The Treatment of Tardive Dyskinesia and Tardive Dystonia

The enthusiasm produced by the introduction of antipsychotic medication in the 1950s gave way toa certain frustration in the 1970s and 1980s. Despite the development of a large number of new drugs,little progress was made in treatment because these new agents were, in essence, therapeuticallyequivalent. This lack of progress was perhaps also related to an emphasis on tardive dyskinesia in the1970s, i.e., the preoccupation with a negative effect of treatment. The reverse is taking place today.Clozapine and the other atypical antipsychotics are associated in people’s minds with fewer or absentextrapyramidal symptoms and less tardive dyskinesia than the older typical agents. As a result, a certainamount of complacency exists. Tardive dyskinesia not only may be painful and disfiguring, but italso predicts poor outcome in patients with schizophrenia. Although many treatments have been tried,none have proven completely efficacious. The best treatment for tardive dyskinesia and dystonia isprevention, which is a function of medication choice. Pharmacologic interventions for tardive dyskinesiainclude clozapine and the other atypical antipsychotics. If typical antipsychotics must be used,they should be started at the lowest possible levels. Studies of risperidone suggest that it, too, shouldbe used at very low doses to minimize the risk of tardive dyskinesia. It is also possible that schizophrenicpatients taking atypical antipsychotics may experience fewer spontaneous dyskinesias, althoughfurther study is warranted.