**Commentary: Tardive Dyskinesia Is Not Over Yet**
Tardive dyskinesia (TD) has been called a disappearing adverse effect—an iatrogenic legacy of first-generation antipsychotics that modern practice might leave behind. The data say otherwise. In their cross-sectional study of 901 Chinese inpatients with chronic schizophrenia, Uludag and colleagues report a TD prevalence of 36%, a stark reminder that this stigmatising and often irreversible movement disorder remains highly prevalent. Published in the *Asian Journal of Psychiatry* (2021), the paper adds valuable real-world evidence from a large, well-characterised sample in an understudied population.
Several findings merit attention. First, TD was independently associated with older age, male sex, lower BMI, and a longer duration of illness—consistent with the classic risk factor literature. The association with higher antipsychotic exposure (more hospitalisations, longer illness) reinforces the cumulative neurotoxic hypothesis. Second, TD patients exhibited more severe negative and cognitive symptoms but fewer depressive symptoms, a pattern that invites speculation about shared basal ganglia pathology or treatment effects. Perhaps most intriguing is the negative association between TD and metabolic biomarkers: patients with TD had lower triglycerides, total cholesterol, HDL, LDL, ApoA1, and ApoB. While residual confounding cannot be ruled out, the finding resonates with emerging hypotheses linking lipid metabolism to synaptic plasticity and dopaminergic signalling. It also contrasts sharply with the well-known metabolic burden of second-generation antipsychotics and raises the possibility that biological vulnerability to TD and to metabolic syndrome may diverge.
Why does this matter now? Because TD has not gone away. Valbenazine and deutetrabenazine have finally brought evidence-based treatment options, yet access remains limited in many settings. Meanwhile, many patients continue to receive older antipsychotics, and even second-generation drugs are not without risk. Studies like this one underscore that routine screening with the AIMS scale should remain a non-negotiable component of schizophrenia care. They also highlight that TD is not merely a motor problem but sits at a complex intersection of demographic, metabolic, and psychopathological factors that may one day guide personalised prevention.
Uludag et al. have given us a timely reminder: TD is not over. It is under-recognised, under-treated, and still demanding our scientific attention.
—
link of study:
https://www.sciencedirect.com/science/article/abs/pii/S1876201821003336
reference:
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.
