Psychopharmacology Aripiprazole induced tardive dyskinesia: a case report

Tardive dyskinesia is a movement disorder after the long-term usage of antipsychotics. This clinical chart is characterized by involuntary movements mainly on the muscles of mouth, lips, tongue and then face, neck and jaw muscles. Pharmaceutically, aripiprazole is an atypical antipsychotic, which is partial agonist of D2 and D3, and 5-HT1A and a modest antagonist of 5-HT2A receptors. In this case report, we aimed to discuss occurrence of tardive dyskinesia during the long-term use of aripiprazole. A 71 years old male patient was admitted with reference delusions, auditory hallucinations, social isolation and involuntary movements on his mouth and tongue. He has been an outpatient treated with antipsychotics for schizophrenia since 15 years. 2 years ago, aripiprazole 10 mg/day treatment has been started. It has been reported by the patient’s relatives that, he has not been going to his outpatient checks regularly, repetitive involuntary movements have started approximately 5 months ago on his mouth and tongue, and he has remained untreated within the last month. He was diagnosed to have tardive dyskinesia and schizophrenia based on his medical history and clinical evaluation with PANSS (score: 82) and Abnormal Involuntary Movements Scale (score: 16). A treatment was planned with clozapine and vitamin E under strict monitoring of white blood cell count. Patient has been scheduled for weekly checks. Extrapyramidal findings like akathisia, tardive dyskinesia, acute dystonia, parkinsonism can be seen in patients, who are using antipsychotics. Due to antipsychotic use, tardive dyskinesia with high potency (especially first generation) is observed more often. So many cases in the literature show that even atypical antipsychotics might cause tardive dyskinesia. Although there was a case series revealing positive results by switching to aripiprazole on tardive dyskinesia cases associated with the use of first or second generation antipsychotics; As seen in our case, tardive dyskinesia can develop even after the long-term use of aripiprazole.