Utility of quetiapine in tardive dyskinesia

Abstract

Introduction. Neuroleptic induced tardive dyskinesia is a late appearing extrapyramidal disorder of involuntary, choreoatetoid movements. It may appear during chronic treatment with classical neuroleptics or a short time after its prolonged administration is interrupted. At present, there is no agreement on what would be the best way to treat dyskinesias. Clozapine is an alternative treatment to take into account, although the risk of agranulocytosis may be excessive to use it when there is a mild or moderate form of dyskinesia. Cases of improvement of dyskinesias both with olanzapine as well as with risperidone, although in a lower number, have been reported. Due to its receptor profile, quetiapine is the atypical antipsychotic that is most similar to clozapine, which leads us to consider it for the treatment of dyskinesias.

Methods. The first patient is a 66 year old woman with schizoaffective disorder of 16 years of evolution who has received many classical neuroleptics and who presents a picture or orolingual dyskinesias with a score of 28 on the AIMS scale. Treatment was substituted with Quetiapine until reaching a dose of 400 mg/day over 4 months, obtaining a decrease in the AIMS score up to 9. The second patient is a 60 year old woman diagnosed of bipolar disorder under treatment since 26 years of age with delusional jealousy ideation. Different atypical antipsychotics were used, all of them causing dyskinetic symptoms in the orolingual region, that disappeared with low doses of quetiapine, with good stabilization of her psychopathology. The third patient is a 33 old male diagnosed of paranoid schizophrenia when he was 18 years old. He was under maintenance treatment with haloperidol, biperiden and lorazepam, until 27 years of age, when the treatment was changed to risperidone, after presenting an orofacial tardive dyskinesia with masticatory type movements and lingual protrusion, with a 19 score on the AIMS scale. The change to quetiapine 600 mg/day reduced the score on the AIMS scale to 3.

Discussion. Our experience, based on 3 cases, shows an early and lasting improvement of the tardive dyskinesia with quetiapine. This experience is reinforced by other investigators with similar cases. In all, we have 12 cases that support the efficacy of quetiapine in the treatment of tardive dyskinesias.