Epidemiology of Tardive Dyskinesia

  • Ross J. Baldessarini


As emphasized by earlier speakers at this symposium on tardive dyskinesia (TD), ambiguous definitions of this complex behavioral syndrome limit certainty about its epidemiology (Baldessarini et al., 1980; Jeste & Wyatt, 1982a; Kane & Smith, 1982; Tarsy & Baldessarini, 1984). Reported prevalence of TD among patients exposed to neuroleptics reflects the criterion of severity of abnormal movements required for the diagnosis. Thus, Smith and colleagues (1979a; 1979b) found a close, inverse correlation between the nominal prevalence rates of TD (ranging from less than 10%, to over 70%) in hundreds of inpatients and outpatients diagnosed as schizophrenic and the severity of dyskinetic movements as rated by the NIMH Abnormal Involuntary Movement Scale (AIMS-- a common, internationally employed instrument for this disorder (Baldessarini et al., 1980). There is also a need to correct raw prevalence rates of TD for the risk of “spontaneous” or idiopathic dyskinesias in similar populations not treated with a neuroleptic agent. In our recent review of such studies, the mean rate (all data are ±SEM) of spontaneous dyskinesias among 18 studies was 5.8 ±1.0% (Smith & Baldessarini, 1980), and others have found even higher rates (over 10%), especially among elderly patients (Kane & Smith, 1982). Among 45 studies, we found a mean (raw) prevalence of TD-like manifestations among neuroleptic-treated patients of 24.0 ±2.5%, and suggested a “best-estimate” for prevalence of neuroleptic drug-associated TD, corrected for the spontaneous risk rate, of 18.5 ±2.4%. To further complicate matters, a recent survey by Owens et al. (1982) found only slightly less dyskinesia among a small group of chronically hospitalized schizophrenic patients who had not been treated with a neuroleptic than in a large group exposed to ordinary antipsychotic chemotherapy. In part, this similarity may reflect age-related spontaneous dyskinesias of older persons as well as possibly increased risk of abnormal movements other than TD among chronically psychotic patients (Owens, 1983). Despite the uncertainty surrounding the amount of risk for the manifestations of TD ascribable to neuroleptic treatment, there is little doubt that such agents contribute to the risk (Baldessarini, 1974; Baldessarini et al., 1980). Data on the incidence of TD are rare and remain inadequate. A recent study by Kane and associates (1982) suggests that among schizophrenic patients followed over four years of cumulative neuroleptic exposure at ordinary doses, the rate of appearance of new cases of TD was about 12%. An impression is that incidence rates are not linear over time (Kane & Smith, 1982), but that there is a peak risk between six months and perhaps 2–5 years of neuroleptic treatment, and the data of Kane et al. (1982) indicate a fairly steady incidence at 2–5% per year over 4 years of treatment.


Schizophrenic Patient Tardive Dyskinesia Spontaneous Remission Psychotic Patient Neuroleptic Treatment 


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  1. Baldessarini, R.J., 1974, Tardive dyskinesia: A review of the etiological association with neuroleptic therapy, J. Can. Psychiat. Assoc., 19:551–554.Google Scholar
  2. Baldessarini, R.J., Cole, J.O., Davis, J.M., Gardos, G., Preskorn, S., Simpson, G.M., and Tarsy, D., 1980, Tardive Dyskinesia, Task Force Report 18, Washington DC, American Psychiatric Association, 205 pp.Google Scholar
  3. Baldessarini, R.J. and Davis, J.M., 1980, What is the best maintenance dose of neuroleptics in schizophrenia? Psychiat. Res. 3:115–122.CrossRefGoogle Scholar
  4. Baldessarini, R.J., Katz, B., and Cotton, P., 1984 (in press), Comparison of doses of neuroleptic agents of high and low potency, Am. J. Psychiatry.Google Scholar
  5. Baldessarini, R.J. and Tarsy, D., 1979, Actions of neuroleptic drugs and the pathophysiology of tardive dyskinesia, Int. Rev. Neurobiol., 21:1–45.PubMedCrossRefGoogle Scholar
  6. Baldessarini, R.J., and Tarsy, D., 1980, Dopamine and the pathophysiology of dyskinesias induced by antipsychotic drugs, Ann. Rev. Neurobiol., 3:23–41.CrossRefGoogle Scholar
  7. Branchey, M.H., Branchey, L.B., and Richardson, M.A., 1981, Effects of neuroleptic adjustment on clinical condition and tardive dyskinesia in schizophrenic patients, Am. J. Psychiatry 138: 608–612.PubMedGoogle Scholar
  8. Campbell, A. and Baldessarini, R.J., 1981, Effects of maturation and aging on behavioral responses to haloperidol in the rat, Psychopharmacology, 73:219–222.PubMedCrossRefGoogle Scholar
  9. Campbell, A., Stoll, A., Maynard, P., and Baldessarini, R.J., 1984 (in press), Effect of age on behavioral responses and tissue levels of apomorphine in rat, Neuropharmacology.Google Scholar
  10. Gee, S. and Mesard, L., 1979, Psychiatric Drug Study, Part I Psychiatric Ward/Unit Study, Office of the Controller, Monograph No. 9, Washington, DC, US Veterans Administration, 73 pp.Google Scholar
  11. Jeste, D.V. and Wyatt, R.J., 1982a, Understanding and Treating Tardive Dyskinesia, New York, The Guilford Press, 363 pp.Google Scholar
  12. Jeste, D.V. and Wyatt, R.J., 1982b, Therapeutic strategies against tardive dyskinesia: Two decades of experience, Arch. Gen. Psychiatry, 39:803–816.PubMedCrossRefGoogle Scholar
  13. Kane, J.M., Rifkin, A., Woerner, M., Reardon, G., Sarantakos, S., Schiebel, D., and Ramos-Lorenzi, J., 1983, Low-dose neuroleptic treatment of outpatient schizophrenics, Arch. Gen. Psychiatry, 40:893–896.PubMedCrossRefGoogle Scholar
  14. Kane, J.M. and Smith, J.M., 1982, Tardive dyskinesia: Prevalence and risk factors, Arch. Gen. Psychiatry, 39:473–481.PubMedCrossRefGoogle Scholar
  15. Kane, J.M., Woerner, M., Weinhold, P., Wegner, J., and Kinon, B., 1982, A prospective study of tardive dyskinesia development: Preliminary results, J. Clin. Psychopharmacol., 2:345–349.PubMedGoogle Scholar
  16. Kapetanovic, I.M., Sweeney, D.J., and Rapoport, S.I., 1982, Age effects on haloperidol pharmacokinetics in male, Fisher-344 rats, J. Pharmacol. Exp. Ther., 221:434–438.PubMedGoogle Scholar
  17. Kazamatsuri, H., Chien, G.P., and Cole, J.O. 1973, Long-term treatment of tardive dyskinesia with haloperidol and tetrabenazine, Am. J. Psychiatry, 130:479–483.PubMedGoogle Scholar
  18. Marsden, C.D., Tarsy, D., and Baldessarini, R.J., 1975, Spontaneous and drug-induced movement disorders in psychotic patients, in D.F. Benson and D.F. Blumer (eds.), Psychiatric Aspects of Neurological Diseases, New York, Grune & Stratton, pp 219–265.Google Scholar
  19. Owens, D.G., 1983, Personal communication, 19 May.Google Scholar
  20. Owens, D.G., Johnstone, E.C., and Frith, C.D., 1982, Spontaneous involuntary movement disorders, Arch. Gen. Psychiatry, 39:452–461.PubMedCrossRefGoogle Scholar
  21. Rosenbaum, K.M., Niven, R.G., Hanson, N.P., and Swanson, D.W., 1977, Tardive dyskinesia: Relationship with primary affective disorder, Dis. Nerv. Syst., 38:423–427.PubMedGoogle Scholar
  22. Simpson, G.M., Varga, E., Lee, J.H., and Zoubok, B., 1978, Tardive dyskinesia and psychotropic drug history, Psychopharmacology, 58:117–124.PubMedCrossRefGoogle Scholar
  23. Smith, J.M. and Baldessarini, R.J., 1980, Changes in prevalence, severity, and recovery in tardive dyskinesia with age, Arch. Gen Psychiatry, 37:1368–1373.PubMedCrossRefGoogle Scholar
  24. Smith, J.M., Kucharski, L.T., Eblen, C., Knutsen, E., and Linn, C., 1979a, An assessment of tardive dyskinesia in schizophrenic outpatients, Psychopharmacology, 64:99–104.PubMedCrossRefGoogle Scholar
  25. Smith, J.M., Kucharski, L.T., Oswald, W.T., and Waterman, M.A., 1976b, A systematic investigation of tardive dyskinesia in inpatients, Am. J. Psychiatry, 136:918–922.Google Scholar
  26. Smith, R.C., Leelavathi, D.E., and Lauritzen, A.M., 1978, Behavioral effects of dopamine agonists increase with age, Commun. Psychopharmacol., 2:39–43.PubMedGoogle Scholar
  27. Tarsy, D. and Baldessarini, R.J., 1984 (in press) Tardive dyskinesia Ann. Rev. Med., 35:000–000.Google Scholar
  28. Triggs, E.J. and Nation, R.L., 1975, Pharmacokinetics in the aged: A review, J. Pharmacokin. Biopharm. 3:387–418.CrossRefGoogle Scholar
  29. Yesavage, J.A., Holman, C.A., and Cohn, R., 1981, Correlation of thio thixene serum levels with age. Psychopharmacology, 74:170–172.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1985

Authors and Affiliations

  • Ross J. Baldessarini
    • 1
    • 2
  1. 1.Departments of PsychiatryNeuroscience Program Harvard Medical SchoolBelmontUSA
  2. 2.Mailman Research CenterMcLean HospitalBelmontUSA

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