Algorithms for neuroleptic-associated tardive movement disorders.

Prolonged neuroleptic exposure is often associated with several forms of tardive movement disorders, conditions adversely affecting the patient's quality of life. Risk factors for individual tardive movement disorders is noted. Once they develop, one should modify neuroleptic regimen with preferential replacement of conventional neuroleptics with lower potency ones. The subsequent algorithm is difficult to formulate, and its success is sometimes hampered by coexisting psychiatric disease. Several suggestions to be tried are as follows: high doses of anticholinergics and/or dantrolene sodium against tardive dystonia, and reduction of anticholinergic dose and/or clonidine, a alpha2 agonist, against tardive dyskinesia and tardive akathisia.