recognized after reaching maximum severity. Frequently reported risk factors are age, dose and duration of neuroleptic exposure, the use of conventional antipsychotics, and co-existing mood disorders. It is possible for a single drug to induce two or more types of movement disorders in the same patient. There are several phenomenologically distinct types of TS. The term tardive dyskinesia has been used to refer to the TS that presents with rapid, repetitive, stereotypic movements mostly involving the oral, buccal, and lingual areas. Other tardive syndromes include tardive dystonia, akathisia, parkinsonism, tics, myoclonus, tremor, and withdrawal-emergent syndrome. While tardive dykinesia, dystonia, and akathisia are clearly delineated syndromes, there are limited data on tics, myoclonus, and the questionable TS. In general, for mild TS, reducing the neuroleptic dose, switching to an atypical agent, or discontinuing antipsychotic treatment altogether in the hope of facilitating remission is recommended. For moderate to severe TS, tetrabenazine or reserpine may be the most effective agent. GABAergic benzodiazepines, adrenergic antagonists, and antioxidants are useful in the next step of treatment of more severe TS. This manuscript summarizes the current evidence with respect to the phenomenology, course and treatment of tardive syndromes.