A CROSS-SECTIONAL STUDY OF TARDIVE DYSKINESIA WITH HOSPITALIZED PATIENTS IN THE PERIOD OF SECOND-GENERATION ANTIPSYCHOTIC USE IN A PSYCHIATRIC HOSPITAL IN JAPAN
Authors: Tsugeno *Yuta , Oyama Kento , Ozawa Chisa , Yamada Raimu , Masatomo Ena , Inoyama Moe , Tanaka Kai , Takahashi Susumu , Tsutsumi Yuichiro 
Published: February 2025

Abstract

Background
Tardive dyskinesia (TD) is an iatrogenic movement disorder known as one of the adverse effects of dopamine receptor-blocking medications, notably first-generation antipsychotics (American Psychiatric Association, 2013). To reduce the adverse effects of first-generation antipsychotics, second-generation antipsychotics (SGAs) were developed in the 1990s as drugs characterized by milder adverse effects profile. Presently, these SGAs are frequently administered in the clinical landscape of Japan. However, in Japan, few studies have examined TD prevalence and its associated risk factors since SGAs were launched.

Aims & Objectives
We aimed to investigate the recent TD prevalence and TD risk factors of inpatients in the Ongata Psychiatric Hospital in Japan.

Method
We performed a cross-sectional survey with hospitalized patients in the Ongata Psychiatric Hospital. We identified 376 inpatients with antipsychotic treatment and excluded 126 inpatients due to disagreement with the study participation or a short duration of antipsychotic use. We assessed the remaining 250 inpatients using the Abnormal Involuntary Movement Scale (AIMS). Subsequently, they were categorized into TD or non-TD groups based on Schooler-Kane criteria for probable TD (Schooler, N.R., Kane, J.M., 1982). We compared the differences between the two groups and investigated TD prevalence and its associated risk factors.

Results
Of the 250 patients, twenty-four were categorized in the TD group (9.2%). Of these, twenty- two (92.2%) had abnormal involuntary movement in their facial region. The ratio of patients with a history of brain damage was significantly higher in the TD group than in the non-TD group (P&lt;0.05; Fisher’ s exact test). On the other hand, there were no significant differences between the TD group and non-TD for age, sex, duration of antipsychotics, the total number of antipsychotics, CP equivalent, and the kind of main antipsychotics.

Discussion & Conclusion
In this study, we could provide information on TD in the period of second- generation antipsychotic use in a psychiatric hospital in Japan. The prevalence of TD was 9.2%, which is lower than in Western populations (Carbon, M. et al., 2019) and generally consistent with previous Asian countries (Xiang, Y.T. et al., 2014), showing that the risk of TD development may be different among races. The ratio of patients with a history of brain damage was significantly higher in the TD group, which is compatible with previous reports (Solmi, M. et al., 2018, etc.) and implies that brain damage may cause vulnerability to antipsychotics. However, we did not find any significant differences between the TD group and non-TD in other comparison items, which implies that the sample size of this study may be relatively small. We will expand this in the future. Our findings suggest that TD is still prevalent in psychiatric hospitals in Japan. Thus, in the use of SGA, especially for patients with brain damage, we should pay more attention to the development of TD.

References
1.American Psychiatric Association. (2013) ‘Diagnostic and Statistical Manual of Mental Disorders, fifth Edition’, Washington, D.C.: American Psychiatric Publishing.
2.Schooler, N.R., Kane, J.M. (1982) ‘Research diagnoses for tardive dyskinesia; Arch Gen Psychiatry, 39, pp. 486-487.
3.Carbon, M. et al. (2019) ‘Tardive Dyskinesia Prevalence in the Period of Second-Generation Antipsychotic Use : A Meta-Analysis; J Clin Psychiatry, 78, pp. e264-e278.
4.Xiang, Y.T. et al. (2014) ‘Common use of high doses of antipsychotic medications in older Asian patients with schizophrenia (2001-2009); Int J Geriatr Psychiatry, 29, pp. 359-366.
5.Solmi, M. et al. (2018) ‘Clinical risk factors for the development of tardive dyskinesia; J Neurol Sci, 389, pp. 21-27.