Tardive Dystonia Related with Aripiprazole

Abstract

Tardive dystonia is characterized by sustained, generally slow involuntary twisting movements. It is estimated to occur at a frequency of 1% to 4% among patients who are taking an antipsychotic agent. Unlike the first generation antipsychotics, the second generation antipsychotics are less likely to cause neuroleptic-induced movement disorder. For aripiprazole, only a few cases have been reported for tardive dystonia. We present a young male, who developed a severe tardive dystonia after taking aripiprazole for 5 years. The patient was admitted to for the treatment of both hisdystonic and psychotic symptoms. Olanzapine was administered instead of aripiprazole and while his psychotic symptoms improved, the dystonic symptoms were continued. Therefore, olanzapine was switched to clozapine while augmenting with benzodiazepine, anti-cholinergic, and ginko biloba to control his tardive dystonia. After 2 weeks of treatment, the dystonic movement decreased remarkably.

Olanzapine-induced Concurrent Tardive Dystonia and Tardive Dyskinesia in Schizophrenia with Intellectual Disability: A Case Report

“…Previous studies have suggested that aripiprazole is an effective treatment for tardive dyskinesia [ 21 - 23 ]; however, this drug did not lead to a significant improvement in our patient. Aripiprazole has a high affinity for D 2 -receptors and a weak affinity for D 1 -receptors, which could lead to an imbalance between D 1 - and D 2 -mediated striatal outputs [ 1 , 23 , 24 ]. While chronic neuroleptic use results in high D 2 -receptor blockade, a lower occupancy rate of D 1 -receptors may lead to sensitization of D 1 -mediated striatal output and, in turn, to abnormal movements [ 25 ].…”

“…Tardive dystonia is a syndrome characterized by sustained muscle contractions that frequently cause twisting and repetitive movements or abnormal postures [ 1 , 2 ]. It differs from tardive dyskinesia, the features of which include involuntary, irregular, stereotyped and choreiform or repetitive abnormal movements of the limbs, body and fingers [ 1 , 3 ].…”

“…Tardive dystonia is a syndrome characterized by sustained muscle contractions that frequently cause twisting and repetitive movements or abnormal postures [ 1 , 2 ]. It differs from tardive dyskinesia, the features of which include involuntary, irregular, stereotyped and choreiform or repetitive abnormal movements of the limbs, body and fingers [ 1 , 3 ]. Both tardive movement disorders are rare extrapyramidal side effects that begin after the long-term use of antipsychotics [ 1 , 2 , 4 ]; however, they are different disorders and rarely occur at the same time [ 5 - 7 ].…”

“…It differs from tardive dyskinesia, the features of which include involuntary, irregular, stereotyped and choreiform or repetitive abnormal movements of the limbs, body and fingers [ 1 , 3 ]. Both tardive movement disorders are rare extrapyramidal side effects that begin after the long-term use of antipsychotics [ 1 , 2 , 4 ]; however, they are different disorders and rarely occur at the same time [ 5 - 7 ]. Olanzapine is an atypical antipsychotic associated with a low risk of extrapyramidal side effects in schizophrenia (SPR) [ 8 ].…”

Tardive Dystonia due to D2 Antagonists and Other Agents

“…Regarding antipsychotics, the emergence of the syndrome seems to be extremely rare following clozapine or quetiapine exposure, probably due to their very low D2 affinity and fast dissociation from the dopamine receptor; in fact, they represent a therapeutic option [26,27]. Numerous case reports are found in the study for several antipsychotic drugs [28][29][30][31]. A matter of serious concern is the administration of extended release preparations, for example, paliperidone palmitate [32,33], Table 2.…”