Tardive Dyskinesia With Risperidone and Anticholinergics

Ms. A, a 40-year-old woman who had never taken psychotropics, developed dysarthria and salivation 2 months into risperidone treatment (3–6 mg/day). Although this was resolved within 2 weeks by the addition of biperiden (3 mg/day), Ms. A’s lips and jaw showed signs of moderate dyskinesia. Risperidone administration was then gradually terminated over 2 weeks and replaced with olanzapine (7.5 mg/day), which was increased to 10 mg/day 2 weeks later. The symptoms of dyskinesia disappeared 23 days after the discontinuation of risperidone and have not reappeared since (5 months to date).

Ms. B was a 28-year-old woman who also had no prior experience with psychotropics. Initially treated with amoxapine (an average of 125 mg/day), she was given risperidone (2 mg/day), which was titrated to 9 mg/day over 7 days. Three weeks later, she developed dysarthria and salivation, requiring either biperiden (6 mg/day) or trihexyphenidyl (4 mg/day). She developed dyskinesia in her lips and jaw 2 months into treatment. This was cured within 6 weeks by gradual termination of risperidone administration and replacement with quetiapine (100–200 mg/day). Ms. B has not had dyskinesia since (8 months to date).

Ms. C, a 24-year-old woman, had taken chlorpromazine (an average of 75 mg/day) and haloperidol (an average of 6 mg/day) for less than 6 weeks. Four months before the treatment, she had also experienced ECT five times. Initially, she had started with haloperidol (an average of 18 mg/day) but was then given risperidone (2 mg/day) and biperiden (2–4 mg/day) because of dysarthria and salivation. Two months later, she developed lip and tongue dyskinesia, requiring replacement of risperidone with quetiapine (150 mg/day) over 6 weeks, as in the case of Ms. B. She has not had dyskinesia since (6.5 months to date).