Q: 72 years old female is recovering in ICU from urosepsis. Patient continues to have periods of delirium with unusual body movements. The psychiatry service diagnosed patient with Tardive Dyskinesis (TD) and advised to discontinue a few home drugs. What does "Tardive" mean in Tardive Dyskinesia?
Answer: Tardive means late
TD is a medication-induced hyperkinetic movement disorder. The most well-known culprits are dopamine receptor-blocking agents i.e., antipsychotic drugs. The two antiemetics which are found to cause TD are metoclopramide and prochlorperazine. As the name applied - Tardive - the onset can be from 4 weeks to six months after the start of a culprit agent. Symptoms are usually subtle and fluctuating. Unfortunately, the cumulative accumulation of drugs makes it worse.
TD involves various kinds of hyperkinetic movements including orofacial dyskinesia, athetosis, dystonia, chorea, and tics.
This nomenclature has a clinical implication. The best management is the early recognition of symptoms and discontinuation of the offending drug. By definition, a diagnosis of TD requires symptoms that must persist for at least four weeks after the removal of the offending drug.
#neurology
#psychiatry
#pharmacology
References:
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
2. Vasan S, Padhy RK. Tardive Dyskinesia. 2021 May 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 28846278.
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