Tardive dyskinesia (TD) is a complex iatrogenic movement disorder caused by prolonged dopamine receptor antagonism, often occurring in individuals on long-term antipsychotic medications. It presents with involuntary movements such as akathisia, dystonia, and buccolingual stereotypy. Even after discontinuing the causative medication, symptoms can persist, making management challenging. This review aims to provide an updated overview of the diagnosis, management, and pharmacological treatments for TD, addressing its multifaceted nature and the difficulties it poses for clinicians.

The review highlights the etiology of TD, which is primarily associated with both first- and second-generation antipsychotics, with first-generation drugs carrying a higher risk. The pathophysiology of TD involves dopamine receptor hypersensitivity, oxidative stress, and neurotransmitter imbalances. Diagnosis relies on the persistence of symptoms following medication use. While treatment options remain limited, VMAT2 inhibitors like valbenazine and deutetrabenazine show promise. Preventative strategies, such as careful prescribing and regular monitoring, are crucial. Advances in pharmacological treatments offer hope, but prevention remains the most effective strategy in managing TD.

Reference: Alshammari SRH, Almutairi YTT, Alotaibi SJF, et al. Tardive Dyskinesia: A Complicated Iatrogenic Movement Condition—An Updated Overview of Diagnosis, Management, and Pharmacological Treatment. JoE. 2024;3(8):9277-9284. doi: https://doi.org/10.62754/joe.v3i8.5534.

Extrapyramidal symptoms (EPS)—including drug-induced parkinsonism, akathisia, dystonia, and tardive dyskinesia—are common adverse effects of antipsychotics that impair function and adherence. Authors of a narrative review (2002-2024; 13 studies selected from 522 records) highlight that risk and severity vary by agent, dose, duration, and patient factors (age, prior antipsychotic use, comorbidities, substance use). Early recognition and routine monitoring with bedside exams plus validated scales are emphasized to reduce burden. Management strategies include dose reduction, switching to lower-EPS agents, targeted adjuncts, and non-pharmacologic therapies, alongside adherence support.

Emerging artificial intelligence tools—video-based motion tracking, natural language processing for patient-reported symptoms, predictive analytics using clinical/genetic data, and speech/facial movement analysis—show promise for earlier detection, objective quantification, and personalized care. However, gaps remain: limited long-term outcomes data, variability in presentation, and concerns about algorithmic bias, privacy, and external validation across diverse settings. A multidisciplinary, patient-centered approach that integrates standard clinical assessment with rigorously validated digital monitoring could improve EPS detection, guide treatment adjustments, and ultimately enhance quality of life.

Reference: Sharma M, Suthar N, Yadav P. Extrapyramidal symptoms in psychiatric disorders: current insights, risk factors, and future directions: a narrative review. Junior Researchers. 2025;3(2):193–201. doi:10.52340/jr.2025.03.02.28.

This pilot study aimed to use social media listening (SML) to gain insights into the patient and caregiver experiences of tardive dyskinesia (TD), a movement disorder associated with prolonged use of dopamine receptor-blocking agents like antipsychotics. Social media platforms, blogs, and forums were analyzed for patient and caregiver posts between March 2017 and November 2019. A total of 261 posts were identified, with 107 used for analysis. The study found that 64% of the posts expressed negative sentiments, with patients often feeling angry about the medication causing their symptoms and insecure about societal acceptance.

The study also revealed that movement-related symptoms were the most common concern for patients, with emotional distress being a significant aspect of their experience. Patients described feelings of anger and insecurity, particularly related to the stigma of having symptoms from a medication used for another condition. The findings suggest that SML can be a valuable tool in understanding the unmet needs of patients with TD. Researchers stress that the emotional and social challenges associated with the condition are significant and should be considered when addressing TD in clinical settings.

Reference: Farrar M, Lundt L, Franey E, Yonan C. Patient perspective of tardive dyskinesia: results from a social media listening study. BMC Psychiatry. 2021;21(1):94. doi: 10.1186/s12888-021-03074-9. 

Tardive dyskinesia (TD), a persistent involuntary movement disorder linked to long-term antipsychotic use, is often underreported or misdiagnosed in routine clinical practice. This retrospective study analyzed electronic health records (EHRs) from over 32,000 US adults with psychotic disorders who were prescribed antipsychotics between 1999 and 2021. Researchers identified patients with either abnormal movements suggestive of TD or documented TD through manual review of clinical notes. While 1,301 patients had clinical indicators of TD in unstructured EHR data, only 64 (4.9%) of them had a formal ICD-coded diagnosis—indicating a significant gap in diagnosis and documentation.

Findings suggest racial and clinical setting disparities in TD diagnosis. Black/African American patients were significantly less likely to receive an ICD-TD diagnosis compared to white patients. Patients treated at community mental health centers were more likely to receive a diagnosis than those treated at academic medical centers. These results underscore the need for improved recognition and documentation of TD in clinical settings to ensure timely intervention and equitable access to treatment. Better diagnostic practices could help identify patients who may benefit from newer therapeutic options for managing TD.

Reference: Griffiths K, Won Y, Lee Z, Wang L, Correll CU, Patel R. 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.

Tardive dyskinesia (TD) significantly impacts patients' physical, cognitive, and psychosocial functioning. The Abnormal Involuntary Movement Scale (AIMS) is commonly used to evaluate TD treatment efficacy in clinical trials but does not capture the patient perspective on the impacts of uncontrolled movements. The Tardive Dyskinesia Impact Scale (TDIS) was developed as a patient-reported outcome measure to address this gap. This study aimed to assess the psychometric properties of the TDIS to determine if it is suitable for measuring the impact of TD from a patient's perspective.

The qualitative results of the study indicated that the TDIS effectively captures the key impacts of TD as reported by patients and caregivers. Quantitative analysis revealed two underlying domains of the TDIS: physical and socioemotional. The TDIS demonstrated good construct validity, including responsiveness to treatment-related changes. The TDIS also showed a low correlation with the AIMS, indicating it provides unique information. Overall, the TDIS complements the AIMS and can be used to assess changes in TD impact over time, offering a more comprehensive evaluation of the disease’s effects.

Reference: Farber RH, Stull DE, Witherspoon B, et al. The Tardive Dyskinesia Impact Scale (TDIS), a novel patient-reported outcome measure in tardive dyskinesia: development and psychometric validation. J Patient Rep Outcomes. 2024;8(1):2. doi: 10.1186/s41687-023-00679-4. 

Tardive dyskinesia (TD) is a persistent movement disorder linked to long-term use of dopamine receptor–blocking medications, and older adults (≥60 years) are at particularly high risk. In long-term care (LTC) settings, TD can add to functional burden, worsening balance, swallowing, and daily functioning. This retrospective, longitudinal study used the STATinMED Real-World Insights Database (2017–2022) to assess how common TD is among LTC residents and to describe their demographics, comorbidities, treatment patterns, and healthcare utilization. Adults with a TD diagnosis, at least one LTC stay, and continuous claims data for 12 months before LTC admission and 12 months after LTC discharge were included.

Among 20,176 patients with TD, 2,294 met criteria for continuous benefits and were analyzed. Most were older (64.6% ≥65 years), female (67.3%), and covered by Medicare (76.8%), with a high comorbidity burden (mean Charlson Comorbidity Index 3.72). Mood disorders were common (66.1%), and antidepressants were the most frequently used medications (56.1%). Polypharmacy was notable: nearly half of patients were prescribed three or more central nervous system–active medications, heightening risk of falls and cognitive impairment in older adults. Post-LTC, 64.8% had at least one emergency department visit. Overall, the study highlights substantial medical complexity and polypharmacy among LTC residents with TD. Researchers underscore the need for further research and targeted interventions to improve outcomes such as fall-related injuries and decline in activities of daily living.

Reference: Bron M, Aweh G, Jen E, Patel A. Real-World Claims Analysis to Characterize the Burden of Tardive Dyskinesia in Long-Term Care Settings. Neurol Ther. 2025 Oct;14(5):2217-2226. doi: 10.1007/s40120-025-00820-z.

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.

In a recent study, researchers used Japan’s JADER adverse drug reaction database to look for safety signals linking antipsychotics to tardive dyskinesia (TD) and other extrapyramidal symptoms (EPS), including akathisia, dystonia, parkinsonism, tremor, and related movement disorders. Across more than 1.19 million reports, both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) showed higher reporting odds of TD and EPS than non-antipsychotic drugs. The signal was especially strong for TD, and the findings remained generally consistent after statistical adjustment. When SGAs were compared directly with FGAs, SGAs overall showed lower reporting signals for TD, dyskinesia, and parkinsonism, but not consistently for akathisia, dystonia, or tremor.

The authors conclude that although SGAs are often viewed as safer than FGAs for movement-related adverse effects, they still carry meaningful TD and EPS risk and should not be considered risk-free. Differences also emerged among SGA subgroups, with some appearing lower risk than others for certain movement disorders. The overall message is that clinicians should actively monitor for TD and EPS with any antipsychotic. The paper also highlights the frequent concomitant use of anticholinergics, noting that long-term use may be inappropriate in some patients and may fail to prevent or even worsen TD. Because the analysis was based on spontaneous reporting data, it identifies reporting “signals” rather than true incidence or causality, but it still offers useful real-world evidence to support careful prescribing and ongoing monitoring.

Reference: Saga Y, Horio H, Chiang CL, Wakamatsu A. Reporting Frequency of Antipsychotics-Induced Tardive Dyskinesia and Other Extrapyramidal Symptoms: Analysis Based on a Spontaneous Reporting System Database in Japan. Neuropsychopharmacol Rep. 2025;45(3):e70049. doi: 10.1002/npr2.70049.

Authors of a narrative review examine the current European landscape of tardive dyskinesia (TD) and argue that TD remains both common and underrecognized across the region. Drawing on limited European data supplemented by findings from other regions, the authors note that TD prevalence remains clinically meaningful even in the era of second-generation antipsychotics, with prior estimates suggesting rates of 22.3% in Europe and a global mean prevalence of 25.3%. They emphasize that diagnosis is often missed or delayed because of poor recognition of the full range of TD symptoms, lack of systematic screening, inconsistent use of diagnostic criteria and rating scales, and shortcomings in coding systems. This includes the absence of a distinct TD code in some countries. The authors also highlight that accurate diagnosis is complicated by the need to distinguish TD from other abnormal movement disorders, and that better training for psychiatrists and closer collaboration with neurologists could help improve detection.

The authors further underscore the substantial disease burden and quality-of-life impact of TD. TD may persist even after stopping the causative agent, increase healthcare use and costs, worsen outcomes related to the underlying psychiatric illness, and negatively affect physical, psychological, social, and vocational functioning. From the European perspective, the authors argue that care is fragmented because TD-specific guidelines are sparse, inconsistent, or absent, and access to newer treatments varies widely by country. Although VMAT2 inhibitors have the strongest evidence base, their availability in Europe is uneven, which may contribute to undertreatment. Overall, the authors call for pan-European guidelines, improved access to newer therapies, better clinician and patient education, more routine screening, and clearer International Classification of Diseases coding. They also emphasize the need for more Europe-based research to better define TD prevalence, burden, and best practices for management.

Reference: Colosimo C, Jain R, Duma K, Kurzeja A, Arango C. A European perspective on tardive dyskinesia. Eur Neuropsychopharmacol. 2026 Mar;104:112740. doi: 10.1016/j.euroneuro.2025.11.017. Epub 2025 Dec 19.

Recent advances have introduced treatment options, including VMAT2 inhibitors, for patients with tardive dyskinesia (TD), which help suppress symptoms, though they do not address the underlying causes. TD remains a critical issue, especially as it can worsen with age and prolonged antipsychotic use. Early diagnosis and preventive strategies, such as regular screening and antipsychotic dose adjustments, are crucial for managing the disorder.

The treatment of TD involves a comprehensive approach, combining medication adjustments, preventive screening, and patient-caregiver discussions. While several agents, such as VMAT2 inhibitors, have shown promise, many clinical trials for alternative treatments have been methodologically flawed, leaving questions about their effectiveness. The dopamine supersensitivity hypothesis, which suggests that TD is triggered by prolonged dopamine D2-receptor blockade, remains a central theory, but it doesn't fully explain the disorder's complexity. New treatments targeting non-dopaminergic pathways, including glutamate, acetylcholine, and gamma-aminobutyric acid agents, offer potential for more effective management. Future research should focus on better understanding these mechanisms and exploring therapies that address the underlying causes of TD.

Reference: Caroff SN. Recent Advances in the Pharmacology of Tardive Dyskinesia. Clin Psychopharmacol Neurosci. 2020;18(4):493-506. doi: 10.9758/cpn.2020.18.4.493.

Tardive dyskinesia (TD) is a chronic, often disabling movement disorder linked to long-term antipsychotic exposure, including atypical agents like olanzapine. It is marked by involuntary, repetitive movements that can affect the face, neck, and limbs. This case report explores the potential role of pyridoxal-5’-phosphate (PLP, P-5-P), the active form of vitamin B6, in reducing TD symptoms. It also cites prior literature suggesting lower PLP levels in some patients with schizophrenia and proposes possible mechanistic effects via neurotransmitter pathways and antioxidant activity.

In the report, a 38 to 39-year-old man with an approximate 8-year history of paranoid schizophrenia on olanzapine (up to 20 mg) developed torticollis with painful neck stiffness and involuntary neck movements consistent with TD. His symptoms were rated as moderate on the Abnormal Involuntary Movement Scale (AIMS). After negligible response to agents such as trihexyphenidyl, baclofen, and tetrabenazine, he began PLP 500 mg daily and reported meaningful improvement within 3 months. Improvements continued over 1 year, including about a 70% reduction in neck pain/stiffness and an AIMS decrease from moderate (15) to mild (5). The authors conclude that high-dose PLP may be a promising adjunct for antipsychotic-induced movement symptoms. They also emphasize that broader studies are needed to clarify long-term efficacy and safety.

Reference: Manakame SK, Vardhan V, Malyam V, et al. Use of Pyridoxal-5′-phosphate for Olanzapine-induced Tardive Dyskinesia: A Case Report. J Med Sci. 2025;11(1–4):00419. doi: 10.5005/jp-journals-10045-00419.

Tardive dyskinesia (TD) is typically caused by long-term use of dopamine receptor antagonists, especially neuroleptics, and can develop after months or years of medication use. The risk of developing TD is linked to the strength of a drug's binding to dopamine receptors, with elderly patients being more susceptible. While pharmacological treatments are the main method of managing TD, a promising alternative for severe cases is deep brain stimulation (DBS). DBS involves surgically implanting electrodes in the brain to deliver controlled electrical currents, which can provide long-term improvement in motor functions and quality of life for patients with TD.

DBS has become an established treatment for patients with severe TD that does not respond to medication. The two main targets for DBS are the internal globus pallidus (GPi) and subthalamic nucleus (STN), both of which have shown positive results in improving motor symptoms. Studies suggest that while GPi DBS is commonly used, STN DBS might offer advantages such as fewer mood and cognitive side effects, better symptomatic control, and longer battery life for the device. Further research is needed to confirm these findings and explore other potential targets for DBS in treating TD.

Reference: Szczakowska A, Gabryelska A, Gawlik-Kotelnicka O, Strzelecki D. Deep Brain Stimulation in the Treatment of Tardive Dyskinesia. J Clin Med. 2023;12(5):1868. doi: 10.3390/jcm12051868. 

Authors of this cross-sectional survey explored patient-reported barriers to tardive dyskinesia (TD) diagnosis and treatment among 327 adults with schizophrenia, bipolar disorder, or major depressive disorder who had TD-like symptoms and current or past antipsychotic use. Participants were grouped into three cohorts: undiagnosed (52%), diagnosed but untreated (30%), and diagnosed and treated (18%). Using descriptive statistics, machine-learning, and multivariable logistic regression, the study examined which factors were associated with receiving a TD diagnosis and, among those diagnosed, with receiving TD treatment.

Patients who talked to their healthcare providers about involuntary movements and were physically examined for TD were far more likely to be diagnosed than those who were not, highlighting communication and exam gaps as major barriers. Undiagnosed participants more often had lower income and lower employment, and those who frequently struggled with food or money were significantly less likely to be diagnosed, underscoring the role of socioeconomic disadvantage. Among those with a TD diagnosis, more frequent healthcare engagement (appointments within the last three months) was strongly associated with receiving TD treatment. Overall, the findings suggest that lack of symptom discussion, low socioeconomic status, and infrequent healthcare contact are key barriers to TD diagnosis and treatment. Researchers stress the need for better patient education and more proactive TD screening and conversation by clinicians.

Reference: Solis G, Chaijale N, Gonzalez A, et al. Patient perspectives on barriers to diagnosis and treatment of tardive dyskinesia from a cross-sectional survey (P4-5.018). Neurology. 2025 Apr 7. doi: 10.1212/WNL.0000000000212081.

This consensus report provides practical recommendations for assessing the real-life impact of tardive dyskinesia (TD), not just the visible severity of abnormal movements. The panel emphasizes that TD can be diagnosed when persistent dyskinetic movements occur in a patient with current or prior exposure to a dopamine receptor blocking agent, after other causes are excluded. Importantly, the patient may not be aware of the movements, and even movements that appear “mild” to a clinician can meaningfully affect daily life. The authors recommend assessing TD impact routinely because it can guide treatment decisions and determine how urgently symptoms should be addressed.

The panel identifies five key domains for assessing TD impact: social, physical, vocational, psychological, and psychiatric. TD may affect relationships, public interactions, speech, eating, breathing, walking, fine motor function, employment, self-image, embarrassment, anxiety, and management of the underlying psychiatric disorder. The authors also recommend gathering input from patients, caregivers, family members, and other care team members because TD symptoms and their impact may fluctuate over time and may not be fully captured during a clinic visit. Overall, the report argues that TD treatment should be a shared decision based not only on movement severity, but also on how much TD disrupts the patient’s function, distress, and quality of life.

Reference: Jackson R, Brams MN, Citrome L, et al. Assessment of the Impact of Tardive Dyskinesia in Clinical Practice: Consensus Panel Recommendations. Neuropsychiatr Dis Treat. 2021 May 24;17:1589-1597. doi: 10.2147/NDT.S310605.

A recent study explored the prevalence and risk factors for tardive dyskinesia (TD) in patients with schizophrenia undergoing long-term antipsychotic treatment. It found that 35.9% of patients exhibited TD symptoms, with older age, Chinese ethnicity, and prolonged antipsychotic use being significant risk factors. The prevalence of TD in these patients highlights the importance of regular monitoring and early detection, particularly for older patients and those with extended histories of antipsychotic treatment. The study also noted that facial and oral movements were the most commonly impacted areas in TD, resulting in significant impairments in self-care and quality of life, as measured by the Personal and Social Performance Scale.

Additionally, the study revealed that patients with TD were more likely to experience severe impairments across various clinical scales, including the Clinical Global Impression, indicating a higher level of overall clinical severity. The findings suggest that tailored treatment strategies, including personalized monitoring based on factors like age, ethnicity, and treatment history, are crucial for mitigating the risk of TD. The study calls for continued vigilance in monitoring TD and further research into ethnic-specific risk factors and long-term management strategies for TD in patients with schizophrenia.

Reference: Nedunjelian A, Ng CG, Lim PK, Sulaiman AH, Koh OH, Francis B. The Prevalence of Tardive Dyskinesia In Patients With Schizophrenia Treated With Antipsychotics In Malaysia. Neuropsychiatr Dis Treat. 2025;21:465-475. doi: 10.2147/NDT.S494458.