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Tardive dyskinesia: reversible and irreversible.

D E Casey

    Psychopharmacology. Supplementum
    |January 1, 1985
    PubMed
    Summary

    Long-term prognosis for tardive dyskinesia (TD) shows many patients improve, even with continued low-dose neuroleptic treatment. Discontinuing medication offered the best TD improvement, but low doses were also beneficial.

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    Area of Science:

    • Neuroscience
    • Psychiatry
    • Pharmacology

    Background:

    • Long-term prognosis of tardive dyskinesia (TD) is poorly understood.
    • A common belief is that TD has an irreversible course, leading to avoidance of neuroleptics.
    • This study investigates the impact of neuroleptic treatment on TD over time.

    Purpose of the Study:

    • To clarify the long-term prognosis of tardive dyskinesia (TD).
    • To evaluate the effect of neuroleptic treatment adjustments on TD symptoms and mental status.
    • To determine if neuroleptics worsen TD or if different doses have varying effects.

    Main Methods:

    • Serial evaluation of 27 patients over 5 years.
    • Monitoring changes in neuroleptic treatment, TD severity, and mental status.
    • Categorizing patients based on medication discontinuation, low-dose, or high-dose neuroleptic therapy.

    Main Results:

    • Majority of patients showed over 50% improvement in TD, regardless of treatment group.
    • TD resolved in 29.6% of patients; only one patient showed worsening.
    • Younger patients experienced the most significant improvement.
    • Improvement was most favorable upon neuroleptic discontinuation, but possible with low-to-moderate doses (<600 mg/day CPZ equivalents).
    • Most patients with schizophrenia or schizoaffective disorder required continued treatment to prevent relapse.

    Conclusions:

    • Tardive dyskinesia prognosis is often better than presumed, with significant improvement possible.
    • Low to moderate doses of neuroleptics may be compatible with TD improvement, suggesting different dose-response mechanisms.
    • Long-term monitoring is crucial for understanding the course of TD.
    • Managing psychosis and TD may require individualized neuroleptic treatment strategies.

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