ARTICLE ON TARDIVE DYSKINESIA

 BY SUNNDEEP CHOPRA:

Tardive Syndromes: These disorders typically manifest or announce themselves months to years after the initiation of neuroleptic (is a tranquilising psychotic medicine or generic drug commonly used to mange psychosis).  Tardive Dyskinesia (TD) is the most common and widely prevalent of these syndromes and usually comprises of chloreiform or involuntary movements of the lips, mouth and tongue. The trunk or lower extremities of the body, limbs and respiratory muscles can be affected or influenced in the most virulent or serious manifestations of the same.

SYMPTOMS: Patients with affective disorders (is either a grouping or conglomeration of both psychotic and medical disorders) are more prone towards developing or then contracting tardive Dyskinesia in comparison to schizophrenic (patients suffering from a mental disorder that affects both the thought processes and emotional responses) patients. The disorder usually re announces or then remits itself in almost one third of all patients within a time frame of three months after stoppage of ingestion of the prescribed drugs and most patients show partial or then gradual improvement over a time span of several years.

The involuntary movements and spasms prove to be more of an irritant to the immediate families of the patients rather than the patients themselves and can be severe, chronic and often even disabling especially in those patients who are victims of or then show a proneness towards the contraction of underlying psychiatric disorders. Atypical or then less commonly prescribed anti psychotic drugs such as clozapine, olanzapine and so on are synonymous with a much lower incidence of  tardive dyskinesia in comparison to older and conservative forms of treatment.

The risk of developing neuroleptic induced tardive dyskinesia is significantly lower in younger patients, while the elderly, the edentulous (toothless) and those with underlying organic cerebral dysfunction are at a much greater peril. Anti-psychotic drugs should be used judiciously and responsibly as a chosen or desired course of treatment as tardive dyskinesia tends to be permanent and resistant to treatment.

TREATMENT: Essentially comprises of or consists the immediate withdrawal or stoppage of the ingestion of all traditional anti-psychotic drugs and due replacement with a newer and more efficacious form of the traditional drug may be considered and started in cases wherein complete withdrawal or then stoppage of all drugs is a remote possibility.

Sudden and abrupt dissociation or complete stoppage of the ingestion of all requisite drugs should also be avoided as acute withdrawal can cause or induce transient (in between two stages) worsening. Tardive Dyskinesia can continue to persist after the withdrawal or cessation of ant-psychotic drugs and become increasingly difficult or problematic to treat or address as time goes by. Benefits or improvements may be induced with the adoption of valproic acid, anticholinergics or botulinum toxin injections based treatments. Catecholamine depletors or inhibitors such as reserpine and tetrabenazine may prove immensely beneficial in treating cases of retraction or recurrence.

Chronic neuroleptic exposure or disorders can also be closely identified or then are almost synonymous with tardive dystonia with preferential, rare or almost discretionary involvement of the axial muscles and signature movement of the trunk and pelvis. It continues to persist or prolong/linger on even after the ingestion of drugs or medicines is at an end and patients are often refractory to medical therapy.

Neuroleptic medications can also be associated with or then linked to a neuroleptic malignant syndrome (NMS). The same is characterized or recognized through it’s resultant symptoms like muscle rigidity, elevated temperature, altered or changed mental status. Symptoms normally evolve or announce themselves over a matter of days or then weeks after initiating or introducing the drug.

Neurological Malignant Syndrome can also be precipitated or aggravated by the abrupt or sudden withdrawal or cessation of antiparkinsonian medications or drugs in patients afflicted with or suffering from the disease. The favoured mode of treatment involves the cessation or withdrawal of the offending drug and the introduction or initiation of a dopaminergic agent.

Levodopa-induced Dyskinesia: Chronic levodopa treatment in psychotic disorder patients is frequently associated or then identified with choreiform dyskinesias that affect or afflict the neck, head, torso and lower/other extremities. They are usually associated or then linked the peak plasma levodopa level and maximal clinical effect (peak dose dyskinesia) but may also occur at the onset or beginning and wearing off the levodopa effect (diphasic dyskinesia).