Tardive dyskinesia: Risk factors, prevention, and treatment

Abstract

Background : Tardive dyskinesia is a complication of antipsychotic treatment characterized by chorieform involuntary movements affecting commonly the orofacial and buccolingual regions, but also trunk and extremities. Even though the exact etiology is not clearly understood, it is believed that upregulation of postsynaptic dopamine receptors after chronic dopamine blockade and neuronal oxidative damage may be implicated. The symptoms may be lifelong in some patients. Risk factors include advanced age, female sex, type of antipsychotic agents and routes of administration, pre existing movement disorders and general health of the patient. Multiple agents including vitamin B6, branched-chain amino acids, Ginko biloba, medications including beta blockers, ondansetron and benzodiazapines have been tried in the treatment of tardive dyskinesia without much success. The newly approved medications valbenazine and deutetrabenazine offer hope to these patients who otherwise had to live with this socially and functionally disabling disorder. Methods : Literature review was conducted using keywords tardive dyskinesia, risk factors, pathophysiology, treatment, Valbenazine, and deutetrabenazine. Search engines used include Pubmed, Cochrane Review, PsycINFO, and Psychiatry Online. Results : We have summarized the history, pathophysiology, risk factors, and management of TD including the recently approved medications. Conclusion : Tardive dyskinesia is a disabling, long term side effect of antipsychotic use. Many risks factors predispose patients to the development of symptoms. Until recently, there were no FDA approved treatments. The newly approved medications valbenazine and tetrabenazine have shown promising results for the