Historical perspectives on tardive dyskinesia
Abstract
Tardive dyskinesia (TD) is a persistent hyperkinetic movement disorder associated with dopamine receptor blocking agents including antipsychotic medications. Although uncertainty and concern about this drug side effect have vacillated since its initial recognition 60 years ago, recent commercial interest in developing effective treatments has rekindled scientific and clinical interest after a protracted period of neglect. Although substantial research has advanced knowledge of the clinical features and epidemiology of TD, many fundamental questions raised by early investigators remain unresolved. In this paper, we review the early clinical reports that led to the acceptance of TD as an iatrogenic disorder and the lingering controversies that emerged thereafter. Continued research on TD as a serious adverse reaction to treatment may not only enhance patient outcomes and recovery efforts but may also provide insights into both the mechanism of action of antipsychotic drugs and the nosology and pathophysiology of idiopathic psychomotor disorders.
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The persistence of TD provides evidence that neuro-adaptations to antipsychotics persist for many years and supports the need for long tapering.
“The persistence of TD, the most visible manifestation of dopaminergic hypersensitivity,75 for a considerable time following cessation of antipsychotics, provides evidence that neuro-adaptations to antipsychotics persist for many years and supports the need for long tapering.”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [75]
TD can resolve when antipsychotics are discontinued but this process might, in some cases, take years and may be irreversible in some patients.
“This suggests that TD (along with, presumably, dopaminergic hypersensitivity) can resolve when antipsychotics are discontinued but this process might, in some cases, take years75,76 and may be irreversible in some patients.75”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [75]
There is likely considerable interindividual variability in the tapering process, with patients able to tolerate greatly varying rates of reduction; some long-term treated patients may need longer periods, and some first-episode patients or those treated for briefer periods may tolerate shorter tapering periods.
“There is likely to be considerable interindividual variability in this process, with patients able to tolerate greatly varying rates of reduction: given the data on time for TD to resolve, some long-term treated patients may need longer periods, and some first-episode patients or those treated for briefer periods may tolerate shorter tapering periods.75,76,78,101”
From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [75]
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References 98 · Cited by 55
- Authors
- Caroff, S. N., Ungvari, G. S., & Cunningham Owens, D. G.
- Affiliations
- Philadelphia VA Medical Center (US)
- The University of Notre Dame Australia (AU)
- Corresponding author
- Caroff, Stanley N.
- Ungvari, Gabor S.
- ORCID
- Caroff, Stanley N.
- Venue
- Journal of the Neurological Sciences
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 389
- Pages
- 4-9
- ISSN
- 0022-510X (ISSN-L)
- OpenAlex
- W2789984341
- Cited by
- 55
- References
- 98
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 9 · 2023: 7 · 2022: 7 · 2021: 8 · 2020: 7 · 2019: 7
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Neurological Sciences (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- tardive dyskinesia, antipsychotic drugs, dopamine antagonists, drug-induced movement disorders, iatrogenic disease, adverse drug reactions, pathophysiology, disease classification
- MeSH terms
- Tardive Dyskinesia, Humans, Antipsychotic Agents, History, 20th Century, History, 21st Century
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