People with schizophrenia may exhibit a variety of mannerisms and movements others may consider abnormal, but these movements are most often the consequence of a condition called tardive dyskinesia, or TD.
Sometimes, these atypical are examples of disorganized behavior, which is one of five types of symptoms associated with schizophrenia. However, it’s more likely they’re the result of TD.
The symptoms of TD can have a negative impact on physical, psychological, and social well-being. They can also intensify the stigma that people with schizophrenia and other complex mental illnesses often experience.
What Is Tardive Dyskinesia?
Tardive dyskinesia is a neurological condition that induces involuntary, repetitive movements in various body parts, particularly the face, trunk, and limbs.
According to the National Organization for Tardive Dyskinesia (NOTD), experts estimate that more than 750,000 in the United States have this condition.
Symptoms of TD can include:
- Rapid, excessive blinking
- Facial tics
- Repetitive movements of the mouth and jaw
- Smacking or puckering of the lips
- Difficulty swallowing
- Puffing of the cheeks
- Grimacing and grunting
- Rocking back and forth
- Swaying from side to side
- Rapid, jerking movements of the arms and legs
- Slow, writing movement of torso and limbs
Many people with schizophrenia develop tardive dyskinesia, though TD is not a symptom of schizophrenia or any other mental health disorder. Instead, tardive dyskinesia results from a common treatment for schizophrenia and other psychotic disorders: medication.
Most cases of TD are related to the extended use of antipsychotic medications that block dopamine receptors in the central nervous system. Many sources report that first-generation, or typical, antipsychotics pose a higher risk of TD, but some studies challenge this.
Commonly prescribed first-generation antipsychotics include:
- Thorazine (chlorpromazine)
- Haldol (haloperidol)
- Loxitane (loxapine)
- Prolixin (fluphenazine)
- Navane (thiothixene)
The category of second generation, or atypical, antipsychotics includes:
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Seroquel (quetiapine)
- Risperdal (risperidone)
In addition to easing symptoms of schizophrenia, antipsychotics can benefit people with schizoaffective disorder, bipolar disorder, and severe cases of depression. People who take antipsychotics for any of these conditions may have an increased risk of TD.
Typically, symptoms of tardive dyskinesia don’t appear for several years. However, it’s possible for symptoms to appear within a few months after starting a new medication.
The Impact of Tardive Dyskinesia
In April 2023, the Journal of Clinical Psychiatry published the results of a two-year online survey about the impact of tardive dyskinesia. The researchers summarize the results here:
“TD imposes a substantial burden on patients’ physical, psychological, social, and professional lives and impacts management of their underlying condition.”
Survey respondents included 269 adults with a median age of 40.6 years. All had tardive dyskinesia as well as either schizophrenia, bipolar disorder, or major depressive disorder. Most took some type of medication to manage their TD symptoms, though the survey did not ask them to disclose which type.
A review of responses revealed:
- 1% said that TD caused severe problems across physical, psychological, and social domains.
- Respondents with schizophrenia (86%) were most likely to report severe impact across all three domains. 71.6% with bipolar disorder and 68.9% with major depressive disorder indicated a similar effect.
- More than 90% said that TD affected sleeping, eating, exercising, speaking clearly, and performing household chores.
- From a psychological perspective, more than 75% said that TD caused them to feel sad or unhappy, anxious, frustrated, embarrassed, or unmotivated. They also reported that TD contributed to low self-esteem and fear of rejection.
- Socially, more than half of the respondents said that acquaintances and strangers stared at them, made jokes at their expense, told them to stop moving, or attempted to physically intervene to prevent their involuntary movements.
In response to these effects, patients reported taking a variety of potentially dangerous steps, such as:
- 48.4% of respondents said they skipped a dose of their antipsychotic medication or took less than directed.
- 39.3% said they completely stopped taking antipsychotics.
- 35.7% said they stopped seeing the clinicians for treatment.
- 48% said they took muscle relaxants for their TD symptoms
- 46.5% said they used sleeping pills or other sleep aids.
Armed with evidence of how tardive dyskinesia undermined quality of life and interferes with treatment, the research team called on fellow researchers to explore more effective options for managing TD:
“Further research is necessary to examine whether better TD symptom control might reduce antipsychotic treatment disruptions and nonadherence, leading to more effective treatment of the underlying psychiatric condition.”
Treatment Options for Tardive Dyskinesia
Historically, treatment for tardive dyskinesia primarily involved switching medications and making lifestyle changes such as:
- Giving up tobacco
- Not abusing alcohol or other drugs
- Managing symptoms of diabetes more effectively
Some professionals also suggested natural approaches such as using gingko biloba, melatonin, or vitamins, even though these are not evidence-supported methods for dealing with TD.
An analysis of literature on TD from the past 54 years notes several diagnostic and treatment-related trends and developments, such as:
- The first publication to use the term “tardive dyskinesia” appeared in 1968. Thid review involved 21 studies with about 500 patients with neurological concerns after taking medications for psychosis.
- The earliest studies on the epidemiology of tardive dyskinesia occurred around 1980.
- Researchers in the 1990s focused on the effect of antioxidants and free radicals, unstable molecules that develop during chemical changes within a cell. Experts previously linked a buildup of free radicals with elevated risk of cancer and some other diseases.
- Several studies from the 1990s also looked at the relationship between clozapine and TD. Research suggests it may pose a lower risk of tardive dyskinesia and suicidal ideation among patients with schizophrenia.
- In the mid-1990s, a few researchers assessed how olanzapine affects people with bipolar disorder. Though olanzapine is a second-generation antipsychotic, studies indicate that it can increase risk of TD.
- In the late 1990s and early 2000s, researchers explored the role serotonin and dopamine play in tardive dyskinesia.
These studies increased our understanding of who TD affects and how clinicians can minimize its impact. They also led to the development of medications to directly address TD symptoms.
In 2017, the U.S. Food and Drug Administration (FDA) approved two medications to treat TD in adults:
- April 2017: Ingrezza (valbenazine)
- August 2017: Prior approval of Austino (deutetrabenazine) expanded to include TD treatment.
- May 2024: Austedo XR (extended-release)
Ingrezza (valbenazine) is equally effective for TD patients with schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder. In addition to sustained improvements in TD symptoms, patients exhibited no increase in suicidal ideation.
Studies of Austedo (deutetrabenazine) show similar results, with one report noting that the drug is well tolerated and led to “significantly reduced abnormal movements.” Few study participants required dosage adjustments, requested the suspension of doses, or failed to complete the full course of treatment.
These medications don’t eliminate all TD symptoms, tardive but they have improved quality of life for people with TD. As researchers continue to analyze their effectiveness, the results of these studies will hopefully fuel continued advancements in the diagnosis and treatment of TD.
Find Help Today
If someone in your life experiences acute symptoms of schizophrenia or another complex mental health condition, Crownview Psychiatric Institute is here to help.
To learn more about our programming, or to discuss treatment options for you or your loved one, please visit our Contact page or call us today.
Gianna Melendez
Jodie Dahl, CpHT