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Tardive dyskinesia

Last reviewed: 9 Apr 2025
Last updated: 10 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • exposure to dopamine receptor-blocking agents
  • stereotypic involuntary movements of the mouth and tongue
Full details

Other diagnostic factors

  • blepharospasm
  • dystonia of the trunk and limbs
  • tardive myoclonus
  • tardive tics (tourettism)
  • tardive chorea
  • tardive akathisia
  • tardive tremor
  • tardive parkinsonism
  • tardive oral and/or genital pain
Full details

Risk factors

  • use of dopamine receptor-blocking agents
  • age >50 years
  • history of acute dystonic reaction, akathisia, or drug-induced parkinsonism with previous medication use
  • alcohol and substance misuse
  • postmenopause
  • smoking
  • African-American ethnicity
  • diabetes mellitus
  • brain injury
  • dementia
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Joseph Jankovic, MD

Professor of Neurology

Distinguished Chair in Movement Disorders

Director

Parkinson's Disease Center and Movement Disorders Clinic

Department of Neurology

Baylor College of Medicine

Houston

TX

Disclosures

JJ declares that he has no competing interests.

Abhishek Lenka, MD, PhD

Movement Disorders Fellow

Parkinson's Disease Center and Movement Disorders Clinic

Department of Neurology

Baylor College of Medicine

Houston

TX

Disclosures

AL is an Associate Editor for Frontiers in Neurology (Movement Disorders).

Peer reviewers

Mark Stacy, MD

Professor of Neurology

Medical University of South Carolina

Charleston

SC

Disclosures

MS declares that he has no competing interests.

Tabish Saifee, FRCP, PhD

Consultant Neurologist

National Hospital for Neurology and Neurosurgery

London North West University Hospitals NHS Trust

London

UK

Disclosures

TS has received travel reimbursement from Ipsen for attending conferences and for consultancy.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.Full text

Ricciardi L, Pringsheim T, Barnes TRE, et al. Treatment recommendations for tardive dyskinesia. Can J Psychiatry. 2019 Jun;64(6):388-99.Full text  Abstract

Caroff SN, Citrome L, Meyer J, et al. A modified Delphi consensus study of the screening, diagnosis, and treatment of tardive dyskinesia. J Clin Psychiatry. 2020 Jan 28;81(2):19cs12983. Abstract

Bhidayasiri R, Jitkritsadakul O, Friedman JH, et al. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018 Jun 15;389:67-75. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Differentials

    • Tic disorder
    • Levodopa-induced dyskinesia
    • Drug-induced parkinsonism
    More Differentials
  • Guidelines

    • Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
    • A modified Delphi consensus study of the screening, diagnosis, and treatment of tardive dyskinesia
    More Guidelines
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