Tardive Dyskinesia Revisited: A Clinical Priority Perspective-Diagnosis and Assessment (Part A)

In this series of papers under the umbrella of tardive dyskinesia (TD), five major related issues are discussed pertaining to TD. These are integrated together. In Part A we evaluate how to diagnose, screen for physical signs and scales for tardive dyskinesia, and in Part B, we focus on the management. Tardive dyskinesia (TD) is a relatively new condition associated with abnormal involuntary movements caused by or aggravated by so-called “neuroleptic” drugs. Neuroleptics are used to manage psychotic conditions, as well as nausea and acid reflux, and latterly are prescribed as adjunct medications to depression and anxiety. Tardive dyskinesia (TD) has also become a major problem forensically, because of the challenge of management, the lack of patient’s being appropriately warned, and insufficient monitoring of patients at risk. In this Part A series of articles we examine several special important priorities in TD. a. First, what is tardive dyskinesia and how does one make the diagnosis? b. The second issue is the need to regularly evaluate patients on neuroleptics because they are at risk for tardive dyskinesia. Measuring and monitoring for symptoms of tardive dyskinesia allows ensuring early detection. The author’s clinical STRAW test has thus far been seldom used, but it may be the best way to monitor TD over time. It appears an improvement over the standard test, the AIMS, as it is broader in ranking (0-10) and is the only scale that measures both frequency and severity, so that monitoring of change is more sensitive. In the series that follows, Part B, we emphasize management and theory, particularly high dose buspirone management, justify the dopamine super sensitivity hypothesis, and re-evaluate the neuroleptics in that context. e1