Incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: a prospective cohort study.

OBJECTIVE Most previous studies of the incidence of tardive dyskinesia with atypical antipsychotics compared with conventional antipsychotics have not had tardive dyskinesia as their primary focus. The current study aimed to compare the incidence of tardive dyskinesia with atypical vs conventional antipsychotics using methods similar to those from a previous prospective cohort study at our site in the 1980s. METHOD Three hundred fifty-two initially tardive dyskinesia-free psychiatric outpatients (diagnosed at baseline using the Structured Clinical Interview for DSM-IV) were examined for a new diagnosis of tardive dyskinesia (using the Abnormal Involuntary Movement Scale and Glazer-Morgenstern criteria) every 6 months for up to 4 years at a community mental health center. At baseline, subjects were receiving conventional antipsychotics only (23%), atypicals only (64%), or both (14%). Only 26 subjects had never received conventional antipsychotics. Baseline evaluations were conducted from November 2000 through May 2003. Follow-ups were conducted through February 2005. RESULTS Compared with subjects treated with conventional antipsychotics alone since the previous visit, the adjusted tardive dyskinesia incidence rate-ratio for subjects treated with atypical antipsychotics alone was 0.68 (95% CI, 0.29-1.64). The incidence and prevalence of tardive dyskinesia was similar to previous findings at this site in the 1980s. CONCLUSIONS The incidence of tardive dyskinesia with recent exposure to atypical antipsychotics alone was more similar to that for conventional antipsychotics than in most previous studies. Despite high penetration of atypical antipsychotics into clinical practice, the incidence and prevalence of tardive dyskinesia appeared relatively unchanged since the 1980s. Clinicians should continue to monitor for tardive dyskinesia, and researchers should continue to pursue efforts to treat or prevent it.

[1]  J. Lieberman,et al.  Incidence and Correlates of Tardive Dyskinesia in First Episode of Schizophrenia , 1996 .

[2]  S Pollack,et al.  Does clozapine cause tardive dyskinesia? , 1993, The Journal of clinical psychiatry.

[3]  A. Tapp,et al.  Combination antipsychotic therapy in clinical practice. , 2003 .

[4]  S. Stahl,et al.  Antipsychotic polypharmacy, Part 1: Therapeutic option or dirty little secret? , 1999, The Journal of clinical psychiatry.

[5]  J. Waddington,et al.  Mortality in schizophrenia , 1998, British Journal of Psychiatry.

[6]  Del D. Miller,et al.  Comparative assessment of the incidence and severity of tardive dyskinesia in patients receiving aripiprazole or haloperidol for the treatment of schizophrenia: a post hoc analysis. , 2007, The Journal of clinical psychiatry.

[7]  T. Erni,et al.  Prevalence of extrapyramidal syndromes in psychiatric inpatients and the relationship of clozapine treatment to tardive dyskinesia , 2000, Schizophrenia Research.

[8]  C. Arango-Dávila,et al.  Response and relapse in patients with schizophrenia treated with olanzapine, risperidone, quetiapine, or haloperidol: 12-month follow-up of the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study. , 2005, The Journal of clinical psychiatry.

[9]  P. Sachdev Early Extrapyramidal Side-Effects as Risk Factors for Later Tardive Dyskinesia: A Prospective Study , 2004 .

[10]  W. Glazer,et al.  Predictors of tardive dyskinesia: results of a cross-sectional study in an outpatient population. , 1987, Journal of chronic diseases.

[11]  T. K. Hazlet,et al.  Neuroleptic drug exposure and incidence of tardive dyskinesia: a records-based case-control study. , 2002, Journal of managed care pharmacy : JMCP.

[12]  M. Munetz,et al.  Distinguishing Akathisia and Tardive Dyskinesia: A Review of the Literature , 1983, Journal of clinical psychopharmacology.

[13]  G. Chouinard,et al.  A 5-year prospective longitudinal study of tardive dyskinesia: factors predicting appearance of new cases. , 1988, Journal of clinical psychopharmacology.

[14]  S. Fahn Dietary constituents and nitrosamine formation in human saliva. , 1978 .

[15]  P. Sachdev Akathisia and Restless Legs , 1995 .

[16]  J. Doucette,et al.  Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. , 1993, The Journal of clinical psychiatry.

[17]  Philip D. Harvey,et al.  Risperidone and haloperidol in first-episode psychosis: a long-term randomized trial. , 2005, The American journal of psychiatry.

[18]  P. Weiden,et al.  Clinical nonrecognition of neuroleptic-induced movement disorders: a cautionary study. , 1987, American Journal of Psychiatry.

[19]  C. Correll,et al.  Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies. , 2004, The American journal of psychiatry.

[20]  J. Alonso,et al.  The European Schizophrenia Outpatient Health Outcomes (SOHO) study: rationale, methods and recruitment , 2003, Acta psychiatrica Scandinavica.

[21]  J. Lieberman,et al.  Clinical correlates of tardive dyskinesia in schizophrenia: Baseline data from the CATIE schizophrenia trial , 2005, Schizophrenia Research.

[22]  S. Woods,et al.  Chlorpromazine equivalent doses for the newer atypical antipsychotics. , 2003, The Journal of clinical psychiatry.

[23]  J. Leon The effect of atypical versus typical antipsychotics on tardive dyskinesia , 2006, European Archives of Psychiatry and Clinical Neuroscience.

[24]  R. McCreadie,et al.  Nithsdale Schizophrenia Surveys 23: movement disorders. 20-year review. , 2002, The British journal of psychiatry : the journal of mental science.

[25]  W. Glazer,et al.  Tremor and tardive dyskinesia. , 1986, The Journal of clinical psychiatry.

[26]  Nancy H. Covell,et al.  Antipsychotic prescribing practices in Connecticut's public mental health system: rates of changing medications and prescribing styles. , 2002, Schizophrenia bulletin.

[27]  J. Lieberman,et al.  Tardive dyskinesia: prevalence, incidence, and risk factors. , 1988, Journal of clinical psychopharmacology.

[28]  J. Lieberman,et al.  Prospective study of tardive dyskinesia in the elderly: rates and risk factors. , 1998, The American journal of psychiatry.

[29]  J. Lieberman,et al.  Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. , 2005, The New England journal of medicine.

[30]  M. Weinborn,et al.  Rate of tardive dyskinesia in hospitalized patients. , 2005, The American journal of psychiatry.

[31]  J. Cummings,et al.  Recognition and Differential Diagnosis of Tardive Dyskinesia , 1990, International journal of psychiatry in medicine.

[32]  J. van Os,et al.  Effects of antipsychotic treatment on tardive dyskinesia: a 6-month evaluation of patients from the European Schizophrenia Outpatient Health Outcomes (SOHO) Study. , 2005, The Journal of clinical psychiatry.

[33]  J. Doucette,et al.  Handedness and the risk of tardive dyskinesia , 1996, Biological Psychiatry.

[34]  J. Csernansky,et al.  A comparison of risperidone and haloperidol for the prevention of relapse in patients with schizophrenia. , 2002, The New England journal of medicine.

[35]  H. Pincus,et al.  Recent patterns and predictors of antipsychotic medication regimens used to treat schizophrenia and other psychotic disorders. , 2000, Schizophrenia bulletin.

[36]  W. Glazer,et al.  A tardive dyskinesia clinic in a mental health center. , 1981, Hospital & community psychiatry.

[37]  G. Crane Pseudoparkinsonism and tardive dyskinesia. , 1972, Archives of neurology.

[38]  N. Nair,et al.  The Bioavailability and Pharmacokinetics of Oral and Depot Intramuscular Haloperidol in Schizophrenic Patients , 1987, Journal of clinical pharmacology.

[39]  G. Gharabawi,et al.  New-onset tardive dyskinesia in patients with first-episode psychosis receiving risperidone or haloperidol. , 2006, The American journal of psychiatry.

[40]  Jane S. Paulsen,et al.  Risk of tardive dyskinesia in older patients. A prospective longitudinal study of 266 outpatients. , 1995, Archives of general psychiatry.

[41]  R. Tamura,et al.  Blind, controlled, long-term study of the comparative incidence of treatment-emergent tardive dyskinesia with olanzapine or haloperidol. , 1997 .

[42]  I. Bitter,et al.  Tardive dyskinesia: Analysis of outpatients with schizophrenia from Africa and the Middle East, Asia, Central and Eastern Europe, and Latin America , 2006, Schizophrenia Research.

[43]  R. Mccue,et al.  Polypharmacy in patients with schizophrenia. , 2003, The Journal of clinical psychiatry.

[44]  D. Jeste,et al.  Incidence and risk factors for severe tardive dyskinesia in older patients , 1997, British Journal of Psychiatry.

[45]  R. Baldessarini,et al.  Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. , 2004, The American journal of psychiatry.

[46]  J. Kane Tardive dyskinesia circa 2006. , 2006, The American journal of psychiatry.

[47]  J. Overall,et al.  Neuroleptic-related dyskinesias in autistic children: a prospective, longitudinal study. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[48]  S. Stahl,et al.  A critical review of atypical antipsychotic utilization: comparing monotherapy with polypharmacy and augmentation. , 2004, Current medicinal chemistry.

[49]  R. Tamura,et al.  Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol , 1999, British Journal of Psychiatry.

[50]  S. Woods Olanzapine and tardive dyskinesia , 1999, British Journal of Psychiatry.

[51]  W. Glazer,et al.  Identifying risk factors for tardive dyskinesia among long-term outpatients maintained with neuroleptic medications. Results of the Yale Tardive Dyskinesia Study. , 1993, Archives of general psychiatry.

[52]  H. Möller,et al.  Maintenance treatment with risperidone or low-dose haloperidol in first-episode schizophrenia: 1-year results of a randomized controlled trial within the German Research Network on Schizophrenia. , 2007, The Journal of clinical psychiatry.

[53]  G. Chouinard,et al.  Atypical Antipsychotics: CATIE Study, Drug-Induced Movement Disorder and Resulting Iatrogenic Psychiatric-Like Symptoms, Supersensitivity Rebound Psychosis and Withdrawal Discontinuation Syndromes , 2008, Psychotherapy and Psychosomatics.

[54]  B. Martin,et al.  Prevalence, trends, and factors associated with antipsychotic polypharmacy among Medicaid-eligible schizophrenia patients, 1998-2000. , 2004, The Journal of clinical psychiatry.