Posted by med_empowered on July 26, 2005, at 1:33:26
In reply to Re: Did I see someone with tardive dyskinesia?, posted by sleepygirl on July 25, 2005, at 22:21:55
I knew a guy with schizophrenia..he was actually kind of young, late 20s, early 30s maybe...who had already developed what I guess would be termed "mild" to "moderate" tardive dyskinesia. He had the same odd, uncontrollable facial movements you described seeing in an older woman. The tongue darting is one of the first signs; in very, very severe cases, tardive dyskinesia can cause abnormal movements around the trunk area and can be disabling. In addition, there is tardive dystonia, which causes uncontrollable muscle contractions. Lots of people on antipsychotics experience tremor, muscle stiffness, that kind of thing, but tardive dystonia can be intensely painful and utterly debilitating; in some cases, people who develop it end up in wheel chairs. Tardive dyskinesia will sometimes disappear on its own after a while...in many cases, though, it is permanent. When it develops, there are almost no ways to treat the disorder; all one can really do is suppress the disorder. The traditional way to do this is to use the neuroleptic the individual was taking when they developed the disorder and increase the dose until the TD is no longer noticeable. The problem is that increasing the dose can cause worsening of the TD; when this becomes apparent, the dose may have to be raised again. The likelihood of developing TD is almost impossible to predict for an individual patient..with old antipsychotics, the given rate is 3% a year baseline risk, with 20% developing the disorder at a moderate or severe level after 5 years of treatment. Other sources put the number around 30-40%. At "end-point" (several decades of antipsychotic treatment), more than 50% of patients will develop TD to some extent. With new, atypical antipsychotics, the risk is even harder to pin down; the best data I've seen puts it at about 1% a year. Women, children, and the elderly are at a higher risk of developing the condition; elderly women are considered the highest risk group. Those with "affective disorders" (bipolar, for example, instead of schizophrenia) are believed to be at a substantially higher risk of developing TD than those with schizophrenia. In addition, those with "moody schizophrenia" or schizoaffective disorder may be at a higher risk than those who have "classic" schizophrenia. Those with mood disorders/affective disorders are also at a higher risk of developing EPS, including akathisia; there may be some connection between the two. What exactly causes TD is unkown; one study I read pointed to "oxidative stress" caused in the brain by neuroleptics. Apparently, old antipsychotics, such as haldol, cause the formation of "free radicals" within the brain...this results in damage to the structure of the brain, changes in brain structure, and, possibly, tardive dyskinesia. Some authors also believe that tardive dyskinesia is not *just* a movement disorder, but a sign of deeper underlying damage to the brain. Some research has shown that those with TD suffer significantly more cognitive impairment and overall cognitive decline than those who are treated with neuroleptics but don't have TD and/or those who have never been treated with neuroleptics. Although cognitive impairment is common in those with schizophrenia, it is apparently much more pronounced among those who develop TD.
poster:med_empowered
thread:533472
URL: http://www.dr-bob.org/babble/20050723/msgs/533629.html