Prevention and management of tardive dyskinesia

There is a growing medical and public concern about neuroleptic-induced persistent tardive dyskinesia. The clinician faces a difficult dilemma because there are no effective substitutes for neuroleptics in the treatment of a majority of schizophrenic patients. In dealing with this dilemma, the physician should 1) periodically assess indications for neuroleptics in each patient, 2) use the lowest effective dose, 3) inform the patient of the risk of tardive dyskinesia, 4) examine the patient at regular intervals for early signs of tardive dyskinesia, and 5) document these steps. Strategies for the management of tardive dyskinesia are also discussed.