Improvement of tardive dyskinesia after switching from zuclopenthixol decanoate to paliperidone palmitate: A case report

Abstract

Long-acting injectable (LAI) antipsychotics are an effective option in schizophrenia that increase treatment adherence in potentially non-compliant patients. Tardive dyskinesia is a potentially treatment-resistant movement disorder that can be a problem after long-term antipsychotic use. Atypical antipsychotics with long-acting formulations offer a safer option for acute extrapyramidal side effects, but their effect in tardive dyskinesia is not clear. We report a case of tardive dyskinesia of the perioral area and the tongue after long-term use of zuclopenthixol decanoate, a LAI antipsychotic is a potent dopamine (D2) receptor antagonist. The patient was a 45-year-old Caucasian male with a 25-year history of schizophrenia who was using olanzapine and zuclopenthixol decanoate at the index consultation when the dyskinesia was recognized. Chlorpromazine, haloperidol, olanzapine, and quetiapine were the antipsychotics that had been used for differing periods in addition to zuclopenthixol decanoate over the last six months, before the emergence of tardive dyskinesia. The Abnormal Involuntary Movements Scale was used in scoring the oropharyngeal dyskinesia. Because of the patient's former non-compliance with oral medication and concerns of treatment adherence, we planned to continue using LAI. After switching to paliperidone palmitate, a second generation LAI with receptor-antagonist effects for dopamine (D2), serotonin (5HT-2), and noradrenaline (NE-alpha2) receptors, we observed the improvement of the tardive dyskinesia.