Historical comments on tardive dyskinesia: a neurologist's perspective.

This article was undertaken to review the history of professional awareness of tardive dyskinesia (TD) and to address reasons for the delay in such recognition. The literature was reviewed, and selections are included to highlight some of the major issues. Personal recollections are deliberately emphasized since they may reflect the phenomenon of personal discovery familiar to others and the now widespread professional awareness of TD. TD is indeed well recognized by psychiatrists and neurologists, and most general practitioners are also aware that the syndrome exists. Physicians were once unfamiliar with the concept of a drug reaction that was so long delayed as is possible with TD, nor did they know that a drug side effect could present in this manner. The historical delay in initial recognition of TD, and the reason for such delay, remain of interest. The lack of a perfect therapy and the uncertainty regarding the precise pathophysiologic basis of TD remain as challenges. Most psychiatrists, and many neurologists, probably have vivid memories of specific patients with TD. This author, a neurologist, was blessed to work with George Crane and other investigators in the early days of TD and was witness to some of the original uncertainty regarding what seemed to be a new phenomenon. TD has reshaped our concepts of disease and our awareness that diseases can originate from deleterious late effects of beneficial agents.

Social context and health consequences of the antipsychotics introduction.

BACKGROUND: From the vantage point of fifty years after the introduction of antipsychotics to clinical practice, this article examines the social context and health consequences of their introduction. METHODS: Historical review of literature sources with commentary. CONCLUSIONS: The availability of antipsychotics over nearly half a century has powerfully influenced concepts of mental illness, dominant models of care versus control, health outcomes and side effect burdens. The large demand and economic success of antipsychotic medications is an important driver for research and development as well as sophistication in marketing. Regulatory agencies, funders and clinicians are faced with a moving target as indications for use of antipsychotics move well beyond the traditional core of schizophrenia and acute mania into depression, anxiety, behavioral disturbance with dementia and some forms of personality disturbance. The history of antipsychotics and mental illness is arguably being written as forcefully now, in an environment of rapid scientific change, as was the case in the 1960s era of rapid social change when chlorpromazine prompted a shift of emphasis from asylum to community. Psychosis is a challenge to how we interpret and approach our inner experiences and societal structures. Accordingly, it is not surprising that the history of antipsychotic drugs resonates with a lively interplay of social, health and economic issues and an ongoing quest to comprehend mental phenomena and their variants.

Historical perspective on movement disorders.

Before atypical antipsychotics were developed, neuroleptics given to patients for the treatment of psychosis often caused movement disorders. Although the role of neuroleptics in the development of tardive dyskinesia was never certain, this adverse effect was of great concern to physicians because its effects could be irreversible and devastating to the patient. It is important to understand whether involuntary movement disorders are an intrinsic part of schizophrenia, because if so, then a certain percentage of patients will develop the dyskinetic syndromes whether they are treated or not. To uncover the role of antipsychotic medications in tardive dyskinesia, it is necessary to examine the descriptions of abnormal movements made by those who were first researching schizophrenia, as well as modern descriptions of neuroleptic-naïve individuals with schizophrenia. The physicians who initially described the syndrome of tardive dyskinesia had observed pre-neuroleptic schizophrenia first hand and saw a difference in the movements of treated and untreated patients. Nevertheless, the idea of a chronic movement disorder caused by treatment with neuroleptics would become controversial for many years. With the development of the atypical antipsychotics, the incidence and prevalence of tardive dyskinesia have dropped remarkably, suggesting that psychosis, its treatment, and dyskinesias are not inextricably linked.

The history of the psychopharmacology of schizophrenia.

OBJECTIVE: To review the historical development of the psychopharmacological treatment of schizophrenia. METHOD: A chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia at different times. RESULTS: Effective treatment of schizophrenia was achieved only after the introduction of antipsychotic drugs, in the 1950s, and is still progressing. CONCLUSION: Close collaboration between basic neuroscience and careful and informed clinical practice are likely to lead to continued progress.

Discinesia tardia ou sindrome paradoxal da discinesia tardia?: um caso / Tardive dyskinesia or paradoxical tardive dyskinesia syndrome?: a case report

E apresentado um caso de discinesia tardia em uma menina de 7 anos de idade, que desde os 18 meses de idade faz uso de propericiazina. Faz-se breve revisao de literatura recente relativa a esta entidade na infancia. O motivo da consulta e a historia pregressa sao apresentados, bem como o quadro clinico encontrado e o tratamento realizado. E discutido o diagnostico enfatizando-se o diferencial com distonia e sindrome paradoxal da discenia tardia. Ao final, fazem-se recomendacoes

Neuroleptic-induced deficit syndrome. Historical introduction.

The treatment of psychotic illness has long been inextricably associated with society's view in general on social deviance. In medieval times, psychotic individuals were contained within the community, a situation which still prevails in many developing countries. Aggregation of such patients in asylums followed the increasing industrialization of communities in the nineteenth century, when the ability of the disadvantaged of all kinds to survive was greatly jeopardized. The twentieth century has seen a gradual reversal of this process, as attitudes towards mentally ill people have become a little more enlightened and liberal. However, the swing against the great lunatic asylums of the last century has proceeded at such an administrative rate that our patients are again in danger of succumbing medically and economically within our communities. It is common to see desperately poor and damaged psychotic individuals on our streets. The advent of neuroleptics was a major factor in the change from a custodial to an ostensibly rehabilitative approach in the treatment of schizophrenia. However, classic neuroleptics have a long list of well-recognized side effects such as affective and cognitive impairment that lead to poor treatment compliance, psychiatric relapse and social decompensation, the state of affairs of our street psychotics. Treatments that lessen the probability of this unfortunate process are desperately needed. The introduction of new neuroleptic drugs with favourable side effect profiles is to be welcomed as a major step in increasing the quality of life of our patients, both in hospital and functioning in the community.