Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2023; 11(32): 7895-7899
Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7895
Multiple therapies relieve long-term tardive dyskinesia in a patient with chronic schizophrenia: A case report
Liang Lv, Ping Guo, Min Feng, Yu Fang, Shi-Kai Wang, Huan-Xin Chen
Liang Lv, Ping Guo, Min Feng, Yu Fang, Shi-Kai Wang, Department of Psychiatry, Huzhou Third People's Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
Huan-Xin Chen, Key Laboratory, Huzhou Third People's Hospital Affiliated to Huzhou University, Huzhou 313000, Zhejiang Province, China
Co-first authors: Liang Lv and Ping Guo.
Author contributions: Lv L, Guo P, Wang SK, and Chen HX conceived, designed, and refined the study protocol; Lv L, Fang Y, and Feng M were involved in data collection; Lv L and Fang Y analyzed the data; Guo P drafted the manuscript; Wang SK and Chen HX revised the manuscript; all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Lv L and Guo P contributed equally to this work as co-first authors. The reasons for designating Lv L and Guo P as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authors accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and management of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-corresponding authors best reflects this diversity. This also promotes the most comprehensive and in-depth examination of the research topic, ultimately enriching readers' understanding by offering various expert perspectives. Third, Lv L and Guo P contributed efforts of equal substance throughout the research process. The choice of these researchers as co-first authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Lv L and Guo P as co-first authors is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Science and Technology Program of Huzhou City, No. 2023GYB32.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Kai Wang, PhD, Chief Physician, Department of Psychiatry, Huzhou Third People's Hospital Affiliated to Huzhou University, No. 2088 Tiaoxi East Road, Huzhou 313000, Zhejiang Province, China. wang-shikai@163.com
Received: August 23, 2023
Peer-review started: August 23, 2023
First decision: September 26, 2023
Revised: October 17, 2023
Accepted: November 3, 2023
Article in press: November 3, 2023
Published online: November 16, 2023
Processing time: 85 Days and 1.4 Hours
Abstract
BACKGROUND

Tardive dyskinesia (TD) is a serious and disabling movement disorder; it impairs social function and quality of life and increases the mortality rate. TD is usually induced by the use of antipsychotic drugs; however, the underlying mechanism remains unclear. Pharmacotherapy of TD includes cholinergic drugs, benzodiazepines, ginkgo biloba extract (GBE), antioxidants, amantadine, propanolol, botulinum toxin, valbenazine, and deutetrabenazine, whereas the non-pharmacotherapy approach includes modified electroconvulsive therapy (MECT) and deep brain stimulation. We successfully treated a chronic schizophrenia patient with comorbid long-term severe TD using deutetrabenazine, clozapine, and MECT.

CASE SUMMARY

A 69-year-old woman who was diagnosed as having schizophrenia 16 years ago developed severe TD after 6-mo prescription of risperidone oral solution. Her TD symptoms did not resolve despite various treatments, such as GBE, vitamin E, trihexyphenidyl, promethazine, benzodiazepines, and switching to quetiapine and olanzapine. After admission, she was given deutetrabenazine 6 mg bid. Her buccal tremor was slightly resolved 3 d later; however, her tongue remained protruded and could not be retracted. Quetiapine was switched to clozapine on day 4, and the buccal tremor remarkably resolved, and the tongue could be retracted into the mouth from day 6 onward. After three sessions of MECT, the buccal tremor resolved further. Since then, she has been able to take a semifluid diet, and her quality of life improved remarkably during 6 mo of follow-up.

CONCLUSION

TD is a serious condition which could be caused by antipsychotic medications; however, the best strategy against TD is prevention and monitoring during using antipsychotics. For patients with TD caused by antipsychotic medication use, multiple measures should be considered like switching to clozapine, adjunction with deutetrabenazine, or even MECT.

Keywords: Tardive dyskinesia; Antipsychotics; Clozapine; Deutetrabenazine; Electroconvulsive therapy; Case report

Core Tip: Tardive dyskinesia (TD) is a serious and disabling movement disorder, and its pathogenesis remains unclear. This report describes the treatment of TD caused by risperidone in a schizophrenia patient, which could not be improved by switching to the other second-generation antipsychotics like quetiapine and olanzapine, neither by adjunction with medications like benzodiazepines, ginkgo biloba extract, or antioxidants. Her TD symptoms were relieved remarkably after multiple measures like switching to clozapine, adjunction with deutetrabenazine, and modified electroconvulsive therapy. Multiple measures are therefore recommended for TD treatment.