Tardive dyskinesia is a movement disorder that appears after months or years of drugs that block dopamine, mostly antipsychotics and metoclopramide. It causes repetitive involuntary movements of the face and body that can be permanent, so prevention and regular screening matter.
Key symptoms
- Lip smacking, puckering and tongue thrusting
- Grimacing and rapid blinking
- Writhing or jerking of the fingers, arms or legs
- Rocking of the trunk; embarrassment and trouble eating or speaking
What you find on exam
- Abnormal Involuntary Movement Scale (AIMS) at baseline and every 6 to 12 months
- Watch the face and mouth at rest and while the patient is distracted
- Gait and limbs for choreiform movements
- Tell it apart from drug-induced parkinsonism and akathisia
Tests
- Clinical diagnosis based on drug history and exam
- Review all dopamine-blocking drugs and doses
- Labs or brain imaging if the picture suggests another cause
Treatment basics
- Review the need for the drug and lower the dose if possible
- Switch to a lower-risk antipsychotic, such as clozapine or quetiapine
- VMAT2 inhibitors: valbenazine or deutetrabenazine
- Stop anticholinergics such as benztropine, which can make it worse
Red flags
- Movements that affect swallowing or breathing
- New depression or suicidal thoughts on a VMAT2 inhibitor
- Stopping the antipsychotic without a plan, risking relapse
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; Open RN, Nursing Pharmacology 2e. Written by Making Synapses. Making Synapses is not affiliated with these organizations.