Tardive dyskinesia in a South Asian population with first episode psychosis treated with antipsychotics

Abstract

Background

Tardive dyskinesia (TD) is a side effect of antipsychotic treatment that often only appears after months or years of treatment. A systematic review of randomized controlled trials lasting more than 1 year showed that second-generation antipsychotics (SGAs) were associated with an approximately fivefold lower risk of TD compared to haloperidol in patients with chronic schizophrenia. In contrast, there is little research on the risk of TD with other first-generation antipsychotics (FGAs), and this applies especially to their use in the treatment of patients with first episode psychosis (FEP).

Objectives

To determine the severity and point prevalence of TD in a naturalistic sample of patients with FEP in Pakistan treated with FGAs or SGAs.

Methods

This was an observational study. TD was assessed by trained clinicians using the Abnormal Involuntary Movement Scale.

Results

In the total sample (number =86) the mean age of patients was 26 years and the prevalence of TD (Schooler Kane criteria) was 29% with no significant difference between those treated with FGAs and SGAs (31% FGAs versus 26% SGAs; P=0.805). The Abnormal Involuntary Movement Scale total score (items 1–7), a measure of the severity of TD, was significantly higher for patients treated with FGAs versus those treated with SGAs (P=0.033). Scores on specific items showed that this reflected higher scores for dyskinesia affecting the muscles of facial expression, as well as of the upper and lower limb, whereas scores did not differ significantly in other body areas.

Conclusion

FGAs were associated with greater severity, though not prevalence, of TD than SGAs. The study highlights the relatively high rate of TD in Asian FEP patients and the need for clinicians to monitor for this and other potential antipsychotic side effects during treatment.

Keywords:

• first-generation antipsychotic
• second-generation antipsychotic
• Abnormal Involuntary Movement Scale

Disclosure

UA and FT have no competing interests to report. IBC, NH, and PMH have received support to attend conferences and/or fees for lecturing and consultancy work (including attending advisory boards) from the manufacturers of various antipsychotics. The other authors report no conflicts of interest in this work.