Skip to main content Accessibility help

Tardive dyskinesia update: the syndrome

  • David Cunningham Owens (a1)


Tardive dyskinesia is a common iatrogenic neurological and neurobehavioural syndrome associated with the use of antidopaminergic medication, especially antipsychotics. Prior to the introduction of the newer antipsychotics in the 1990s, it was one of the major areas of psychiatric research but interest waned as the new drugs were reputed to have a reduced liability to extrapyramidal adverse effects in general, a claim now discredited by numerous pragmatic research studies. Early small-scale short-term prevalence studies were presented as evidence to support the assumption that patients on the newer drugs did indeed have a lower prevalence of tardive dyskinesia but recent large-scale review of studies with patients exposed for longer suggest that things have not changed. This article presents a clinical overview of a complex and varied syndrome in terms of its phenomenology, epidemiology and risk factors; a companion article will consider treatment. This overview aims to highlight tardive dyskinesia once again, especially to practitioners who have trained in an environment where this was considered mainly in historical terms.


  • Understand the complex phenomenology comprising the syndrome of tardive dyskinesia
  • Appreciate recent data on prevalence and incidence with the newer antipsychotics
  • Be aware of risk factors when recommending antipsychotic (and other antidopaminergic) drugs




Corresponding author

Correspondence Professor David Cunningham Owens, University Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK. Email:


Hide All

A companion article by David Cunningham Owens will discuss the treatment and management of tardive dyskinesia.



Hide All
Adityanjee, , Aderibigbe, YA, Chowdary, VC, et al. (1999) The current status of tardive dystonia. Biological Psychiatry, 45: 715–30.
Alexopoulos, GS (1979) Lack of complaints in schizophrenics with tardive dyskinesia. Journal of Nervous and Mental Disease, 167: 125–7.
Aquino, CCH, Lang, AE (2014) Tardive dyskinesia syndromes: current concepts. Parkinsonism and Related Disorders, 20(suppl 1): S1137.
Ayd, FJ (1967) Persistent dyskinesia: a neurologic complication of major tranquillisers. Medical Science, 18: 3240.
Barnes, TRE, Braude, WM (1985) Akathisia variants and tardive dyskinesia. Archives of General Psychiatry, 42: 874–8.
Branchey, M, Branchey, L (1984) Patterns of psychotropic drug use and tardive dyskinesia. Journal of Clinical Psychopharmacology, 4: 41–5.
Campbell, M, Adams, P, Perry, R, et al. (1988) Tardive and withdrawal dyskinesia in autistic children: a prospective study. Psychopharmacology Bulletin, 24: 251–5.
Carbon, M, Hsieh, C-H, Kane, JM, et al. (2017) Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. Journal of Clinical Psychiatry, 78: e26478.
Chakos, MH, Alvir, JMJ, Woerner, MG, et al. (1996) Incidence and correlates of tardive dyskinesia in first episode of schizophrenia. Archives of General Psychiatry, 53: 313–9.
Chong, S-A, Tay, JAM, Subramaniam, M, et al. (2009) Mortality rates among patients with schizophrenia and tardive dyskinesia. Journal of Clinical Psychopharmacology, 29: 58.
Chouinard, G, Jones, BD (1979) Early onset of tardive dyskinesia: case report. American Journal of Psychiatry, 136: 1323–4.
Dean, CE, Thuras, PD (2009) Mortality and tardive dyskinesia: long-term study using the US National Death Index. British Journal of Psychiatry, 194: 360–4.
DeVeaugh-Geiss, J (1982) Prediction and prevention of tardive dyskinesia. In Tardive Dyskinesia and Related Involuntary Movement Disorders (ed DeVeaugh-Geiss, J): 161–6. John Wright.
Dufresne, RL, Wagner, RL (1988) Antipsychotic-withdrawal akathisia v. antipsychotic-induced akathisia: further evidence for the existence of tardive akathisia. Journal of Clinical Psychiatry, 49: 435–8.
Dure, LS, DeWolfe, J (2006) Treatment of tics. Advances in Neurology, 99: 191–6.
Edwards, MJ, Lang, AE, Bhatia, P (2012) Stereotypies: a critical appraisal and suggestion of a clinically useful definition. Movement Disorders, 27: 179–85.
Faurbye, A, Rasch, PJ, Peterson, PB, et al. (1964) Neurological symptoms in pharmacotherapy of psychoses. Acta Psychiatrica Scandinavica, 40: 1027.
Fleeman, F, McLeod, C, Bagust, A, et al. (2010) The clinical effectiveness and cost-effectiveness of testing for cytochrome P450 polymorphisms in patients with schizophrenia treated with antipsychotics: a systematic review and economic evaluation. Health Technology Assessment, 14(3): 1157.
Frei, K, Truong, DD, Fahn, S, et al. (2018) The nosology of tardive syndromes. Journal of the Neurological Sciences, 389: 10–6.
Gardos, G, Cole, JO (1980) Overview: public health issues in tardive dyskinesia. American Journal of Psychiatry, 137: 776–81.
Gardos, G, Cole, JO (1983) The prognosis of tardive dyskinesia. Journal of Clinical Psychiatry, 44: 177179.
Gardos, GE, Casey, DE (1984) Tardive Dyskinesia and Affective Disorders. American Psychiatric Press.
Gardos, GE, Casey, DE, Cole, JO, et al. (1994) Ten year outcome of tardive dyskinesia. American Journal of Psychiatry, 151: 836–41.
Glazer, WM, Morgenstern, H, Neidzwiecki, D, et al. (1988) Heterogeneity of tardive dyskinesia: a multivariate analysis. British Journal of Psychiatry, 152: 253–9.
Glazer, WM, Morgenstern, H, Doucette, JT (1993) Predicting the long-term risk of tardive dyskinesia in outpatients maintained on neuroleptic medications. Journal of Clinical Psychiatry, 54: 133–9.
Gureje, O (1989) The significance of subtyping tardive dyskinesia: a study of prevalence and associated factors. Psychological Medicine, 19: 121–8.
Jeste, DV, Potkin, SG, Sinha, S, et al. (1979) Tardive dyskinesia: reversible and persistent. Archives of General Psychiatry, 36: 585–90.
Jeste, DV, Caligiuri, MP, Paulson, JS, et al. (1995) Risk of tardive dyskinesia in older patients: a prospective longitudinal study of 266 patients. Archives of General Psychiatry, 52: 756–65.
Jeste, DV (2000) Tardive dyskinesia in older patients. Journal of Clinical Psychiatry, 61(suppl 4): 2734.
Kane, JM, Woerner, MG, Weinhold, P, et al. (1982) A prospective study of tardive dyskinesia development: preliminary results. Journal of Clinical Psychopharmacology, 2: 345–9.
Kane, JM, Woerner, MG, Borenstein, M, et al. (1986) Integrating incidence and prevalence of tardive dyskinesia. Psychopharmacology Bulletin, 22: 254–8.
Kane, JM, Woerner, MG, Lieberman, JA (1988) Epidemiological aspects of tardive dyskinesia. Encephale, 14: 191–4.
Kang, UJ, Burke, RE, Fahn, S (1986) Natural history and treatment of tardive dystonia. Movement Disorders, 1: 193208.
Kidger, T, Barnes, TRE, Trauer, T, et al. (1980) Subsyndromes of tardive dyskinesia. Psychological Medicine, 10: 513–20.
Koller, W (1983) Edentulous orodyskinesia. Annals of Neurology, 13: 97–9.
Kuo, SH, Jankovic, J (2008) Tardive gait. Clinical Neurology and Neurosurgery, 110: 198201.
MacNeil, RR, Muller, DJ (2016) Genetics of common antipsychotic-induced adverse effects. Molecular Neuropsychiatry, 2: 6178.
Marsden, CD, Tarsy, D, Baldessarini, RJ (1975) Spontaneous and drug-induced movement disorders in psychotic patients. In Psychiatric Aspects of Neurological Disease) (eds Benson, DF, Blummer, D): 219–66. Grune and Stratton.
Marsden, CD, Mindham, RHS, Mackay, AVP (1986) Extrapyramidal movement disorders produced by antipsychotic drugs. In The Psychopharmacology and Drug Treatment of Schizophrenia) (eds Bradley, PB, Hirsch, SR): 340402. Oxford University Press.
McCreadie, RG, Thara, R, Kamath, S, et al. (1996) Abnormal movements in never-medicated Indian patients with schizophrenia. British Journal of Psychiatry, 168: 221–6.
McPherson, R, Collis, R (1992) Tardive dyskinesia: patients’ lack of awareness of movement disorder. British Journal of Psychiatry, 160: 110–2.
Melamed, E, Achiron, A, Shapira, A, et al. (1991) Persistent and progressive parkinsonism after discontinuation of chronic neuroleptic therapy: an additional tardive syndrome. Clinical Neuropharmacology, 14: 273–8.
Morgenstern, H, Glazer, WM (1993) Identifying risk factors for tardive dyskinesia among long-term outpatients maintained with neuroleptic medications. Archives of General Psychiatry, 50: 723–33.
Munetz, MR, Cornes, CL (1982) Distinguishing akathisia and tardive dyskinesia: a review of the literature. Journal of Clinical Psychopharmacology, 3: 343–50.
Muscettola, G, Pampallona, S, Barbato, G, et al. (1993) Persistent tardive dyskinesia: demographic and pharmacological risk factors. Acta Psychiatrica Scandinavica, 87: 2936.
Owens, DGC, Johnstone, EC, Frith, CD (1982) Spontaneous involuntary disorders of movement: their prevalence, severity and distribution in chronic schizophrenics with and without treatment with neuroleptics. Archives of General Psychiatry, 39: 452–61.
Owens, DGC (2014) A Guide to the Extrapyramidal Side-Effects of Antipsychotic Drugs (2nd edn). Cambridge University Press.
Paulson, GW, Caligiuri, MP, Palmer, B, et al. (1996) Risk factors for orofacial and limb-truncal tardive dyskinesia in older patients: a prospective, longitudinal study. Psychopharmacology, 123: 307–14.
Ridley, R (1994) The psychology of perseverative and stereotyped behaviour. Progress in Neurobiology, 44: 221–31.
Ryu, S, Yoo, JH, Kim, JH, et al. (2015) Tardive dyskinesia and tardive dystonia with second-generation antipsychotics in non-elderly schizophrenic patients unexposed to first-generation antipsychotics: a cross-sectional and retrospective study. Journal of Clinical Psychopharmacology, 35: 1321.
Sandyk, R, Kay, SR, Awerbuch, GI (1993) Subjective awareness of abnormal movements in schizophrenia. International Journal of Neuroscience, 69: 120.
Schonecker, M (1957) Ein eigentumliches Syndrom im ovalen Bereich bei Megaphen Applikation. Nervenarzt, 28: 3542.
Schooler, NR, Kane, JM (1982) Research diagnoses for tardive dyskinesia. Archives of General Psychiatry, 39: 486–7.
Sigwald, J, Bouttier, D, Raymondeaud, C, et al. (1959) Quatre cas de dyskinesie facio-bucco-linguo-masticatrice à evolution prolongée secondaire à un traitment par les neuroleptiques. Revue Neurologique, 100: 751–5.
Tarsy, D, Baldessarini, RJ (2006) The epidemiology of tardive dyskinesia: is risk declining with modern antipsychotics? Movement Disorders, 21: 589–98.
Tenback, DE, van Harten, PN, Schloof, CJ, et al. (2006) Evidence that early extrapyramidal symptoms predict later tardive dyskinesia: a prospective analysis of 10000 patients in the European Schizophrenia Outpatient Health Outcomes (SOHO) Study. American Journal of Psychiatry, 163: 1438–40.
Uhrbrand, L, Faurbye, A (1960) Reversible and irreversible dyskinesia after treatment with perphenazine, chlorpromazine, reserpine and ECT. Psychopharmacologia, 1: 408–18.
Ure, RJ, Dhanju, S, Lang, AE, et al. (2016) Unusual tremor syndromes: know in order to recognise. Journal of Neurology, Neurosurgery and Psychiatry, 87: 1191–203.
van Harten, PN, Hoek, HW, Matroos, GE, et al. (1998) Intermittent neuroleptic treatment and risk for tardive dyskinesia: Curaçao Extrapyramidal Syndromes Study III. American Journal of Psychiatry, 155: 565567.
Woerner, MG, Kane, JM, Lieberman, JA, et al. (1991) The prevalence of tardive dyskinesia. Journal of Clinical Psychopharmacology, 11: 3442.
Woerner, MG, Alvir, JMJ, Saltz, BL, et al. (1998) Prospective study of tardive dyskinesia in the elderly: rates and risk factors. American Journal of Psychiatry, 155: 1521–8.
Zutshi, D, Cloud, LJ, Factor, SA (2014) Tardive syndromes are rarely reversible and discontinuing dopamine receptor blocking agents: experience from a university-based movement disorders clinic. Tremor and Other Hyperkinetic Movements, 4: 266.


Tardive dyskinesia update: the syndrome

  • David Cunningham Owens (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Tardive dyskinesia update: the syndrome

  • David Cunningham Owens (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *