Tardive dyskinesia and atypical antipsychotic drugs

Typical antipsychotic agents produce central nervous system effects, especi ally extrapyramidal symptoms (EPS) and tardive dyskinesia (TD). Nearly ever y patient who receives neuroleptic therapy has one or more identifiable ris k factors for TD, among the most significant of which are older age, female gender, presence of EPS, diabetes mellitus, affective disorders, and certa in parameters of neuroleptic exposure (i.e. dose and duration of therapy). The typical course of TD is a gradual onset after several years of drug the rapy, followed by slow improvement or remission, but a large number of pati ents have persistent TD with irreversible symptoms. In the management of TD , the patient's mental status is of primary concern. Currently, no uniforml y safe and effective therapies for TD exist, though a variety of therapeuti c agents, including some of the atypical neuroleptics, have been reported t o treat TD successfully in some patients. Because TD liability is so much l ower with novel antipsychotic therapy, all patients who have TD or are at r isk for TD, as well as EPS, should be considered candidates for switching t o these new drugs. (C) 1999 Elsevier Science B.V. All rights reserved.