References
Multifactorial Tardive Dyskinesia: a case study
Abstract
This article is a case review of an older lady presenting with Tardive Dyskinesia, a rare phenomenon in modern times. This case is interesting, as the typical causative factor of this presentation was absent. The authors discuss the risk factors for developing Tardive Dyskinesia, as well as medication likely contributing to this lady's case. The paper also discusses treatment, prognosis and how the mechanism of Tardive Dyskinesia can be multifactorial. The authors hope this case review will provide an update to prescribers both within the mental health field and in other medical specialties, as Tardive Dyskinesia is seen less often in practice.
Tardive Dyskinesia (TD) has a global mean prevalence of 25%, with slightly lower rates seen in treatment with atypical (or second generation) antipsychotics – 20.7%, as opposed to 30.0% with typical/first generation antipsychotics (Carbon et al, 2017). This case was particularly interesting, given that the patient had no known previous history of treatment with antipsychotic medication. The case highlighted the many other factors that can contribute to the development of TD.
TD is a neurological disorder that is characterised by involuntary movements of the face and jaw (Royal College of Psychiatrists [RCPsych], 2019); described by Waln and Janovic (2013) as any ‘tardive hyperkinetic movement disorder, such as stereotypy, akathisia, dystonia, tremor, tics, chorea, and myoclonus’. It is a recognised side-effect of prolonged use of anti-psychotic medication. TD is a ‘hyperkinetic syndrome’ that occurs later in the treatment journey than extra-pyramidal side-effects (EPSEs), and is persistent (Fann et al, 1976). The prevalence is thought to be 20–50% of all patients treated with neuroleptics (Carbon et al, 2017), although this varies with age.
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