Hostname: page-component-7c8c6479df-7qhmt Total loading time: 0 Render date: 2024-03-28T02:46:46.828Z Has data issue: false hasContentIssue false

Predictors of Improvement in Tardive Dyskinesia Following Discontinuation of Neuroleptic Medication

Published online by Cambridge University Press:  02 January 2018

William M. Glazer*
Affiliation:
Yale University School of Medicine, Director, TD Clinic
Hal Morgenstern
Affiliation:
UCLA School of Public Health
Nina Schooler
Affiliation:
Psychotic Disorders, Research Program, Department of Psychiatry, University of Pittsburgh, School of Medicine
Cathy S. Berkman
Affiliation:
Columbia University, School of Public Health
Daniel C. Moore
Affiliation:
Yale University School of Medicine
*
School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, Connecticut 06519, USA

Abstract

Forty-nine chronic psychiatric out-patients (ten were schizophrenic) with tardive dyskinesia (TD) were examined monthly for a mean of 40 weeks (range 1–59 months) after discontinuation of neuroleptic medication. Complete and persistent reversibility of TD was rare (2%), but many patients showed noticeable improvement in movements within the first year of discontinuation, which was sometimes interrupted by psychological relapse. Using three separate outcome measures and appropriate model-fitting techniques for each, we identified several predictors of improvement in TD, including an affective or schizoaffective psychiatric diagnosis, chronic (over 20 years) psychiatric illness, being employed, younger age, and increased neuroleptic dose before discontinuation. Consistent findings emerging from these analyses suggest that the type and history of psychiatric illness affect the course of TD.

Type
Papers
Copyright
Copyright © Royal College of Psychiatrists, 1990 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Carpenter, W. T. & Heinrichs, D. W. (1983) Early intervention, time-limited, targeted pharmacotherapy of schizophrenia. Schizophrenia Bulletin, 9, 533542.CrossRefGoogle ScholarPubMed
Crane, G. E. (1973) Persistent dyskinesia. British Journal of Psychiatry, 122, 395405.Google Scholar
Crane, G. E., Ruis, P., Kernohan, W. J., et al (1969) Effects of drug withdrawal on tardive dyskinesia. Actizitas Nervosa Superior, 11, 3035.Google Scholar
Crow, T. J., Owens, D. G. C., Johnstone, E. C., et al (1983) Does tardive dyskinesia exist? Moderne Probleme der Pharmakopsychiatrie, 21, 206219.Google Scholar
Cutler, N. R., Post, R. M., Rey, A. C., et al (1981) Depression-dependent dyskinesias in two cases of manic-depressive illness. New England Journal of Medicine, 304, 10881089.Google Scholar
Davis, K. L., Berger, P. A. & Hollister, L. E. (1976) Tardive dyskinesia and depressive illness. Psychopharmacology Communications, 2, 125130.Google ScholarPubMed
Degkwitz, R. (1969) Extrapyramidal motor disorders following long-term treatment with neuroleptic drugs. In Psychotropic Drugs and Dysfunctions of the Basal Ganglia (eds G.E. Crane & R. Gardner). Washington, DC: US Public Health Service.Google Scholar
Edwards, H. (1970) The significance of brain damage in persistent oral dyskinesia. British Journal of Psychiatry, 116, 271275.CrossRefGoogle ScholarPubMed
Endicott, J. & Spitzer, R. L. (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35, 837844.Google Scholar
Glazer, W. M. (1986) Notes from a tardive dyskinesia clinic. Yale Psychiatric Quarterly, 8, 415.Google Scholar
Glazer, W. M. & Moore, D. C. (1981) A tardive dyskinesia clinic in a mental health center. Hospital and Community Psychiatry, 32, 572574.Google Scholar
Glazer, W. M., Moore, D. C., Schooler, N., et al (1984) Tardive dyskinesia: a discontinuation study. Archives of General Psychiatry, 41, 623627 Google Scholar
Glazer, W. M., Moroenstern, H. & Niedzwiecki, D. (1988) Heterogeneity of tardive dyskinesia: a multivariate analysis. British Journal of Psychiatry, 152, 253259.Google Scholar
Granacher, R. (1981) Differential diagnosis of tardive dyskinesia: an overview. American Journal of Psychiatry, 138, 12881297.Google ScholarPubMed
Hambra, B. J., Nasrallah, H., Clancy, J., et al (1983) Psychiatric diagnosis and risk for tardive dyskinesia. Archives of General Psychiatry, 40, 347348.Google Scholar
Hershon, H. I., Kennedy, P. F. & McGuire, R. J. (1972) Persistence of extrapyramidal disorders and psychiatric relapse after withdrawal of long-term phenothiazine therapy. British Journal of Psychiatry, 120, 4150.Google Scholar
Hollister, L. E. (1977) Anti-psychotic medications and the treatment of schizophrenia. In Psychopharmacology: From Theory to Practice (eds J. D. Barchas, P. A. Berger, R. D. Ciaranello, et al). New York: Oxford Publishing Press.Google Scholar
Hunter, R., Earl, C. J. & Thornicroft, S. (1964) An apparently irreversible syndrome of abnormal movements following phenothiazine medication. Proceedings of the Royal Society of Medicine, 157, 758762.Google Scholar
Jeste, D., Potkin, S., Feder, S., et al (1979) Tardive dyskinesia: reversible and persistent. Archives of General Psychiatry, 36, 585590.Google Scholar
Kane, J., Wegner, J. T., Stenzler, S., et al (1980) The prevalence of presumed tardive dyskinesia in psychiatric inpatients and outpatients. Psychopharmacology, 69, 247251.Google Scholar
Kane, J., Woerner, M., Weinhold, P., et al (1984) Incidence of tardive dyskinesia: five year data from a prospective study. Psychopharmacology Bulletin, 20, 3940.Google ScholarPubMed
Karson, C. G., Jeste, D. V. & Bigelow, L. B. (1985) Tardive dyskinesia and psychopathology in chronic schizophrenia: a cross-sectional study. Comprehensive Psychiatry, 26, 388391.CrossRefGoogle ScholarPubMed
Mukherjee, S., Rosen, D. & Cardenas, C. (1982) Tardive dyskinesia in psychiatric outpatients: a study of prevalence and association with demographic, clinical and drug history variables. Archives of General Psychiatry, 39, 466469.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The brief psychiatric rating scale. Psychological Reports, 10, 799812.Google Scholar
Owens, D. G. C., Johnstone, E. C. & Frith, C. D. (1982) Spontaneous involuntary disorders of movement. Archives of General Psychiatry, 39, 452461.CrossRefGoogle ScholarPubMed
Paulson, C. W. (1968) An evaluation of the permanence of the “tardive dyskinesia”. Diseases of the Nervous System, 24, 692694.Google Scholar
Pearlson, G. D., Garbacz, D. J., Tompkins, R. H., et al (1984) Clinical correlates of lateral ventricular enlargement in bipolar affective disorder. American Journal of Psychiatry, 141, 253256.Google Scholar
Pryce, I. G. & Edwards, H. (1966) Persistent oral dyskinesia in female mental hospital patients. British Journal of Psychiatry, 112, 983987.Google Scholar
Quitkin, F., Rifkin, A. & Gochfeld, L. (1977) Tardive dyskinesia: are first signs reversible? American Journal of Psychiatry, 134, 8487.Google Scholar
Rush, M., Diamond, F. & Alpert, M. (1982) Depression as a risk factor in tardive dyskinesia. Biological Psychiatry, 17, 387392.Google Scholar
Smith, J. M., Kucharski, L. T. & Oswald, W. T. (1979) Tardive dyskinesia: effect of age, sex and criterion level of symptomatology on prevalence estimates. Psychopharmacology Bulletin, 15, 6971.Google ScholarPubMed
Smith, J. M. & Baldessarini, R. J. (1980) Changes in prevalence, severity and recovery in tardive dyskinesia with age. Archives of General Psychiatry, 37, 13681373.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research diagnostic criteria: rationale and reliability. Archives of General Psychiatry, 35, 773782.Google Scholar
Uhrbrand, L. & Faurbye, A. (1960) Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine, and electroconvulsive therapy. Psychopharmacologia, 1, 408418.Google Scholar
Yagi, G., Ogita, K., Ohtsuha, N., et al (1976) Persistent dyskinesia after long-term treatment with neuroleptics in Japan: its present status and clinical problems. Keio Journal of Medicine, 25, 2735.Google Scholar
Yassa, R., Nair, V. & Schwartz, G. (1984) Tardive dyskinesia and the primary psychiatric diagnosis. Psychosomatics, 25, 135138.CrossRefGoogle ScholarPubMed
Yassa, R. & Schwartz, G. (1984) Depression as a predictor in the development of tardive dyskinesia. Biological Psychiatry, 19, 441444.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.