Drub–induced Parkinsonism and tardive dyskinesia

Abstract

Drug–induced Parkinsonism (DIP) and tardive dyskinesia (TD) are stigmatizing movement disorders associated with exposure to dopamine receptor blocking agents such as antipsychotics. DIP and TD prevalence estimates range from approximately 20 to 35% among antipsychotic users. The majority of DIP cases appear within weeks of initiation of an antipsychotic. TD onset is delayed, typically appearing after at least 3 months, and patients commonly present with involuntary facial movements. Broadly, proposed mechanisms underlying these adverse events include decreased dopamine binding on dopamine D2 receptors of the striatal neurons and resultant dopamine hypersensitivity, for DIP and TD, respectively. DIP often resolves with discontinuation of the causative agent, but DIP patients with preclinical Parkinson's disease often need levodopa treatment. In TD, treatment options include the new reversible vesicular monoamine 2 transporter inhibitors, valbenazine. It is important for clinicians to be able to recognize DIP and TD in patients using antipsychotics so that they can minimize the impact of these adverse events on their patients' quality of life. Collaboration between neurologists and psychiatrists is absolutely necessary to made early accurate diagnosis that will drive the selection of the correct treatment.