Clinical practice guidelines for the treatment of tardive dyskinesia in Europe: A descriptive review

While evidence-based clinical practice guidelines promote high-quality care, their absence may create unwarranted variation in disease management, leading to suboptimal outcomes. This study aimed to identify existing clinical practice guidelines for tardive dyskinesia (TD) in France, Germany, Italy, Spain, and the United Kingdom (EU4+UK), assessing the evidence for recommended TD treatments.

MEDLINE, PubMed, and other sources (e.g., government/public agencies, associations, patient/research organizations) were searched to identify clinical practice guidelines for TD published between January 2000 and February 2025 in EU4+UK. Mentions of TD treatments in identified documents were classified as "recommendations" or "descriptions." Recommendations were ranked according to the Scottish Intercollegiate Guidelines Network grading system or received a "no-rank" label. Subanalyses on tetrabenazine and tiapride, were performed.

Of the 31 documents identified, only two were TD-specific, with the remainder primarily developed for schizophrenia, major depressive disorder, and bipolar disorder. Data extraction led to 112 mentions of TD treatments (40 recommendations, 72 descriptions). Most recommendations focused on antipsychotic regimen modification (75%) and had no rank (88%). Only five recommendations (no rank) proposed a pharmaceutical (add-on) treatment: three for tetrabenazine and one each for amantadine and buspirone. Neither of the TD-specific guidelines contained TD treatment recommendations.

No specific clinical practice guidelines for TD in EU4 + UK were found, although TD management was mentioned in guidelines for other disorders. Most recommendations were not supported by high-quality evidence. To improve quality of care for patients with TD in Europe, updated treatment recommendations are needed based on high-quality studies.