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Tardive syndromes are rarely reversible after discontinuing dopamine receptor blocking agents: experience from a university-based movement disorder clinic

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Zutshi, Deepti, Cloud, Leslie J., Factor, Stewart A.·2014·Tremor and Other Hyperkinetic Movements
DOI 10.5334/tohm.199
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Abstract

Background: Several studies have examined reversibility of tardive syndromes (TS), primarily in psychotic patients who are maintained on dopamine receptor blocking drugs. The results have varied widely. However, few have assessed remission rates after discontinuing the offending agents. This study evaluated reversibility of TS in patients who permanently withdrew the causative agent(s). We also examined for any possible clinical predictors of reversibility. Methods: A retrospective cohort of 108 TS patients was studied. Most of the patients were not psychotic; most patients were being treated either for a mood disorder with atypical antipsychotics or for a gastrointestinal disturbance with metoclopramide. Patients were stratified on the basis of reversibility, and statistical tests were used for subgroup comparisons of relevant clinical variables. Logistic regression was undertaken to identify clinical variables predictive of reversibility. Results: Only 13% of the cohort experienced reversibility of the TS, 2% without medical intervention. When stratified by reversibility, there were no significant differences in any study variables between subgroups. None of the study variables predicted reversibility in the logistic regression. Discussion: Our study demonstrated a low remission rate for TS in a cohort of psychiatric and non-psychiatric patients seen in a movement disorder clinic after the offending agents were completely withdrawn. Such a finding has significant prognostic implications. It is possible that limitations of the retrospective design may have resulted in an underestimation. There is a clear need for prospective, multicenter, clinical trials in populations that can be safely withdrawn from dopamine receptor blocking agents so that true remission rates can be measured.

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  • A more recent study found that in patients with 1 year of TD, 13% had symptoms resolve completely (taking 2-4 years, average 2.3), and the number defined as moderate or severe decreased from 63% to less than 20%.

    “A more recent study examined patients with 1 year of TD in whom dopamine antagonists (including metoclopramide) were ceased after 5 years of exposure74: in 13% of the patients, symptoms resolved completely (taking 2–4 years, average 2.3), and the number defined as moderate or severe decreased from 63% to less than 20%.78”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [78]

    The Results report complete resolution in 14 of 108 patients (13%) and a general improvement in severity after discontinuation. They do not support the stated 2–4-year resolution period or a fall in the combined moderate-or-severe group to less than 20%; the reported 2.3-year figure concerns follow-up, not time to resolution. The paper studies tardive syndromes rather than TD alone. (LLM, conf=0.87)

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  • 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 [78]

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Research works printed but not linked: 28

  1. American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. 4th ed., text review (DSM-IV TR) Washington, DC: American Psychiatric Association, p.pp. 803–805.
  2. Schonecker, M (1957). Paroxysmal dyskinesia as the effect of megaphen Nervenarzt 28: 550–553. German. [PubMed]
  3. Fahn, S, Jankovic, J and Hallett, M (2011). The tardive syndromes: Phenomenology, concepts on pathophysiology and treatment, and other neuroleptic-induced syndromes Fahn, S, Jankovic, J and Hallett, M eds. Principles and practice of movement disorders. 2nd ed. Philadelphia, PA: Elsevier Sanders, p.pp. 415–446.
  4. Cloud, LJ, Zutshi, D and Factor, SA (2014). Tardive dyskinesia: Therapeutic options for an increasingly common disorder Neurotherapeutics 11: 166–176, DOI: https://doi.org/10.1007/s13311-013-0222-5 [PubMed] · DOI
  5. Samie, MR, Dannenhoffer, MA and Rozek, S (1987). Life-threatening tardive dyskinesia caused by metoclopramide Mov Disord 2: 125–129, DOI: https://doi.org/10.1002/mds.870020207 [PubMed] · DOI
  6. Correll, CU and Schenk, EM (2008). Tardive dyskinesia and new antipsychotics Curr Opin Psychiatry 21: 151–156, DOI: https://doi.org/10.1097/YCO.0b013e3282f53132 [PubMed] · DOI
  7. Woods, SW Morgenstern, H Saksa, JR et al. (2010). incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: A prospective cohort study J Clin Psychiatry 71: 463–474, DOI: https://doi.org/10.4088/JCP.07m03890yel [PubMed] · DOI
  8. Miller, DD Caroff, SN Davis, SM et al. (2008). Extrapyramidal side-effects of antipsychotics in a randomized trial Br J Psychiatry 193: 279–288, DOI: https://doi.org/10.1192/bjp.bp.108.050088 [PubMed] · DOI
  9. Bateman, DN, Rawlins, MD and Simpson, JM (1985). Extrapyramidal reactions metoclopramide BMJ (Clin Res Ed) 291: 930–932, DOI: https://doi.org/10.1136/bmj.291.6500.930 · DOI
  10. Wilholm, BE, Mortimer, O, Boethius, G and Häggström, JE (1984). Tardive dyskinesia associated with metoclopramide BMJ (Clinical Research Ed.) 288: 545–547, DOI: https://doi.org/10.1136/bmj.288.6416.545 [PubMed] · DOI
  11. Sewell, DD, Kodsi, AB, Caligiuri, MP and Jeste, DV (1994). Metoclopramide and tardive dyskinesia Biol Psychiatry Nov 1;36: 630–632. [PubMed]
  12. Ganzini, L, Casey, DE, Hoffman, WF and McCall, AL (1993). The prevalence of metroclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders Arch Intern Med 153: 1469–1475, DOI: https://doi.org/10.1001/archinte.1993.00410120051007 [PubMed] · DOI
  13. Hyde, TM, Apud, JA, Fisher, WC and Egan, MF (2005). Tardive dyskinesia Factor, SA, Lang, AE and Weiner, WJ eds. Drug induced movement disorders. 2nd ed. Oxford: Blackwell Publishing, p.pp. 213–256.
  14. Smith, JM and Baldessarini, RJ (1980). Changes in prevalence, severity and recovery in tardive dyskinesia with age Arch Gen Psychiatry 37: 1368–1373, DOI: https://doi.org/10.1001/archpsyc.1980.01780250054006 [PubMed] · DOI
  15. Burke, RE (1984). Tardive dyskinesia: Current clinical issues Neurology 34: 1348–1353, DOI: https://doi.org/10.1212/WNL.34.10.1348 [PubMed] · DOI
  16. Glazer, WM, Moore, DC, Schooler, NR, Brenner, LM and Morgenstern, H (1984). Tardive dyskinesia. A discontinuation study Arch Gen Psychiatry 41: 623–627, DOI: https://doi.org/10.1001/archpsyc.1984.01790170097011 [PubMed] · DOI
  17. Glazer, WM, Morgenstern, H, Schooler, N, Berkman, CS and Moore, DC (1990). Predictors of improvement in tardive dyskinesia following discontinuation of neuroleptic medication Br J Psychiatry 157: 585–592, DOI: https://doi.org/10.1192/bjp.157.4.585 [PubMed] · DOI · Paper page
  18. Soares, KV and McGrath, JJ (1999). The treatment of tardive dyskinesia—a systematic review and meta-analysis Schizophr Res 39: 1–16, discussion 17–18. DOI: https://doi.org/10.1016/S0920-9964(99)00021-3 [PubMed] · DOI
  19. Kang, UJ, Burke, RE and Fahn, S (1986). Natural history and treatment of tardive dystonia Mov Disord 1: 193–208, DOI: https://doi.org/10.1002/mds.870010305 [PubMed] · DOI
  20. Kane, JM, Woerner, M, Borenstein, M, Wegner, J and Lieberman, J (1986). Integrating incidence and prevalence of tardive dyskinesia Psychopharmacol Bull 22: 254–258. [PubMed]
  21. Esper, CD and Factor, SA (2008). Failure of recognition of drug-induced parkinsonism in the elderly Mov Disord 23: 401–404, DOI: https://doi.org/10.1002/mds.21854 [PubMed] · DOI
  22. Paulson, GW (1968). An evaluation of the permanence of the “tardive dyskinesias.” Dis Nerv Syst 29: 692–694. [PubMed]
  23. Quitkin, F, Rifkin, A, Gochfeld, L and Klein, DF (1977). Tardive dyskinesia: Are first signs reversible? Am J Psychiatry 134: 84–87. [PubMed]
  24. Jeste, DV, Potkin, SG, Sinha, S, Feder, S and Wyatt, RJ (1979). Tardive dyskinesia—reversible and persistent Arch Gen Psychiatry May 197936: 585–590, DOI: https://doi.org/10.1001/archpsyc.1979.01780050095012 [PubMed] · DOI
  25. Tarsy, D and Baldessarini, RJ (2006). Epidemiology of tardive dyskinesia: Is risk declining with modern antipsychotics? Mov Disord 21: 589–598, DOI: https://doi.org/10.1002/mds.20823 [PubMed] · DOI
  26. Fernandez, HH, Krupp, B and Friedman, JH (2001). The course of tardive dyskinesia and parkinsonism in psychiatric inpatients: 14-year follow-up Neurology 56: 805–807, DOI: https://doi.org/10.1212/WNL.56.6.805 [PubMed] · DOI
  27. Bhidayasiri, R, Fahn, S, Weiner, WJ, Gronseth, GS, Sullivan, KL and Zesiewicz, TA (2013). Evidence-based guideline: Treatment of tardive syndromes: Report of the Guideline Development Subcommittee of the American Academy of Neurology Neurology 81: 463–469, DOI: https://doi.org/10.1212/WNL.0b013e31829d86b6 [PubMed] · DOI
  28. (self.__next_s=self.__next_s||[]).push([0,{"children":"window.__ENV__ = {\"RECAPTCHA_SITE_KEY\":\"6Le0hRwlAAAAAITIRbvt3u-Wt6RC5wmUUb_jefX3\",\"SERVICE_CODE\":\"up-j-tohm\",\"FRONTEND_URL\":\"https://tremorjournal.org\",\"FRONTEND_DOMAIN\":\"tremorjournal.org\",\"OJS_API_URL\":\"https://api.account.up-j-tohm.ubiquityjournal.website/api/journal/1\"};","id":"public-env"}])This page is for printing. If you wish to read this article, please visit its full version.Tardive Syndromes are Rarely Reversible after Discontinuing Dopamine Receptor Blocking Agents: Experience from a University-based Movement Disorder ClinicDeepti ZutshiLeslie J. CloudStewart A. FactorAbstractBackground: Several studies have examined reversibility of tardive syndromes (TS), primarily in psychotic patients who are maintained on dopamine receptor blocking drugs. The results have varied widely. However, few have assessed remission rates after discontinuing the offending agents. This study evaluated reversibility of TS in patients who permanently withdrew the causative agent(s). We also examined for any possible clinical predictors of reversibility.Methods: A retrospective cohort of 108 TS patients was studied. Most of the patients were not psychotic; most patients were being treated either for a mood disorder with atypical antipsychotics or for a gastrointestinal disturbance with metoclopramide. Patients were stratified on the basis of reversibility, and statistical tests were used for subgroup comparisons of relevant clinical variables. Logistic regression was undertaken to identify clinical variables predictive of reversibility.Results: Only 13% of the cohort experienced reversibility of the TS, 2% without medical intervention. When stratified by reversibility, there were no significant differences in any study variables between subgroups. None of the study variables predicted reversibility in the logistic regression.Discussion: Our study demonstrated a low remission rate for TS in a cohort of psychiatric and non-psychiatric patients seen in a movement disorder clinic after the offending agents were completely withdrawn. Such a finding has significant prognostic implications. It is possible that limitations of the retrospective design may have resulted in an underestimation. There is a clear need for prospective, multicenter, clinical trials in populations that can be safely withdrawn from dopamine receptor blocking agents so that true remission rates can be measured.Year: 2014Volume 4Page/Article: 266DOI: 10.5334/tohm.199Accepted on Sep 17, 2014Published on Oct 23, 2014Peer ReviewedCC BY-NC-ND 3.0 · DOI

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Authors
Zutshi, D., Cloud, L. J., & Factor, S. A.
Affiliations
  • Emory University (US)
  • Virginia Commonwealth University (US)
  • Wayne State University (US)
Corresponding author
Factor, Stewart A.
ORCID
Venue
Tremor and Other Hyperkinetic Movements
Publisher
Ubiquity Press, Ltd.
Published
2014-10-23
Volume
4
Issue
0
Pages
266
ISSN
2160-8288 (ISSN-L)
DOI
10.5334/tohm.199
OpenAlex
W4246973800
Cited by
71
References
0
Citations by year
2026: 3 · 2025: 7 · 2024: 7 · 2023: 2 · 2022: 4 · 2021: 7 · 2020: 9 · 2019: 14 · 2018: 8 · 2017: 8 · 2016: 1 · 2015: 1
FWCI
2.54
Type
journal article
Language
en
Open access
Licence
Locations
Tremor and Other Hyperkinetic Movements (publishedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Neurological and metabolic disorders
  • Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
Keywords
tardive dyskinesia, tardive syndromes, reversibility, dopamine receptor blocking agents, antipsychotic withdrawal, atypical antipsychotics, metoclopramide, predictors of remission, movement disorders, mood disorders

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