Minimization and overreaction to tardive dyskinesia

Psychiatry's response to the risk of tardive dyskinesia (TD) from long-term neuroleptic drug use continues to swing from one extreme (overreaction) to the other (minimization or denial). The potential negative effects on psychiatric practice of these extreme responses are reviewed. We suggest that while concerns about litigation may partially account for the continued overreaction and minimization, a more fundamental explanation is psychiatry's continuing inability to integrate itself fully as a medical discipline. We suggest that four basic concepts about schizophrenia and its long-term treatment need to be accepted before TD can be responded to objectively: schizophrenia is a serious brain disease; neuroleptics are helpful when properly used; there are limits to the value of neuroleptic drugs in the treatment of schizophrenia; and neuroleptic drugs can cause serious side effects.