| Abstract [eng] |
Introduction. Tardive dyskinesia is a movement disorder that begins due to dopamine receptor-blocking agents exposure for at least a few months. These agents include most of antipsychotics, which are used widely in the treatment of mental illness. This disabling disease will remain a clinical part of modern psychiatry, and the large number of publications on tardive dyskinesia that have appeared in the literature in recent years is a huge step forward in this area. Case descriptions. A 43-year-old woman with paranoid schizophrenia hospitalized in 2018 due to constant involuntary movements of the whole body, especially expressed for ~2 years. The patient has been taking antipsychotics for about 20 years, the first dyskinetic movements were observed ~10 years ago (various jerks) and described in 2014 (champing). Tardive dyskinesia was diagnosed and the patient treated with tetrabenazine. The patient's condition in the hospital clearly improved and the stereotypical dystonic-hyperkinetic movements of the limbs and torso and other symptoms disappeared. Another patient, a 55-year-old woman, hospitalized for involuntary movements in 2019, and had been taking antipsychotics regularly for ~10 years for delusional disorder. Akathisia and hand dyskinesias appeared ~7 years ago and gradually progressed to choreoathetoid movements of the face, neck, arms, and torso. During hospitalization, paranoid schizophrenia and tardive dyskinesia were diagnosed and treatment with tetrabenazine was initiated. During treatment, the amplitude of involuntary movements partially decreased, and the patient became more functional. Literature review. One of the difficulties in psychiatry in the treatment of tardive dyskinesia is the need to continue the antipsychotics that caused the disorder. In this case, the best choice would be second-generation atypical antipsychotics. The first-line treatment for tardive dyskinesia is VMAT2 inhibitors - deutetrabenazine, valbenazine, if they are unavailable- tetrabenazine. Conclusions. In order to provide reliable, evidence-based recommendations for the treatment of tardive dyskinesia, a better understanding of its pathophysiology, genetic predisposition, and therapeutic agents, more studies should be performed with larger-sample and more equal conditions. |
