Incidence of Tardive Dyskinesia and Tardive Dystonia in African Caribbean Patients on Long-Term Antipsychotic Treatment: The Curaçao Extrapyramidal Syndromes Study V
J Clin Psychiatry 2006;67(12):1920-1927
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: Tardive dyskinesia (TD) and
tardive dystonia (TDt) syndromes represent severe side effects of first-generation
antipsychotics (FGAs). Although second-generation
antipsychotics (SGAs) confer a lower risk for
tardive syndromes, many patients continue to use
FGAs alone or in combination with SGAs. Some patients remain free of TD or TDt even after
many years of antipsychotic treatment with predominantly FGAs. Do these patients remain at risk
for TD or TDt and, consequently, should a switch
to SGAs be considered? A longitudinal cohort study in patients on long-term antipsychotic
treatment may answer this question.
Method: A 9-year cohort study
(1992-2001) was conducted of the whole, mostly chronic,
psychiatric inpatient population on the Caribbean island of Curaçao (N = 194). Almost all
patients (95%) were of African Carribean origin. TD
and TDt were assessed (1 baseline, 6 follow-ups)
with the Abnormal Involuntary Movement Scale and the Fahn-Marsden rating scale, respectively.
New cases of TD or TDt were diagnosed if they fulfilled the criteria at 2 successive follow-up visits.
Results: In patients with a mean
antipsychotic use of approximately 18 years, the yearly
incidence rates of TD and TDt were 10.2% (95% CI = 7.7 to 13.5) and 0.7% (95% CI = 0.4 to
1.5), respectively. The severity of TD was
strongly associated with the severity of TDt (beta =
0.08, 95% CI = 0.03 to 0.14) and vice versa (beta
= 0.10, 95% CI = 0.03 to 0.16). TD severity was positively associated with age and akathisia
but negatively associated with parkinsonism.
Conclusions: Patients who are free of TD
after many years of antipsychotic treatment still have a considerable risk for TD. Switching to
an SGA may be warranted. The risk for incident TDt in this group was very low.