Folia Psychiatrica et Neurologica Japonica, Vol. 33, No. 1, 1979
Reversibility of Tardive Dyskinesia Hitoshi Itoh, M.D. and Gohei Yagi, M.D. Deparlment of Neuropsychiatry, School of Medicine, Keio University, Tokyo
INTRODUCTION The term tardive dyskinesia which was introduced by Faurbye and his colleagues11 is now most commonly used to describe the dyskinetic involuntary movement disorder as a complication of long-term therapy with neuroleptics. Not like the early drug-induced extrapyramidal symptoms such as parkinsonism and acute dystonic reaction, tardive dyskinesia persists for years despite discontinuation of antipsychotic drugs. So, tardive dyskinesia is also called “persistent dyskinesia,” “terminal extrapyramidal insufficiency” and even “irreversible dyskinesia.” Much of the literature indicates that, in the majority of patients, dyskinesia can be permanent or irreversible. On the other hand, some investigators2 U i !) 22 suggest that the earlier the dyskinesia is detected and the responsible neuroleptic is stopped, the better is the prognosis for amelioration. According to their opinion, it is not always true that the terms “tardive dyskinesia” and “irreversible dyskinesia” are interchangeable. Today, opinions on the natural course of this syndrome are still Received for publication Dec. 1, 1978. Presented at the VI World Congress of Psychiatry, Aug. 1977, Honolulu, USA. This work was partially supported by Grant-in-Aid for Scientific Research No. 148214 from the Japanese Ministry of Education.
confused. Many psychiatrists and neurologists who are concerned about their patients with tardive dyskinesia are likely to consider the syndrome irreversible. Actually, we previously described one case with tardive dyskinesia lasting for 14 years.’> The earlier rcport by Uhrbrand and Faurbye ( 1 9 6 0 p in which the term “irreversible dyskinesia” was probably used for the first time, said that, in 11 of 17 cases in which antipsychotic treatment was discontinued, dyskinesia proved irreversible after an observation period of four to 22 months. Recently some investigators have pointed out that long-term observation after complete cessation of the neuroleptic treatment would be necessary to determine whether dyskinesia is reversible or irreversible. From this point of view, the authors made a long-term follow-up study of patients with tardive dyskinesia where neuroleptic treatment had been discontinued, for as long as five years from 1971 to 1976. This study pointed out, 1 ) that, in many of the patients with tardive dyskinesia, the symptoms can be considerably improved only with neuroleptic withdrawal, and 2 ) that the pharmacological treatment of tardive dyskinesia could become a material for discussion considering long-term prognosis of tardive dyskinesia, especially that the administration of certain neuroleptics for only
H. Itoh and G. Yagi
44
Table 1 :
Malt
Ale
< 39 40-48 so 59 80-69 70 78
-
80
Reversibility of Tardive Dyskinesia Hitoshi Itoh, M.D. and Gohei Yagi, M.D. Deparlment of Neuropsychiatry, School of Medicine, Keio University, Tokyo
INTRODUCTION The term tardive dyskinesia which was introduced by Faurbye and his colleagues11 is now most commonly used to describe the dyskinetic involuntary movement disorder as a complication of long-term therapy with neuroleptics. Not like the early drug-induced extrapyramidal symptoms such as parkinsonism and acute dystonic reaction, tardive dyskinesia persists for years despite discontinuation of antipsychotic drugs. So, tardive dyskinesia is also called “persistent dyskinesia,” “terminal extrapyramidal insufficiency” and even “irreversible dyskinesia.” Much of the literature indicates that, in the majority of patients, dyskinesia can be permanent or irreversible. On the other hand, some investigators2 U i !) 22 suggest that the earlier the dyskinesia is detected and the responsible neuroleptic is stopped, the better is the prognosis for amelioration. According to their opinion, it is not always true that the terms “tardive dyskinesia” and “irreversible dyskinesia” are interchangeable. Today, opinions on the natural course of this syndrome are still Received for publication Dec. 1, 1978. Presented at the VI World Congress of Psychiatry, Aug. 1977, Honolulu, USA. This work was partially supported by Grant-in-Aid for Scientific Research No. 148214 from the Japanese Ministry of Education.
confused. Many psychiatrists and neurologists who are concerned about their patients with tardive dyskinesia are likely to consider the syndrome irreversible. Actually, we previously described one case with tardive dyskinesia lasting for 14 years.’> The earlier rcport by Uhrbrand and Faurbye ( 1 9 6 0 p in which the term “irreversible dyskinesia” was probably used for the first time, said that, in 11 of 17 cases in which antipsychotic treatment was discontinued, dyskinesia proved irreversible after an observation period of four to 22 months. Recently some investigators have pointed out that long-term observation after complete cessation of the neuroleptic treatment would be necessary to determine whether dyskinesia is reversible or irreversible. From this point of view, the authors made a long-term follow-up study of patients with tardive dyskinesia where neuroleptic treatment had been discontinued, for as long as five years from 1971 to 1976. This study pointed out, 1 ) that, in many of the patients with tardive dyskinesia, the symptoms can be considerably improved only with neuroleptic withdrawal, and 2 ) that the pharmacological treatment of tardive dyskinesia could become a material for discussion considering long-term prognosis of tardive dyskinesia, especially that the administration of certain neuroleptics for only
H. Itoh and G. Yagi
44
Table 1 :
Malt
Ale
< 39 40-48 so 59 80-69 70 78
-
80
