Tardive dyskinesia (TD) presents with involuntary movements of the tongue, lips, chin, face, trunk, and limbs in patients treated with long-term dopaminergic antagonists. TD is most common in patients with schizophrenia, schizoaffective disorder, or bipolar disorder who have received antipsychotics for a long time (at least 3 months in adults and at least 1 month in older patients). TD occasionally occurs in people without mental illness, especially if they are received due to stomach problems
Metoclopramide
Elderly people treated, as well as people with fetal alcohol syndrome, other developmental disorders, and other brain disorders. Diagnosing TD is challenging because these symptoms can easily be mistaken for symptoms of mental illness or other side effects. Do you know the differential diagnosis of TD? This article will test everyone's understanding through 5 small questions, let's try it together.
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Question One
Which observation helps distinguish delayed tremor from cerebellar tremor or psychogenic tremor?
A. There is no tardive tremor in spontaneous movement
B. There is no delayed tremor at rest
C. Late-onset tremor is rhythmic and usually occurs in a resting state, accompanied by autonomous movement
D. During long-term physical examination, delayed tremor is weakened
Swipe to see the answer
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【Answers and analysis】
Answer: C. Tardive tremor is rhythmic (as opposed to irregular TD movements) and usually occurs in a resting state, accompanied by autonomous movements. This differs from cerebellar tremor, which manifests as spontaneous movement but is absent at rest. In addition, unlike psychogenic tremor, late-onset tremor is persistent and does not weaken during prolonged physical examination.
Question two
Which of the following suggests Huntington's disease rather than antipsychotic TD?
A. Jaundice
B. Unstable posture
C. Bradykinesia
D. Tachycardia
Answer: B. Postural instability often occurs in patients with Huntington's disease but is uncommon in patients with anti-dopaminergic-induced TD. Unlike TD tardive dyskinesia, Huntington's disease manifests as chorea (derived from the Greek word for dance) on the face and proximal extremities. The term "chorea" refers to a unique dance-like gait. At first, mild chorea may be considered irritable. Severe chorea may manifest itself as uncontrollable waving of the limbs (i.e., chorea), which interferes with functioning.
Question three
The presence of jaundice, hepatomegaly, abdominal pain, serum ceruloplasmin deficiency, or corneal Kayser-Fleischer rings require further evaluation to rule out which disease?
A. Wilson's disease
B. Huntington's disease
C. Antipsychotic-induced TD
D. Tumors of the central nervous system
Answer: A. If jaundice, hepatomegaly, abdominal pain, serum ceruloplasmin deficiency due to copper transporter gene abnormalities, or Kayser-Fleischer rings in the cornea are present, further evaluation should be done to rule out Wilson's disease. Slit lamp inspection may be the best way to observe The Kayser-Fleischer ring. For patients with suspected Wilson's disease, an ophthalmic consultation is mandatory.
Question four
What signs and symptoms may suggest TD?
A. Rapid muscle twitching
B. Movement disorders
C. Slow, twisting muscle movements
D. Rigidity
Answer: C. Patients with TD may have slower writhing or "dancey" movements (as opposed to the rapid muscle movements or twitches that occur in other disorders such as Tourette syndrome). Movement disorders and rigidity are most common in patients with Parkinson's disease, while movement disorders are seen in patients with TD.
Question five
In which cases are brain calcifications, especially basal ganglia calcifications, commonly detected by brain imaging in patients?
A.TD
C. Fahr syndrome
D. Cerebral infarction
Answer: C. Imaging tests such as brain CT and MRI scans in patients with TD are usually normal but may be helpful in the differential diagnosis. Patients with Fahr syndrome often present with cerebral calcifications, particularly basal ganglia. Caudate nucleus atrophy is a common symptom in patients with Huntington's disease. Imaging results can also rule out tumors and cerebral infarction.
医脉通编译自：Christoph U. Correll, MD. Fast Five Quiz: Tardive Dyskinesia Differential Diagnosis- Medscape - Jan 18, 2022.