Fast Five Quiz: Movement Disorders

Helmi L. Lutsep, MD


July 08, 2021

Atypical neuroleptics may control psychosis while reducing the risk for tardive dyskinesia. Whereas traditional neuroleptics primarily block dopamine D2 receptors, atypical neuroleptics bind variably to dopaminergic, serotonergic, alpha-adrenergic, histaminic, and muscarinic receptors. In particular, clozapine has been recommended as treatment for patients with tardive dyskinesia who require antipsychotics. Clozapine is one of the most effective atypical neuroleptics for treatment-refractory schizophrenia. Although clozapine has been associated with tardive dyskinesia, the incidence of tardive dyskinesia with this and other atypical agents appears markedly less than that of traditional neuroleptics.

The evidenced-based guidelines of the American Academy of Neurology recommend the use of clonazepam and ginkgo biloba for tardive dyskinesia.

Abrupt cessation of dopamine antagonists may lead to an acute exacerbation of symptoms (which presumably were controlled by medication). Accordingly, caution must be exercised in reducing and discontinuing treatment. Life-threatening conditions, such as malignant neuroleptic syndrome, are exceptional situations in which immediate discontinuance may be justified. Abrupt cessation of treatment with dopamine antagonists may precipitate a florid psychosis with delusions, hallucinations, and suicidal or homicidal behavior. Whenever possible, it is preferable to taper the dose slowly (by 10% increments of the original dose) while closely observing the patient for exacerbation of psychotic symptoms.

Oxidative stress may contribute to the development of tardive dyskinesia. Dehydroepiandrosterone, an endogenous antioxidant, is hypothesized to function as a neuroprotective agent against tardive dyskinesia. A genetic basis to protect against the development of tardive dyskinesia through the endogenous production of dehydroepiandrosterone has not been confirmed.

Read more about the treatment of tardive dyskinesia.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Tardive Dyskinesia, Dystonias, and Essential Tremor.

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