Consultation-Liaison Case Conference: Stimulant-Induced Tardive Dyskinesia

We present Mx. A, a 35-year-old nonbinary patient with a complex psychiatric history, including major depressive disorder with psychotic features, attention deficit hyperactivity disorder, and posttraumatic stress disorder, who developed tardive dyskinesia following stimulant (amphetamine/dextroamphetamine) initiation, which improved significantly after discontinuing the stimulant and switching to quetiapine. The case highlights the challenges of managing tardive dyskinesia in patients with overlapping psychiatric conditions and polypharmacy, emphasizing the role of stimulants in exacerbating movement disorders. A review of stimulant-induced movement disorders underscores their association with tics, dyskinesia, and tardive dyskinesia, particularly in attention deficit hyperactivity disorder populations. We discuss treatment strategies, including Vesicular monoamine transporter 2 inhibitors (e.g., valbenazine), antipsychotic switches (e.g., clozapine, quetiapine), and adjunctive therapies (e.g., vitamin E). The report advocates vigilant monitoring, early intervention, and individualized approaches for tardive dyskinesia in high-risk patients.