Psychopharmacology Tardive dyskinesia in long term hospitalized patients with mental retardation

Objective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders of various phenomenology caused by dopamine receptor-blocking agents. This phenomenon can be seen while using such agents as well as after a short-term discontiniuation. TD, characterized by oro-buccal-lingual stereotype, can manifest in the form of akathisia, dystonia, tics, tremor, chorea, or as a combination of different types of abnormal movements. Tardive syndromes were first defined after first antipsychotics were introduced. TD prevalence is estimated to be 20–50% of all patients treated with neuroleptics, but it varies among different age groups, with prevalence increasing with advanced age. This study aims to research (TD) in long-term hospitalized patients with mental retardation at Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases.

Method: Socio-demographic data were obtained from both case records and interviews. We recorded age, gender, duration and type (first/second generation or mix) of medication both at the time of interview and over the preceding year. Dyskinesia was assessed using the Abnormal Involuntary Movements Scale (AIMS). Dyskinesia was defined as probably present (Schooler & Kane, 1982) if movements were ‘mild’ in at least two of seven body areas or ‘moderate’ in at least one. We also used the Simpson–Angus Rating Scale (Simpson & Angus, 1970) for the severity of the cases. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS) and was said to be present if the score was 2 (‘mild’) or more on the global scale (Barnes, 1989).

Results: Of the 20 patients included in this study 17 (85%) were males, 3 (15%) females; mean age was 46 years; mean duration of current antipsychotics was 114.5 months and mean duration of the most used antipsychotics was 169 months. Current antipsychotic medication status was first generation; 6 (30%), second generation; 10(50%), mix; 4 (20%). The most used antipsychotic medication status was first generation; 13 (65%) second generation; 7(35%). 18(90%) patients have received any of first generation drugs during their long-term treatment. Probable tardive dyskinesia was found as 4 (20%). There were no significant gender differences in the prevalence of TD. Also there were no significant differences in the type and duration of current or most used treatment for the prevalence of TD. There were significant differences between age and TD. There were weak correlation without significant difference between duration of current or most used medication and SAS points.

Conclusion: Regarding the long term and regular use of antipsychotics, it is surprising that duration of medication wasn’t associated with the prevalence of TD. We found no differences for TD between first or second generation antipsychotics; and there were no gender differences. Age seemed to be the most prominent factor for TD.