Background: Our aim was to study the risk of developing tardive dyskinesia in highly vulnerable patients (i.e., middle-aged and older adults with borderline dyskinesia) treated with conventional versus atypical antipsychotics. Methods: We examined the cumulative incidence of definitive tardive dyskinesia at 1, 3, and 6 months during antipsychotic treatment among 240 outpatients at least 45 years of age who had borderline tardive dyskinesia at baseline. Results: Patients treated with conventional antipsychotics were approximately two times more likely to develop definitive tardive dyskinesia during the study period compared with those treated with atypical antipsychotics (p < .001). This difference was found despite patients in the atypical antipsychotic group being significantly older and having more severe extrapyramidal symptoms at baseline than those prescribed typical antipsychotics. Conclusions: Among patients at a very high risk for worsening tardive dyskinesia, the use of atypical antipsychotics was associated with a significantly lower risk of developing definitive tardive dyskinesia compared with conventional antipsychotics. © 2003 Society of Biological Psychiatry.
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