TARDIVE DYSKINESIA A B A N D C O U R T N E Y S C H O L L

TARDIVE DYSKINESIA A B A N D C O U R T N E Y S C H O L L

WHAT IS TARDIVE DYSKINESIA? Katz, Kaner, Carrion, & Goldstein (2010) provide the following definition: An involuntary movement disorder of neurologic origin caused by the use of neuroleptic drugs known as dopamine receptor antagonists DSM IV criteria: A group of involuntary movements of the tongue, jaw, trunk or extremities developed in association with the use of neuroleptic medication (Bhat, Pardal, & Diwakar, 2010)

Research surfaced during the 1950 s after neuroleptics were further examined Cases emerged in 1957 documenting the presence of oral movements following use of neuroleptics (Bhat, 2010) Term established by Faurbye et al. (1964)

ETIOLOGIES OF TARDIVE DYSKINESIA Natural occurrence Prevalence for geriatric population: *1.3% (Medically stable) *4.8% (Inpatients) Deferred side-effect of antipsychotic medications Incidence for adults using neuroleptic drugs: *20% following 5 years *24% following 7 years (Joyce, 2011) Results from a study of 99 subjects that researched the prevalence of neuroleptic-induced movement disorders in schizophrenic patients (Janno, Holi, Tuisku, & Wahlback, 2004).

SYMPTOMS OF TARDIVE DYSKINESIA Tongue protrusion Key Symptom: repetitive, involuntary, purposeless movements Lip smacking Puckering/pursing Rapid eye blinking Rapid arm, leg, trunk movements Involuntary finger movements Food for thought: Could some of these symptoms cause difficulty in feeding and/or swallowing? http://www.ninds.nih.gov/disorders/tardive/tardive.htm

WHAT DO WE NEED TO KNOW ABOUT TARDIVE DYSKINESIA? Tardive dyskinesia is a condition that develops over time. The symptoms can persist even after the patient stops taking the prescription that caused it (Drummond & Kirkpatrick, 2004) Patients cannot help the movements; they are involuntary and not volitionally controlled (Bhat, Pardal, & Diwakar, 2010). Tardive dyskinesia may affect swallowing due to medicinal impairment of the CNS, which coordinates movement for activities including feeding and swallowing (Carl & Johnson, 2007). The primary reason for acquiring tardive dyskinesia is mental illness. As such, treatment of the patient will almost always require antipsychotic medication..therefore, medication that causes tardive dyskinesia may continue to be prescribed!

JERI LOGEMANN (2006) STATES THAT AS CLINICIANS, WE MUST BE KNOWLEDGEABLE OF medications or combinations of medications which can worsen or even create the dysphagia problems exhibited by a patient. The clinician working with dysphagia patients must be knowledgeable about known drug effects on the oropharyngeal and esophageal mechanisms (As cited in Carl & Johnson, 2007). These effects include: coordination reaction times gastroesophageal motility

HOW DOES TARDIVE DYSKINESIA RELATE TO SWALLOWING? Research has indicated that there is an increased prevalence of dysphagia amongst the population being treated with antipsychotic medication. According to Carl and Johnson (2007), motor functions associated with the coordination/activation deglutition phases may be affected due to depression of neurotransmitters of the CNS. These links interfere with all stages of deglutition! Neuromuscular blockage Depression of brainstem swallowing function Impaired oral/pharyngeal sensation Neurotransmitter depression Decreased voluntary muscular control Xerostomia/Sialorrhea

We all know that dysphagia increases chances of: DIAGNOSIS IMPACT ON SWALLOWING well, it certainly doesn t IMPROVE feeding and swallowing outcomes! Malnutrition Dehydration Poor wound healing Pulmonary risks Pain Burning Itching sensations Involuntary lingual/mandibular movements Delayed oral transit time Sialorrhea Ill-fitting dentures exacerbate oral phase difficulties (Katz, Kaner, Carrion, & Goldstein, 2010) Impaired gag reflex Nasal regurgitation Delayed swallow initiation Stases in pyriform sinuses Aspiration (before & after deglutition) Reduced hyolaryngeal elevation Reduced vestibule closure TD may lead to buccolingualmasticatory syndrome, a collection of symptoms that involve the tongue, face, palate, mandible, and pharynx. Drummond & Kirkpatrick, 2004 Poor muscle contraction

MEDICAL TREATMENT IMPACT ON SWALLOWING Treatment options: Changing from typical to atypical antipsychotic medication most common method however, most patients can t stop taking antipsychotic medication that caused tardive dyskinesia to begin with! studies indicate that this helps in ameliorating symptoms, but symptoms may still persist. atypical medication is also more costly than typical medication Botox injections (Botulinum toxin) to the tongue Improves tongue position and decreases excessive protrusion (Van Harten & Hovestadt, 2006) In the future: deep brain stimulation? was done in one study with positive outcomes (Kefalopoulou, Paschali, Markaki, Vassilakos, Ellul, & Constantoyannis, 2009) In a nutshell, some antipsychotic medications are better than others, but treating TD with better antipsychotics will not guarantee improvement or recovery! Therefore, swallowing may still be impacted even with medical treatment! Seroquel (quetiapine) is a second-generation, atypical antipsychotic medication used in part to decrease CNS symptoms in patients. One of its side effects is tardive dyskinesia (Emsley, Turner, Botha, & Oosthuizen, 2004).

MEDICAL TREATMENT IMPACT ON SWALLOWING Evidence supporting the reduced risk of tardive dyskinesia with typical (first generation) versus atypical (second generation) neuroleptics has been reported in several research studies (Jeste, 2004; Joyce, 2011; Katz et al., 2010). Prolixin Trilafon Clopixol Mellaril Stelazine Neuroleptic drugs (Brand names) Typical Atypical Clozaril Geodon Seraquel Risperdal Invega Antidepressants Xanax Desyrel Table obtained from Katz et al., 2010

TARDIVE DYSKINESIA FACT SHEET From the NIH: http://www.ninds.nih.gov/disorders/tardive/tardive.htm VIDEO HTTP://WWW.YOUTUBE.COM/WATCH?V=UDUPVOFQX1O&FEATURE=YOUTU.BE

REFERENCES Bhat, P. S., Pardal, P. K., & Diwakar, M. M. (2010). Dysphagia due to tardive dyskinesia. Industrial Psychiatry Journal, 19(2), 134-135. doi:10.4103/0972-6748.90347 Carl, L., & Johnson, P. (2007). Drugs and dysphagia. Dysphagia, 17(4), 143-148. Drummond, S. S., & Kirkpatrick, A. W. (2004). Speech and swallowing performances in tardive dyskinesia: A case study. Journal of Medical Speech-Language Pathology, 12(1), 9-19. Emsley, R., Turner, J. H., Botha, K., & Oosthuizen, P. P. (2004). A single-blind, randomized trial comparing quetiapine and haloperidol in the treatment of tardive dyskinesia. Journal of Clinical Psychiatry, 65(5), 696-700. Janno, S., Holi, M., Tuisku, K., & Wahlback, K. (2004). Prevalence of neuroleptic-induced movement disorders in chronic schizophrenia inpatients. The American Journal of Psychiatry, 161(1), 160-163. Jeste, D. V. (2004). Tardive dyskinesia rates with atypical antipsychotics in older adults. Journal of Clinical Psychiatry, 65(9), 21-24. Joyce, J. P. (2011). Consent to antipsychotic drugs and tardive dyskinesia after Chester v Afshar. Clinical Risk, 17(1), 12-14. Katz, W., Kaner, T., Carrion, J., & Goldstein, G. (2010). The management of a completely edentulous patient with tardive dyskinesia. International Journal Of Prosthodontics, 23(3), 217-220. Kefalopoulou, Z. Z., Paschali, A. A., Markaki, E. E., Vassilakos, P. P., Ellul, J. J., & Constantoyannis, C. C. (2009). A double-blind study on a patient with tardive dyskinesia treated with pallidal deep brain stimulation. Acta Neurologica Scandinavica, 119(4), 269-273. doi:10.1111/j.1600-0404.2008.01115.x Van Harten, P. N., & Hovestadt, A. (2006). Botulinum toxin as a treatment for tardive dyskinesia. Movement Disorders, 22(8), 1276-1277.