Treatment Outcomes of Patients With Tardive Dyskinesia and Chronic Schizophrenia

Objective: We compared the response to antipsychotic treatment between patients with and without tardive dyskinesia (TD) and examined the course of TD.

Method: This analysis compared 200 patients with DSM-IV-defined schizophrenia and TD and 997 patients without TD, all of whom were randomly assigned to receive one of 4 second-generation antipsychotics. The primary clinical outcome measure was time to all-cause treatment discontinuation, and the primary measure for evaluating the course of TD was change from baseline in Abnormal Involuntary Movement Scale (AIMS) score. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to compare treatment discontinuation between groups. Changes in Positive and Negative Syndrome Scale (PANSS) and neurocognitive scores were compared using mixed models and analysis of variance. Treatment differences between drugs in AIMS scores and all-cause discontinuation were examined for those with TD at baseline. Percentages of patients meeting criteria for TD postbaseline or showing changes in AIMS scores were evaluated with χ2 tests. Data were collected from January 2001 to December 2004.

Results: Time to treatment discontinuation for any cause was not significantly different between the TD and non-TD groups (χ21 = 0.11, P = .743). Changes in PANSS scores were not significantly different (F1,974 = 0.82, P = .366), but patients with TD showed less improvement in neurocognitive scores (F1,359 = 6.53, P = .011). Among patients with TD, there were no significant differences between drugs in the decline in AIMS scores (F3,151 = 0.32, P = .811); 55% met criteria for TD at 2 consecutive visits postbaseline, 76% met criteria for TD at some or all postbaseline visits, 24% did not meet criteria for TD at any subsequent visit, 32% showed a ≥ 50% decrease in AIMS score, and 7% showed a ≥ 50% increase in AIMS score.

Conclusions: Schizophrenia patients with and without TD were similar in time to discontinuation of treatment for any cause and improvement in psychopathology, but differed in neurocognitive response. There were no significant differences between treatments in the course of TD, with most patients showing either persistence of or fluctuation in observable symptoms.

Trial Registration: clinicaltrials.gov Identifier: NCT00014001

J Clin Psychiatry 2011;72(3):295-303′ ‹

Submitted: October 25, 2009; accepted February 15, 2010.

Online ahead of print: August 10, 2010 (doi:10.4088/JCP.09m05793yel).

Corresponding author: Stanley N. Caroff, MD, Veterans Affairs Medical Center-116A, University & Woodland Avenues, Philadelphia, PA 19104 ([email protected]).