From Diagnosis to Management: How to Treat Tardive Dyskinesia
In this video, PA Williams delves into the complexities of treating Tardive Dyskinesia (TD) by examining its underlying pathophysiology, which may involve dopamine hypersensitivity and GABA-nergic dysfunction. He highlights that while increasing antipsychotic doses might temporarily mask symptoms, it’s essential to avoid using anticholinergics due to their negative effects on TD.
PA Williams recommends considering VMAT2 inhibitors for moderate to severe cases, as they help reduce dopamine transport and alleviate symptoms. He also addresses the challenges of underdiagnosis and treatment hesitancy, empowering physician associates to take an active role in diagnosing and managing TD without always needing a neurologist’s consultation.
Key Takeaways:
- Tardive dyskinesia (TD) is likely caused by dopamine hypersensitivity; decreasing the antipsychotic medication could exacerbate symptoms.
- VMAT2 inhibitors should be considered for TD treatment.
- PAs can and should diagnose and treat TD.
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References and Additional Resources:
American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. American Psychiatric Association Publishing; 2020. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890424841
Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn S. Updating the recommendations for treatment of tardive syndromes: A systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018;389:67-75. doi:10.1016/j.jns.2018.02.010
Caroff SN. A new era in the diagnosis and treatment of tardive dyskinesia. CNS Spectr. 2023;28(4):401-415. doi:10.1017/S1092852922000992
New Data from Teva Shows Substantial Rates of Undertreated Tardive Dyskinesia in Long-Term Care Settings at Psych Congress Elevate 2025. Tevausa.com. Accessed August 5, 2025. https://www.tevausa.com/news-and-media/press-releases/new-data-from-teva-shows-substantial-rates-of-undertreated-tardive-dyskinesia-in-long-term-care-settings-/
Ruparelia P, Pandya U, Gill N, Verma O. Restless tongue: Lingual Tardive Dyskinesia – A rare case report. J Oral Biol Craniofac Res. 2022;12(1):99-101. doi:10.1016/j.jobcr.2021.10.006
Stahl SM. Neuronal traffic signals in tardive dyskinesia: not enough “stop” in the motor striatum. CNS Spectr. 2017;22(6):427-434. doi:10.1017/S109285291700061X
Takeuchi H, Mori Y, Tsutsumi Y. Pathophysiology, prognosis and treatment of tardive dyskinesia. Ther Adv Psychopharmacol. 2022;12:20451253221117313. doi:10.1177/20451253221117313
Vanegas-Arroyave N, Caroff SN, Citrome L, et al. An evidence-based update on anticholinergic use for drug-induced movement disorders. CNS Drugs. 2024;38(4):239-254. doi:10.1007/s40263-024-01078-z
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. doi:10.1007/s40120-018-0105-0
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