Diabetes Status, Female Status Among Risk factors for Tardive Dyskinesia

Marco Solmi, MD, PhD

Some modifiable comorbidities for tardive dyskinesia (TD) may include diabetes, smoking, and alcohol and substance abuse, according to a recent meta analysis.

Researchers from Padua, Italy and Long Island, New York conducted a literature review of 41 papers discussing risk factors for TD, in hopes of categorizing modifiable and non-modifiable patient and illness related variables and comorbidities.

The results show that most risk factors for TD are modifiable, study author Marco Solmi, MD, PhD told MD Magazine. With concise patient clinical history collection, assessment of comorbidity, routine screening for early dyskinetic movements, and choice of second-generation antipsychotics over first-generation, TD risks could be lowered.

“However, no prevention trial has been run to date to test such a preventive approach, which may be the aim of future clinical research to minimize tardive dyskinesia incidence,” Solmi said.

Some of the non-modifiable risk factors that the researchers determined were patient-related — such as older age, female sex, and white or African descent. They noted that Asian race “seems to be a protective factor against tardive dyskinesia, compared with other races.”

Of the risk factors related to patient illness, some of the variables leading to TD were longer illness duration, intellectual disability and brain damage, negative symptoms for schizophrenia, mood disorders, and cognitive symptoms. The most significant links between negative schizophrenia symptoms and tardive dyskinesia remain unconfirmed after the analysis, just as significant links between cognitive symptoms and tardive dyskinesia are inconsistent.

Mood disorder associations seem to refer mostly to first generation antipsychotic effects used (or used in high doses) in the literature review, the researchers found.

There were fewer comorbidity related risk factors than those related to treatment risk factors, the study authors learned. Concurrent issues such as diabetes, smoking, and use and/or dependence on alcohol, cocaine, or other substances were found to be modifiable risk factors for tardive dyskinesia.

One risk factor related to treatment the investigators found was being on first versus second generation antipsychotic treatment. The study authors noted that many medications — antidepressants, mood stabilizers, and others – have been linked to movement disorders, antipsychotics are the class of drugs most strongly linked to tardive dyskinesia.

Other treatment related risk factors included the early warning signs of Parkinson’s disease onset, akathisia, withdrawal emergent dyskenesia, dose and duration of exposure to dopamine receptor blocking agents (DRBAs), intermittent antipsychotic treatment, and anticholinergic treatment.

Prevention of TD should be a primary goal for caregivers, the study authors said. Additionally, second generation antipsychotics should be preferred over first generation antipsychotics, especially in patients with any or several of the modifiable risk factors.

“Choose the lowest-risk DRBA treatment for these patients and increase the monitoring frequency,” the study authors advised.

They also suggested smoking cessation interventions should be a part of DRBA prescriptions, as mental health disorders often go hand in hand with tobacco use. The researchers wrote that individuals with mental disorders smoke nearly half of the cigarettes consumed in the United States.

The study, titled “Clinical risk factors for the development of tardive dyskinesia,” was published in the Journal of the Neurological Sciences.

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