Am J Psychiatry 1991; 148:1055-1059
Copyright © 1991 by American Psychiatric Association
A review of 32 cases of tardive dystonia
JD Wojcik, WE Falk, JS Fink, JO Cole and AJ Gelenberg
Department of Psychiatry, Massachusetts General Hospital, Boston.
OBJECTIVE: Tardive dystonia, historically combined with tardive dyskinesia,
is now viewed as probably having a different pathophysiology, course,
outcome, and treatment response than tardive dyskinesia. In addition,
patients with tardive dystonia are reported to be younger, and most are
men. This study evaluates characteristics of 32 patients with tardive
dystonia and compares results to other reports. METHOD: Twenty-four
patients had been referred for research purposes and were videotaped, while
eight had been followed clinically. Two of the authors reviewed all
available videotapes and clinical reports to assess the course of symptoms
over time. For global ratings and ratings of affected body parts, two
scales were used: the Abnormal Involuntary Movement Scale (AIMS) for
tardive dyskinesia and a similar scale for tardive dystonia. The method of
case finding does not provide incidence or prevalence data for tardive
dystonia. RESULTS: Fifty-nine percent of the patients experienced onset of
tardive dystonia symptoms within 6 years of antipsychotic drug exposure;
women had a shorter exposure time. No patient had complete remission of
tardive dystonia symptoms, and 22 were moderately or severely impaired when
their movements were most prominent. CONCLUSIONS: While epidemiological
studies of tardive dystonia have yet to be performed, these results support
the observations of others that most patients with tardive dystonia are
men, have a short history of exposure to antipsychotic drugs, and may
initially present with blepharospasm. Tardive dystonia rarely remits
completely, can cause notable disability, and may partially respond to
anticholinergic agents.
