Skill Checkup: A 55-Year-Old Man With Schizophrenia and New-Onset Involuntary Movements

Christoph U. Correll, MD


January 14, 2022

Reversible vesicular monoamine transporter type 2 inhibitors (VMAT2) inhibitors (eg, valbenazine and deutetrabenazine, which are US Food and Drug Administration–approved for the treatment of TD) are recommended by the American Psychiatric Association for patients with moderate to severe or disabling TD associated with antipsychotic therapy. VMAT2 inhibitors modulate the presynaptic packaging and release of dopamine into the synapse and may offset the movement-related effects of antipsychotics and other dopaminergic blockers. In phase 3 clinical trials, these drugs have demonstrated significant improvement in TD compared with placebo based on the AIMS score. In those who do not have access to, cannot tolerate, or did not show improvement with VMAT2 inhibitors, clonazepam (a benzodiazepine) can be considered as an alternative. In those whose symptoms are still not adequately controlled, amantadine (a tricycle amine) may be used as an adjuvant, although adverse events (eg, depression, parkinsonism, and visual hallucinations) should be monitored closely. There is limited evidence that branched-chain amino acids may reduce TD-related movements; however, this unapproved intervention should not be used in pregnant women and requires additional trials to confirm its safety and efficacy.


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