Mental Health

Tardive Dyskinesia: A Problem That Has Not Gone Away

Leslie Citrome, MD, MPH

Posted: 04/30/2010

Incidence of Tardive Dyskinesia With Atypical Versus Conventional Antipsychotic Medications: A Prospective Cohort Study

Woods SW, Morgenstern H, Saksa JR, et al
J Clin Psychiatry. 2010;71:463-474

Summary

This was a prospective cohort study examining the incidence rate of tardive dyskinesia (TD) among 352 outpatients receiving atypical and/or typical antipsychotic medications at a community mental health center. Patients were examined for a new diagnosis of TD every 6 months for up to 4 years. The study began in November 2000 and ended in February 2005. The incidence and prevalence of TD was similar to previous findings at this study site in the 1980s. The authors concluded that the incidence of TD with recent exposure to atypical antipsychotics alone was more similar to that of conventional antipsychotics than has been reported in most previous studies.

Leslie Citrome, MD, MPH

Posted: 04/30/2010

Incidence of Tardive Dyskinesia With Atypical Versus Conventional Antipsychotic Medications: A Prospective Cohort Study

Woods SW, Morgenstern H, Saksa JR, et al
J Clin Psychiatry. 2010;71:463-474

Summary

This was a prospective cohort study examining the incidence rate of tardive dyskinesia (TD) among 352 outpatients receiving atypical and/or typical antipsychotic medications at a community mental health center. Patients were examined for a new diagnosis of TD every 6 months for up to 4 years. The study began in November 2000 and ended in February 2005. The incidence and prevalence of TD was similar to previous findings at this study site in the 1980s. The authors concluded that the incidence of TD with recent exposure to atypical antipsychotics alone was more similar to that of conventional antipsychotics than has been reported in most previous studies.

Viewpoint

Although TD is a problem that has not gone away, and a warning for TD appears in the product labeling for all antipsychotics, it is generally believed that we see less TD among our patients who are exposed to second-generation antipsychotic drugs. The only method to actually answer the question whether second-generation antipsychotics are less likely to be associated with TD than the older agents is to conduct a randomized controlled study among patients who are antipsychotic-naive over a lengthy period of time. This prospective cohort study answers a quite different question in that it examines the incidence of TD among patients who have been exposed to a variety of different medications for varying periods of time.

The authors note that the patients had a lifetime history of extensive conventional antipsychotic use. Another difficulty in interpreting this study is the possibility that some may have had TD in the past and had their medications switched. In the opposite vein, were those who remained on first-generation antipsychotic medications selected in some way because they tolerated the older agents very well or in general were less severely ill? The authors observed that patients receiving clozapine seemed to be at higher risk for TD, and correctly suggest that this observation can be attributed to confounding, the bane of observational studies.

Authors and Disclosures

Author(s)

Leslie Citrome, MD, MPH

Professor, Department of Psychiatry, New York University School of Medicine, New York, NY; Director, Clinical Research and Evaluation Facility, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York

Disclosure: Leslie L. Citrome, MD, MPH, has disclosed the following relevant financial relationships:
Owns stock, stock options or bonds from: Abbott Laboratories; Bristol-Myers Squibb Company; Eli Lilly and Company; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Merck & Co., Inc.; Pfizer Inc.
Received grants for clinical research from: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Barr Laboratories, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; Janssen Pharmaceuticals Products, L.P; Pfizer Inc.
Served as an advisor or consultant for: Azur Pharma Inc.; Eli Lilly and Company; Forest Research Institute; GlaxoSmithKline; Janssen Pharmaceuticals Products, L.P; Merck & Co, Inc.; Pfizer Inc.; Vanda Pharmaceuticals Inc.
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; AstraZeneca Pharmaceuticals LP; Azur Pharma Inc.; Eli Lilly and Company; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.

Abstract

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