Topic presentation delivered to nursing home staff in Julesburg, CO

1. TARDIVE DYSKINESIA
What is Tardive Dyskinesia (TD)?
o Neurological syndrome caused by long-term use of drugs to treat psychiatric
disorders
o Presents as repetitive, involuntary, and purposeless movements
o Symptoms include:
o Grimacing o Tongue protrusion
o Lip smacking o Puckering or Pursing of the lips
o Rapid eye blinking o Rapid movements of the arms
o Rapid leg movement o Finger movements
Parkinson’s Disease Symptoms
o Often TD symptoms can be confused for parkinsonian movement disorders
o Present as:
o Resting tremors
o Rigidity
o Postural Instability
o Bradykinesia

2. Psycosis
o Dysfunction of the mesolimbic
system caused by too much
dopamine in the brain
according to the dopaminergic
hyperactivity theory
o Medications for the treatment
mental conditions block
dopamine receptors
o Blocking dopamine results in
reduced amounts of dopamine
or malfunctioning of receptors
and causes extrapyramidal
side effects
o End result is decreased
dopamine in
mesocorticolimbic pathway
and nigrostriatal pathway of
the brain
Parkinson’s Disease
o Dysfunction in the nigrostriatal
pathway caused by too little
dopamine working in the body
o For treatment, medications
are used that provide extra
dopamine
o Side effects of the medication
can cause psycosis from the
increased dopamine in the
mesocorticolimbic pathway in
the brain

3. What medications cause TD?
o Metoclopramide (Reglan®) o Trifluoperazine (Stelazine®)
o Prochlorperazine (Compazine®) o Perphenazine (Trilafon®)
o Promethazine (Phenergan®) o Fluphenazine (Prolixin®)
o Chlorpromazine (Thorazine®) o Thiothixene (Navane®)
o Haloperidol (Haldol®) o Thioridazine (Mellaril®)
 Olanzapine (Zyprexa®)  Quetiapine (Seroquel®)
 Risperidone (Risperdal®)  Amisulpride (Solian®)
Selectivity of Psychiatric Medications
o First Generation Antipsychotics
o Known as DOPAMINE ANTAGONISTS
o Bind and block multiple receptors in the brain including D1, D2, D4, and
serotinergic receptors
o When 60% of the D2 receptors are blocked, efficacy is reached. At 80% D2
receptor blockade, extrapyramidal side effects can be seen
o Atypical Antipsychotics (Second Generation)
o Known as SEROTONIN-DOPAMINE ANTAGONISTS
o Have higher affinities for 5-HT2, D1 and D4 rather than D2
o Cause fewer extrapyramidal side effects
o More specific for mesolimbic pathway
o Thought to have faster dissociation from D2 receptors
Treatment of TD:
o Three basic approaches
o Prevention
o Diagnosis
o Management
o Discontinue medication or reduce dose
o Change to different antipsychotic
o Initiating benzodiazepine or vitamin E may relieve some of the
patient’s symptoms
o Benztropine may be used to treat extrapyramidal symptoms
Distinguishing TD from other Movement disorders:
o Youtube video demonstrates the symptoms of Parkinson’s disease
http://www.youtube.com/watch?v=xuVY7wS25rc&feature=related
o Youtube video demonstrates various TD symptoms and how to score them
http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related
o Using forms and scoring techniques, it is easier to document symptoms patients
have and track progression
o Remember that people with Parkinson’s Disease have difficulty moving, while
those with tardive dyskinesia have difficulty not moving

4. References:
"Bjeaaan213 - Parkinson's." Bjeaaan213 - Home. Web. 13 July 2010.
<http://bjeaaan213.wikispaces.com/parkinson's>.
Hsiung, Robert. "Abnormal Involuntary Movement Scale." The Dr. Bob Home Page. Web.
13 July 2010. <http://www.dr-bob.org/tips/aims.html>.
"Neuroleptics - Tardive Dyskinesia Causes." Tardive Dyskinesia & Reglan - Symptoms,
Side Effects & Treatments. 14 May 2010. Web. 13 July 2010.
<http://www.tardivedyskinesia.com/causes/neuroleptics.php>.
"Nutritional Treatment of Tardive Dyskinesia." Pharmaceuticals Anonymous. Web. 13
July 2010. <http://pharmaceuticalsanonymous.blogspot.com/2008/03/nutritional-
treatment-of-tardive.html>.
"Parkinson's Disease - Homepage." BIO349, CSB/EEB/BIOTA, University of Toronto. 13
Mar. 2009. Web. 13 July 2010.
<http://bio349.biota.utoronto.ca/20089/20089bio349graham/parkinsons/index.ht
ml>.
Rang, H. P. Rang and Dale's Pharmacology. 6th ed. Philadelphia, PA: Churchill
Livingstone/Elsevier, 2007. Print.
Sadock, Benjamin J., Harold I. Kaplan, and Virginia A. Sadock. Kaplan & Sadock's
Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. 10th ed.
Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.
"Tardive Dyskinesia: EMedicine Neurology." EMedicine - Medical Reference. Web. 13 July
2010. <http://emedicine.medscape.com/article/1151826-overview>.
"Tardive Dyskinesia Information Page." National Institute of Neurological Disorders and
Stroke (NINDS). 14 Feb. 2007. Web. 10 July 2010.
<http://www.ninds.nih.gov/disorders/tardive/tardive.htm>.
"YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast
Yourself. Web. 10 July 2010.
<http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=related>.
"YouTube - Tardive Dyskinesia Diagnosis - (AIMSDVD.com)." YouTube - Broadcast
Yourself. Web. 13 July 2010.
<http://www.youtube.com/watch?v=rqsKGTBB8Ag&feature=player_embedded>.