Dyskinesia and neuroleptic exposure in elderly psychiatric inpatients

A wide variation in prevalence rates of tardive dyskinesia and spontaneous orofacial dyskinesia has been reported in the elderly. To clarify these discrepancies, we studied 45 patients over the age of 60 years admitted to a short-term psychiatric unit. Standardized criteria for the diagnosis of dyskinesia were used. We found a rate of tardive dyskinesia of only 21% (7/33) in our patients having a history of neuroleptic exposure. We found no cases (0/12) of spontaneous orofacial dyskinesia. There was a significant association between tardive dyskinesia and psychiatric diagnosis, with the highest rate of tardive dyskinesia in those patients with schizophrenic disorders, followed by those with organic disorders and mood disorders, respectively. There was also a significant association between the presence of tardive dyskinesia and radiographic evidence of cortical atrophy, and a trend towards an association with leukoencephalopathy. Our results suggest that published rates of tardive and spontaneous dyskinesia in the elderly may overestimate the prevalence of these disorders, especially among geriatric patients with acute psychiatric presentations.