Tardive Syndromes are Rarely Reversible after Discontinuing Dopamine Receptor Blocking Agents: Experience from a University-based Movement Disorder Clinic

Abstract

Background: Several studies have examined reversibility of tardive syndromes (TS), primarily in psychotic patients who are maintained on dopamine receptor blocking drugs. The results have varied widely. However, few have assessed remission rates after discontinuing the offending agents. This study evaluated reversibility of TS in patients who permanently withdrew the causative agent(s). We also examined for any possible clinical predictors of reversibility. Methods: A retrospective cohort of 108 TS patients was studied. Most of the patients were not psychotic; most patients were being treated either for a mood disorder with atypical antipsychotics or for a gastrointestinal disturbance with metoclopramide. Patients were stratified on the basis of reversibility, and statistical tests were used for subgroup comparisons of relevant clinical variables. Logistic regression was undertaken to identify clinical variables predictive of reversibility. Results: Only 13% of the cohort experienced reversibility of the TS, 2% without medical intervention. When stratified by reversibility, there were no significant differences in any study variables between subgroups. None of the study variables predicted reversibility in the logistic regression. Discussion: Our study demonstrated a low remission rate for TS in a cohort of psychiatric and non-psychiatric patients seen in a movement disorder clinic after the offending agents were completely withdrawn. Such a finding has significant prognostic implications. It is possible that limitations of the retrospective design may have resulted in an underestimation. There is a clear need for prospective, multicenter, clinical trials in populations that can be safely withdrawn from dopamine receptor blocking agents so that true remission rates can be measured.

Tardive dyskinesia risk with first‐ and second‐generation antipsychotics in comparative randomized controlled trials: a meta‐analysis

“…Considering the high incidence of clinically meaningful weight gain during SGA treatment, EPS partly lost their weight in clinical decision‐making. Nevertheless, TD remains a clinical problem in movement disorders clinics: SGA‐related tardive syndromes lately outnumbered FGA‐related TD cases in a movement disorders clinic, likely due to increasing on‐label, as well as off‐label use of SGAs.…”

Hospital utilization rates following antipsychotic dose reduction in mood disorders: implications for treatment of tardive dyskinesia

“…In a previous retrospective cohort study, we demonstrated that antipsychotic dose reductions resulted in significant increases in both all-cause and mental health-related hospitalizations, worsening the overall healthcare burden in schizophrenia patients [23]. However, there are no data examining the effect of dose reduction on symptoms of TD in mood disorders [20,24,25]. Even more important for clinical decision making, there is no evidence on the impact of antipsychotic dose reduction on the course of illness in patients with BD or MDD [14,26].…”

“…When side effects emerge during maintenance treatment with antipsychotics, management options include drug maintenance, discontinuation, switching, or dose reduction [5,6,12,[19][20][21][22][23]. For example, in patients with mood disorders in remission, maintenance treatment with antipsychotics may be unnecessary, and discontinuation may be reasonable to facilitate remission of TD or other side effects.…”

Tardive dyskinesia update: the syndrome

“…orofacial versus peripheral, especially dystonia) and durations of drug exposure and movement disorder. Recently, Zutshi et al (2014) reported very low rates of spontaneous reversibility: 2.8% over an average of 4.3 years. The paediatric literature strongly suggests that reversibility on antipsychotic cessation is the rule (Campbell 1988), whereas in working-age adults, it is much less predictable and in the elderly it is probably not likely (Gardos 1983).…”