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

Christoph U. Correll, MD


August 08, 2023

There are several ways to minimize the risk for TD. For example, clinicians should follow the prescribing information for antipsychotic agents carefully, including avoiding off-label use. In addition, these drugs should be prescribed as a single agent (ie, avoid prescribing multiple antipsychotics in the same patient) and at the lowest effect dose and for the shortest possible time. Use of second-generation antipsychotics may also lower the risk for TD. In some cases, second-generation antipsychotics can increase blood pressure and other cardiovascular side effects; further, all antipsychotics carry some risk for cardiovascular-related averse events. Should the patient not have exhibited symptoms, their physician could work with them to find the most appropriate second-generation antipsychotic.

In addition, clinicians should conduct a baseline evaluation of abnormal movements (eg, the AIMS) and continue to monitor for TD throughout treatment, so that treatment can be changed if involuntary movements emerge. Intermittent treatment should be avoided, as this has been associated with an increased risk for TD.

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Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

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