title: 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).
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.forename: Usman U
authors.initials: UU
authors.lastname: Adam
authors.forename: Nusrat
authors.initials: N
authors.lastname: Husain
authors.forename: Peter M
authors.initials: PM
authors.lastname: Haddad
authors.forename: Tariq
authors.initials: T
authors.lastname: Munshi
authors.forename: Fauzia
authors.initials: F
authors.lastname: Tariq
authors.forename: Farooq
authors.initials: F
authors.lastname: Naeem
authors.forename: Imran B
authors.initials: IB
authors.lastname: Chaudhry
keywords: Abnormal Involuntary Movement Scale; first-generation antipsychotic; second-generation antipsychotic