Multiple therapies relieve long-term tardive dyskinesia in a patient with chronic schizophrenia: A case report

Table 1 Timelines of patient events and medications in current admission and follow-up

Date	Event	Medication/s	Comment
July 2008	Hospitalization	ROS 4 mg/d	First onset with delusion and auditory hallucination
November 2009	TD	ROS 4 mg/d + Alp 0.4 mg qn + GBE	Psychotic symptoms resolved, but her bucco-linguo-masticatory syndrome appeared and could not be relieved by GBE
November 09-18, 2010		Que 0.2 g/d + Alp 0.4 mg qn + GBE 1 tab bid + Vit E 0.1/d	TD was not relieved by switching ROS to Que and combining it with GBE and Vit E
November 19, 2011		Ola 10 mg/d + Alp 0.4 mg qn + GBE 1 tab bid + Vit E 0.1/d	TD was not relieved by switching Que to Ola and combining it with GBE and Vit E
October 12, 2020	Readmission	Ola 10 mg/d + PTZ 25 mg bid + THP 2 mg bid	TD was not relieved by a combination of PTZ and THP during hospitalization
October 21, 2020-June 08, 2022		Que 0.2 g/d + PTZ 25 mg bid + Vit E 0.1/d	TD was not relieved by switching to Que and combining it with PTZ and Vit E
June 09-11, 2022	Readmission	Que 0.1 bid + DTB 6 mg bid + Vit E 0.1/d + PTZ 50 mg tid + Alp 0.4 mg qn	TD was slightly ameliorated when administered in combination with DTB after admission; however, her tongue could not be retracted into the mouth. Video 1 (June 10, 2022). Baseline: AIMS 31, PANSS 56, CGI 7. D3: AIMS 29, PANSS 56, CGI 6
June 12-15, 2022		Clo 25 mg/d + DTB 6 mg bid + Vit E 0.1/d + PTZ 25 mg tid + Lor 1 mg qn	TD was relieved remarkably after switching Que to Clo, and her tongue could now be retracted into the mouth. Video 2 (June 14. 2022) D7: AIMS 23, PANSS 52, CGI 4
July 16-19, 2021		Clo 25 mg bid + DTB 6 mg bid + Vit E 0.1/d + PTZ 25 mg qn + Lor 1 mg qn + MECT for the first session	TD was ameliorated after combining MECT, and the tremor in her lower jaw was reduced. D10: AIMS 22, PANSS 48, CGI 3
July 20-22, 2021		Clo 25 mg bid + DTB 6 mg bid + Vit E 0.1/d + MECT for the second session	TD did not worsen after stopping Lor and PTZ
July 23, 2021	Discharge		D14: AIMS 20, PANSS 48, CGI 3
July 24, 2021-now		Clo 25 mg bid + DTB 6 mg bid	TD did not worsen after stopping Vit E, and she could take a semi-fluid diet. Video 3 (December 26, 2022). D182: AIMS 20, PANSS 46, CGI 3

AIMS: Abnormal involuntary movement scale; Alp: Alprazolam; Clo: Clozapine; DTB: Deutetrabenazine; GBE: Ginkgo biloba extract; Lor: Lorazepam; MECT: Modified electroconvulsive therapy; Ola: Olanzapine; PANSS: Positive and Negative Syndrome Scale; PTZ: Promethazine; Que: Quetiapine; ROS: Risperidone oral solution; TD: Tardive dyskinesia; THP: Trihexyphenidyl; Vit E: Vitamin E.