This case report describes a woman with treatment-resistant schizophrenia, tardive dyskinesia (TD), and comorbid epilepsy who improved after carefully adjusted clozapine therapy. She had a long history of antipsychotic exposure, persistent psychotic symptoms despite multiple agents, and involuntary movements consistent with TD, including repetitive chewing, lip smacking, mouth opening and closing, and hand tremors. Clozapine was started because of refractory psychosis and severe TD, but after titration to 150 mg/day, she developed tonic-clonic seizures. Because the seizure occurred shortly after clozapine initiation and decades after her prior seizure, the authors considered it likely clozapine-induced.

After discussion of risks, the clozapine dose was reduced to 100 mg/day while valproate was continued. The patient chose to remain on clozapine because both her psychotic symptoms and TD had improved. Within 2 months, her Abnormal Involuntary Movement Scale score improved by 50%, and by 6 months it decreased further. Over 1 year of follow-up on low-dose clozapine, she had no further seizures, no TD worsening, and substantial improvement in psychiatric symptoms. The authors conclude that, in carefully selected patients with schizophrenia, epilepsy, and TD who do not respond to other treatments, low-dose clozapine with anticonvulsant coverage and close monitoring may be a possible option when clinically necessary.

Reference: Selçuk M. Safe and Effective Use of Low-Dose Clozapine for Tardive Dyskinesia in a Patient with Schizophrenia and Comorbid Epilepsy: A Case Report. Psychiatry Clin Psychopharmacol. 2023 Jun 1;33(2):143-146. doi: 10.5152/pcp.2023.23651.

Tardive dyskinesia (TD) is a chronic, often persistent movement disorder associated with long-term use of dopamine receptor-blocking agents, especially antipsychotics used for schizophrenia, bipolar disorder, and other psychiatric conditions. Symptoms commonly include involuntary facial, mouth, tongue, trunk, or limb movements that can interfere with eating, speaking, walking, daily function, and quality of life. Risk is higher with long-term or high-dose dopamine receptor-blocking agent (DRBA) exposure, older age, female sex, Black race, mood disorders, cognitive disturbance, diabetes, substance use, HIV-positive status, and early extrapyramidal symptoms. Diagnosis relies on medication history, characteristic abnormal movements, exclusion of other movement disorders, and use of validated tools such as the Abnormal Involuntary Movement Scale.

Management begins with prevention, routine monitoring, and use of DRBAs at the lowest effective dose for the shortest necessary duration. When feasible, clinicians may consider gradual dose reduction, discontinuation, or switching to a lower-risk antipsychotic, though stopping antipsychotic therapy is often not practical because psychiatric symptoms may worsen. For moderate-to-severe or disabling TD, VMAT2 inhibitors are first-line pharmacologic therapy; valbenazine and deutetrabenazine are the only FDA-approved treatments. Both have shown significant reductions in TD severity versus placebo, with differences in dosing, formulation, metabolism, hepatic considerations, interactions, and adverse event profiles guiding individualized selection. The review emphasizes proactive screening, multidisciplinary management, and continued research into long-term safety, biomarkers, and nonpharmacologic options for refractory TD.

Reference: Sarna K. Managing tardive dyskinesia: drug-induced risks and therapeutic advances. Pharmacy Practice News. Published Jan 9, 2026. Accessed June 9, 2026. https://www.pharmacypracticenews.com/Clinical/Article/01-26/Tardive-Dyskinesia-Management-Risks-and-Therapeutic-Advances/79341.

This case series describes three patients who developed tardive dyskinesia (TD) associated with aripiprazole use and achieved remission after aripiprazole was discontinued. The cases included two older women with bipolar affective disorder and one young woman with schizoaffective disorder. Symptoms included involuntary tongue and lip movements, facial movements, hand tremors, jaw clenching, neck twisting, and purposeless arm movement, with Abnormal Involuntary Movement Scale Scores ranging from 14 to 18. In all three cases, discontinuing aripiprazole led to progressive improvement and complete symptom resolution within 1 to 2 months, with no recurrence during 1 year of follow-up.

The authors note that TD has traditionally been considered chronic and often irreversible, but published case reports suggest aripiprazole-induced TD may sometimes improve or remit, especially when recognized early and managed promptly. They also emphasize that evidence remains limited and mixed, with some reports showing persistent symptoms and others showing resolution after discontinuation, dose reduction, switching to lower-risk antipsychotics, or adding other treatments. Current management generally includes reassessing the offending agent, considering dose reduction or discontinuation when clinically feasible, switching to a lower-risk antipsychotic such as quetiapine or clozapine, and considering VMAT2 inhibitors for persistent or distressing TD. The authors conclude that early detection and careful monitoring are essential, and larger studies are needed to better understand remission rates and predictors of reversibility.

Reference: Alshahrani SM, Althagafi LM, Saeedi JA, et al. Reversible aripiprazole-induced tardive dyskinesia: a case series from Saudi Arabia and literature review. Front Psychiatry. 2026 Feb 18;17:1749247. doi: 10.3389/fpsyt.2026.1749247.