2. Case:
A 55 YEAR OLD WOMAN IN A PSYCHIATRIC WARD
RECEIVED A DRUG FOR TREATMENT OF HER
BIZARRE BEHAVIOR AND HALLUCINATIONS. AFTER
THE TREATMENT WAS INITIATED, SHE HAD
DECREASED FACIAL EXPRESSION AND AN
ABSENCE OF ARM SWING WHILE WALKING. AFTER
6 MONTHS OF TREATMENT, STEREOTYPED,
REPETITIVE INVOLUNTARY MOVEMENTS OF THE
TONGUE, MOUTH AND FACE DEVELOPED. OTHER
FINDINGS WERE NORMAL EXCEPT FOR MINIMAL
PIANO PLAYING MOVEMENTS OF THE FINGERS
3. MANIFESTATIONS
After initiation of treatment
Decreased facial expression
Absence of arm swing while walking
After 6 months of treatment
Stereotyped, repetitive involuntary movement of
tongue, mouth and face
Minimal piano playing movements
13. ANTIPSYCHOTIC
MEDICATIONS
MECHANISM OF ACTION:
The therapeutic action of the conventional antipsychotic
medications is correlated best with antagonist activity at
postjunctional dopamine D-2 receptors, where dopamine
normally inhibits adenylyl cyclase activity.
The therapeutic action of atypical antipsychotic drugs is
correlated with antagonistic activity at both 5-HT-receptors
and dopamine D2 or D4 receptors.
THE THERAPEUTIC ACTION IS BEST CORRELATED WITH THE ACTIONS
OF THESE DRUGS IN THE MESOLIMBIC AND MESOCORTICAL
AREAS OF THE CNS.
14. MANIFESTATIONS
After initiation of treatment
Decreased facial expression
Absence of arm swing while walking
After 6 months of treatment
Stereotyped, repetitive involuntary movement of
tongue, mouth and face
Minimal piano playing movements
Second Look…
16. ANTIPSYCHOTIC
MEDICATIONS
TARDIVE DYSKINESIA
Likely with conventional drugs
Characterized by disfiguring orofaciolingual movements and at times
dystonic movements of the trunk
Result of developing supersensitivity of the postjunctional dopamine
receptors in the CNS, perhaps in the basal ganglia.
Occurs months to years of drug exposure
Often irreversible
More likely to occur in elderly or institutionalized patients who receive
long term, high-dose therapy
17. DIAGNOSIS
There is no single test for tardive dyskinesia
Diagnostic process may involve more than one
physician
Requires thorough review of medical history
Physical examination and neuro-psychological
evaluation is needed
18. Physical Exam
abnormal, involuntary, irregular choreoathetoid
movements
muscles of the head, limbs, and trunk
Perioral movements are the most common and
darting, twisting, and protruding movements of
the tongue
chewing and lateral jaw movements;
lip puckering; and facial grimacing
Finger movements and hand clenching
19. In most severe and serious cases:
Torticollis, retrocollis, trunk twisting, and pelvic
thrusting
breathing and swallowing irregularities
aerophagia, belching, and grunting
20. Laboratory Studies
Thyroid Function Test
Serum copper and Serum ceruloplasmin Test
Serum Calcium Test
RBC count
Connective tissue disease screening tests