140 - References

References

Schizophrenia and related psychoses CHAPTER 1 Table 1.30  Other options for the treatment of tardive dyskinesia (in alphabetical order). Drug Comments Amino acids85 Use is supported by a small randomised, placebo-­controlled trial. Low risk of toxicity. Botulinum toxin86–89 Case reports of success for localised dyskinesia. Probably now treatment of choice for disabling or distressing focal symptoms. Calcium antagonists90 A few published studies but not widely used. A Cochrane review is dismissive.91 A 2020 meta-­analysis found no effect.57 DBS8,92,93 Reports refer most commonly to stimulation of the globus pallidus internus. The evidence is limited but DBS may potentially have a role when TD symptoms are severe and distressing and unresponsive to pharmacological treatment. Donepezil94–96 Supported by a single open study and a case series. One very small, negative RCT. Dose is 10mg/day. No clear evidence of efficacy for rivastigmine or galantamine.97 Fish oils98,99 Very limited support for use of EPA at dose of 2g/day Fluvoxamine100 Three case reports. Dose is 100mg/day. Beware interactions. Gabapentin101 Adds weight to the theory that GABAergic mechanisms improve TD. Dose is 900– 1200mg/day. Inconclusive data on other GABA agonists.102 Levetiracetam103–106 Three published case studies. One RCT. Dose up to 3000mg/day. Melatonin107 Use is supported by a meta-­analysis of four trials.108 Usually well tolerated. Dose is 10mg/day. Some evidence that melatonin receptor genotype determines risk of TD.109 Naltrexone110 May be effective when added to benzodiazepines. Well tolerated. Dose is 200mg/day. Ondansetron111,112 Limited evidence but low toxicity. Dose is up to 12mg/day. Propranolol113–115 Formerly a relatively widely used treatment. Open-­label studies only but a prospective randomised trial is probably warranted. Dose is 40–120mg/day. Beware contraindications, such as asthma, bradycardia and hypotension. Quercetin116 Plant compound which is thought to be an antioxidant. Some promising case reports.116–118 Sodium oxybate119 One case report. Dose was 8g/day. rTMS120,121 RCT data on patients with ‘tardive syndromes’ suggest that bilateral hemispheric high-frequency rTMS has the potential to be a feasible treatment where TD is unresponsive to ‘first-­line’ pharmacological treatment120 Zolpidem122 Three case reports. Dose is 10–30mg a day. DBS, deep brain stimulation; EPA, eicosapentaenoic acid; GABA, gamma-­aminobutyric acid; rTMS, repetitive transcranial magnetic stimulation. References

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