Assessment
➤ Tardive syndromes are persistent abnormal involuntary movement disorders
caused by sustained exposure to antipsychotic medication, the most common
of which are tardive dyskinesia, tardive dystonia, and tardive akathisia.
➤ They begin later in treatment than acute dystonia, akathisia, or medication-
induced parkinsonism and they persist and may even increase, despite
reduction in dose or discontinuation of the antipsychotic medication.
➤ Typically, tardive dyskinesia presents as "involuntary athetoid or
choreiform movements (lasting at least a few weeks) generally of the
tongue, lower face and jaw, and extremities (but sometimes involving the
pharyngeal, diaphragmatic, or trunk muscles)".
➤ Tardive dystonia and tardive akathisia resemble their acute counterparts in
phenomenology.
➤ Regular assessment of patients for tardive syndromes through clinical
examination or through the use of a structured evaluative tool can aid in
identifying tardive syndromes, clarifying their likely etiology, monitoring
their longitudinal course, and determining the effects of medication
changes or treatments for tardive dyskinesia.
• Patients, family members, and other persons of support may be able to
provide information about the onset of movements; their longitudinal course
in relation to treatment or other precipitants; and their impact on functioning,
health status (including dentition), and quality of life.
➤ Clinical assessment of akathisia, dystonia, parkinsonism, and other
abnormal involuntary movements, including tardive dyskinesia, should be
performed at each visit.
➤ Assessment with a structured instrument (e.g., AIMS, DISCUS) should be
performed at a minimum of every 6 months in patients at high risk of tardive
dyskinesia and at least every 12 months in other patients as well as if a new
onset or exacerbation of preexisting movements is detected at any visit.
• When using scales such as the AIMS or the DISCUS, it should be noted that
there is no specific score threshold that suggests a need for intervention
although ranges of scores are noted to correspond with mild, moderate, and
severe symptoms.
• In addition, the same total score can be associated with significantly different
clinical manifestations and varying impacts on the patient.
Assessment
