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

Christoph U. Correll, MD


August 08, 2023

Vesicular monoamine transporter type 2 (VMAT2) inhibitors (eg, valbenazine and deutetrabenazine) are the only Food and Drug Administration-approved treatments for TD and are recommended 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 than with placebo on the basis of 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. However, some benzodiazepines have been associated with decreased blood pressure.

In those whose symptoms are still not adequately controlled, amantadine (a tricyclic amine) may be used as an adjuvant, although adverse events (eg, depression, parkinsonism, and visual hallucinations) should be monitored closely. In some cases, tricyclic amines have been shown to decrease blood pressure as well.

There is limited evidence that branched-chain amino acids may reduce TD-related movements.


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