Differential diagnosis is key to identifying and managing tardive dyskinesia (TD)

TD is distinct1-4

Although the symptoms of TD and drug-induced parkinsonism (DIP) may appear similar, they are the 
result of different pathophysiological mechanisms. It is therefore important to appropriately diagnose TD 
and DIP because they require distinctly different therapeutic management. Treating either condition with 
a therapy not specifically indicated for it could lead to a worsening of symptoms.

Appropriate management of TD requires differentiating between TD and DIP

The difference between tardive dyskinesia and drug-induced parkinsonism. The difference between tardive dyskinesia and drug-induced parkinsonism.

AUSTEDO may cause parkinsonism in patients with Huntington’s disease or tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. The risk of parkinsonism may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops parkinsonism, the AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.

When treating TD, consider all options available to you, including those that may not require APD adjustments3

While APD manipulation has historically been used, it is not always effective:

  • Changes in APD dosing can have a negative impact on psychiatric status3
  • Withdrawal can exacerbate TD symptoms6
  • TD symptoms often persist even after discontinuation or dose reduction6

View Demystifying EPS: TD Is Distinct—a 3-part series on the importance of differential diagnosis

Watch: Chapter 1

Considering the landscape of antipsychotic usage

Watch: Chapter 2

Opposing mechanisms of TD and DIP

Watch: Chapter 3

Differential diagnosis of TD

APD, antipsychotic drug; EPS, extrapyramidal symptoms; VMAT2, vesicular monoamine transporter 2.

REFERENCES: 1. Motor systems: basal ganglia. In: Neuroanatomy. 409-421. Accessed May 26, 2021. http://www.neuroanatomy.wisc.edu/coursebook/
motor2.pdf 2. Hauser RA, Truong D. Tardive dyskinesia: out of the shadows. J Neurol Sci. 2018;389:1-3. 3. Caroff SN, Hurford I, Lybrand J, Campbell EC. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurol Clin. 2011;29:127-148. 4. Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008;21:151-156. 5. Carbon M, Hsieh C-H, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264-e278. 6. Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (NY). 2013;3:tre-03-161-4138-1. 7. Ward KM, Citrome L. Antipsychotic-related movement disorders: drug-induced parkinsonism vs. tardive dyskinesia—key differences in pathophysiology and clinical management. Neurol Ther. 2018;7(2):233-248. 8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.