Incidence of Tardive Dyskinesia in First-Episode Psychosis Patients Treated With Low-Dose Haloperidol
J Clin Psychiatry 2003;64(9):1075-1080
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Previous studies suggest that the
risk of tardive dyskinesia is increased with higher doses of
conventional antipsychotics. This study evaluates the 12-month
incidence of tardive dyskinesia in subjects with first-episode
psychosis who were treated with very low doses of haloperidol.
Method: Fifty-seven subjects with first-episode
psychosis and a DSM-IV diagnosis of schizophreniform disorder,
schizophrenia, or schizoaffective disorder were treated according
to a fixed protocol with a mean dose of haloperidol of 1.68
mg/day and prospectively studied for 12 months. Subjects were
assessed for extrapyramidal symptoms and psychiatric symptoms at
3-month intervals. Data were gathered from 1999 to 2001.
Results: Twelve-month incidence of probable or
persistent tardive dyskinesia according to Schooler and Kane
criteria was 12.3% (N = 7). Subjects with tardive dyskinesia did
not differ from the rest of the sample regarding gender, race,
duration of untreated psychosis, or baseline clinical
characteristics. Subjects with tardive dyskinesia were older
compared with subjects without tardive dyskinesia (37.14 ± 9.23
vs. 27.30 ± 8.09 years, respectively; t = -2.77, df = 30, p =
.01) and received higher mean doses of haloperidol at 12 months
(2.80 ± 1.64 vs. 1.39 ± 0.69 mg/day, respectively; t = -3.13,
df = 25, p = .004). Cox regression analysis revealed that age at
inclusion (p = .031), percentage change in negative symptoms (p =
.028), and dose of haloperidol at 12 months (p = .016) were
significant predictors of risk for tardive dyskinesia.
Conclusion: Incidence of tardive dyskinesia was
at least as high as in other samples treated with standard doses
of conventional antipsychotics. Subjects at risk for tardive
dyskinesia could not be identified on the basis of initial
clinical features or acute treatment response. Risk of tardive
dyskinesia was related to age, antipsychotic dose, and worsening
of negative, depressive, and parkinsonian symptoms.