Epidemiology of Tardive Dyskinesia
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.
KeywordsSchizophrenic Patient Tardive Dyskinesia Spontaneous Remission Psychotic Patient Neuroleptic Treatment
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