title: Tardive dyskinesia in the era of typical and atypical antipsychotics. Part 2: Incidence and management strategies in patients with schizophrenia.
abstract: OBJECTIVE
  Tardive dyskinesia (TD), the principal adverse effect of long-term conventional antipsychotic treatment, can be debilitating and, in many cases, persistent. We sought to explore the incidence and management of TD in the era of atypical antipsychotics because it remains an important iatrogenic adverse effect.
  
  
  METHODS
  We conducted a review of TD incidence and management literature from January 1, 1965, to January 31, 2004, using the terms tardive dyskinesia, management, therapy, neuroleptics, antipsychotics, clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. Additional articles were obtained by searching the bibliographies of relevant references. We considered articles that contributed to the current understanding of both the incidence of TD with atypical antipsychotics and management strategies for TD.
  
  
  RESULTS
  The incidence of TD is significantly lower with atypical, compared with typical, antipsychotics, but cases of de novo TD have been identified. Evidence suggests that atypical antipsychotic therapy ameliorates long-standing TD. This paper outlines management strategies for TD in patients with schizophrenia.
  
  
  CONCLUSIONS
  The literature supports the recommendation that atypical antipsychotics should be the first antipsychotics used in patients who have experienced TD as a result of treatment with conventional antipsychotic agents. The other management strategies discussed may prove useful in certain patients.
authors.affiliation: Department of Psychiatry, McGill University, Montreal, Quebec. psychopharm.unit@mcgill.ca
authors.forename: Howard C
authors.initials: HC
authors.lastname: Margolese
authors.forename: Guy
authors.initials: G
authors.lastname: Chouinard
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Kolivakis
authors.forename: Linda
authors.initials: L
authors.lastname: Beauclair
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.forename: Lawrence
authors.initials: L
authors.lastname: Annable
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000009:adverse effects; D003024:Clozapine / Q000009:adverse effects; D003987:Dibenzothiazepines / Q000009:adverse effects; D004409:Dyskinesia, Drug-Induced / Q000209:etiology*; D006801:Humans; D015994:Incidence; D000077152:Olanzapine; D010879:Piperazines / Q000009:adverse effects; D000069348:Quetiapine Fumarate; D015363:Quinolones / Q000009:adverse effects; D018967:Risperidone / Q000009:adverse effects; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology*; D013844:Thiazoles / Q000009:adverse effects
chemical_list: D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000068180:Aripiprazole; D003024:Clozapine; D018967:Risperidone; D000077152:Olanzapine