Tardive Dyskinesia (TD) is a serious, nonrhythmic and iatrogenic movement disorder, and is a common comorbidity in patients with schizophrenia (SZ). The main goal of this study was to investigate the prevalence, clinical correlates, and risk factors of TD in Chinese patients with chronic SZ, which has not been fully studied. This study adopted a cross-sectional design. A total of 901 Chinese inpatients with SZ were recruited between 2008 and 2011. We used the Abnormal Involuntary Movement Scale (AIMS) to measure the severity of TD, and the Positive and Negative Syndrome Scale (PANSS) was used to measure the psychopathological symptoms of SZ. Blood samples were also collected for routine blood tests, including the levels of triglyceride (TG), cholesterol (CHO), HDL-cholesterol (HDL-CHO), LDL-cholesterol (LDL-CHO), Apolipoprotein A1 (ApoA1), and Apolipoprotein B (ApoB). Overall, 36% of patients with SZ had TD. Compared with the non-TD patients, the TD patients were more likely to be men, had older age, lower education level, higher smoking rate, higher hospitalization frequency, and longer duration of illness (DOI). Further, compared with the non-TD patients, the TD patients had higher PANSS total, PANSS negative subscale, and cognitive subscale scores, but had lower depressive subscale scores and lower mean levels of metabolic biomarkers, including TG, CHO, HDL-CHO, LDL-CHO, ApoA1 and ApoB. Moreover, binary regression analysis showed that antipsychotic type, BMI, gender, age, HDL-CHO, and ApoB were associated with TD. Our findings indicate that TD is a common movement disorder in patients with chronic SZ, with certain demographic and clinical variables being risk factors for the development of TD.
Comments:
The Antipsychotic Hierarchy: Are All Drugs Equal?
The most clinically actionable finding would be a comparison of TD risk across specific agents. Does the study show that clozapine or aripiprazole—drugs with low dopamine D2 receptor occupancy profiles—are associated with lower TD rates than risperidone or olanzapine? Or does it lump all SGAs together, obscuring important differences? Moreover, the commentary should address the “covert dyskinesia” phenomenon: some antipsychotics (e.g., clozapine) may suppress existing TD, leading to underestimation of prevalence in cross-sectional designs. Longitudinal data on drug switching would be far more informative than a single snapshot.
Clinical Implications: What Should Prescribers Do?
Ultimately, a commentary must answer: How should this study change practice?
link of study: https://pubmed.ncbi.nlm.nih.gov/34638091/
Uludag, K., Wang, D. M., Goodman, C., Chen, D. C., Wang, L., & Zhang, X. (2021). Prevalence, clinical correlates and risk factors associated with Tardive Dyskinesia in Chinese patients with schizophrenia. Asian journal of psychiatry, 66, 102877. https://doi.org/10.1016/j.ajp.2021.102877
