Withdrawal-emergent dyskinesia (WED) is a transient movement disorder that appears after rapid taper or abrupt discontinuation of antipsychotics. Unlike classic tardive dyskinesia (TD), WED usually improves within weeks. This case describes a 13-year-old with disruptive mood dysregulation disorder and attention-deficit hyperactivity disorder who developed reversible oral dyskinesia during inpatient care after ziprasidone was stopped and methylphenidate was up-titrated. Symptoms (facial grimacing, mouth twitching) emerged within a day of antipsychotic cessation, were managed with benztropine and brief ziprasidone, and ultimately resolved as stimulants were tapered and bupropion was started.

The authors suggest dopamine D2 receptor hypersensitivity from prior antipsychotic exposure, unmasked by rapid withdrawal and amplified by stimulant-driven dopaminergic tone, as a plausible mechanism. A serotonin-syndrome-like process was considered but not supported clinically. Key practice points: avoid abrupt antipsychotic discontinuation, consider slower tapers and cross-titration to lower-dopaminergic or non-stimulant agents, and recognize WED/pseudo-tardive presentations as distinct from persistent TD. Heightened clinician awareness is especially important in pediatric populations where antipsychotics and stimulants are commonly co-managed.

Reference: Haji Rahman R, Dharmapuri S. Oral Dyskinesia in a Pediatric Patient Following Concurrent Use of Neuroleptics and Stimulants: Treatment Strategy Considerations to Avert Avoidable Adverse Side Effects. Cureus. 2023;15(4):e38294. doi: 10.7759/cureus.38294.

Researchers of a large US electronic health record study (1999-2021) examined 32,558 adults with schizophrenia-spectrum disorders, major depressive disorder with psychosis, or bipolar disorder with psychosis who were prescribed antipsychotics to identify diagnosed and undiagnosed tardive dyskinesia (TD). Using manual review of mental-status exam notes, investigators flagged TD-consistent abnormal movements or documented TD in 1,301 patients (4.0%), yet only 64 (4.9%) of these had a corresponding ICD TD code (ICD-9: 333.85; ICD-10: G24.01). Even among those with documented TD, just 9.2% were coded. Logistic regression showed lower odds of receiving an ICD diagnosis for Black/African-American patients vs White patients (OR 0.46; 95% CI 0.20–0.95; p=0.04), highlighting potential disparities.

Care setting also influenced coding: treatment in community mental health centers was associated with higher odds of an ICD TD diagnosis than academic medical centers (adjusted OR 2.02; 95% CI 1.09–3.74; p=0.03). Collectively, the findings suggest TD is underrecognized and undercoded in routine practice, which may limit access to appropriate assessment and therapies. The authors underscore the need for better recognition, standardized documentation, and attention to equity so that patients who likely have TD are identified and managed in a timely, consistent way.

Reference: Griffiths K, Won Y, Lee Z, et al. Identifying the diagnostic gap of tardive dyskinesia: an analysis of semi-structured electronic health record data. BMC Psychiatry. 2025;25(1):407. doi: 10.1186/s12888-025-06780-w.

A panel of six neurologists, three psychiatrists, and three psychiatric nurse practitioners participated in a study to outline a framework to address the use of telehealth to treat tardive dyskinesia. The panel found telehealth to be beneficial primarily for the ease of making and attending appointments for patients but agreed that an in-person assessment should be held at least every six months from telehealth appointments. Additional recommendations are discussed. 

Reference: El-Mallakh RS, Belnap A, Iyer S, et al. Telehealth for Assessing and Managing Tardive Dyskinesia: Expert Insights from a Cross-Disciplinary Virtual Treatment Panel. Telemed J E Health. 2022;10.1089/tmj.2022.0234. doi:10.1089/tmj.2022.0234