Tardive dyskinesia: natural history studies assist the pursuit of preventive therapies

A diagnostic analysis of the Casebooks of Ticehurst House Asylum, 1845-1890

Ticehurst House, a private asylum, flourished during the nineteenth century as the most expensive of such establishments, being owned and run by the Drs Newington over five successive generations. The discovery of the full set of patient casebooks begun in 1845-6 made it possible to review in detail the clinical features of a complete cohort of patients admitted to the asylum between 1845 and 1890. Six-hundred-and-one patients were thus analysed in terms of their age, sex, length of stay, symptoms, treatment and outcome. Modern operational diagnoses were used, and 80% of the cohort were found to conform to Research Diagnostic Criteria, in particular to the categories for schizophrenia and manic-depressive disorder. An additional finding was the high prevalence of movement and postural disorder among the schizophrenic group, as well as a significant trend towards the selection of a treatable, good-outcome group of patients with manic-depressive illness. These results are discussed by comparison with other modern studies of the asylum period, and in the contemporary context of Victorian psychological medicine. It is suggested that the violence, physicality and chronicity of psychotic illness must be seen as central to the debate about the rise of the asylum in nineteenth-century Britain. Furthermore, the similarity in core symptoms found in such patients and those seen in the 1980s indicates that the categories 'schizophrenia' and 'manic-depressive disorder' have a robust validity that is not confined to the social parameters of a particular time period.

Clinical variants of tardive dyskinesia in Japan

Involuntary movement disorders were investigated in a psychiatric hospital in Japan. The prevalence of tardive dyskinesia was 9.9% and four clinical variants of tardive dyskinesia could be classified. Of the 716 patients, tardive dystonia was identified in 15 cases, tardive akathisia in one, respiratory dyskinesia in two and rabbit syndrome in 17. The existence of tardive forms for acute dystonic reactions and akathisia suggests that any type of acute extrapyramidal symptoms can have a tardive form.

A statistical trial of subclassification for tardive dyskinesia

The authors applied a statistical method to subclassify tardive dyskinesia (TD) in 71 psychiatric patients. Based on two-step statistical procedures and findings reported previously, TD is considered to consist of 2 subgroups: a classical dyskinesic group and a dystonic group. Symptoms manifested in the former group are seen most frequently in the oral region while the latter group, which is usually called tardive dystonia, is manifested by movement disorders in the trunk and extremities, predominantly. Abnormal movements occurring in the facial region characterize a population whose members may belong to either group.

Spontaneous orofacial movements induced in rodents by very long-term neuroleptic drug administration: phenomenology, pathophysiology and putative relationship to tardive dyskinesia

While understanding of the major clinical and ethical issue of tardive dyskinesia would be greatly facilitated by the development of an isomorphic or homologous animal model, particularly in rodents, this has proved to be a highly contentious issue. The literature on orofacial function in rats administered neuroleptic drugs for substantial proportions of their adult lifespan is reviewed. It reveals the emergence of late-onset orofacial movements in a number of studies, but very early-onset movements or no effect in others. Potential explanations for these discrepancies are considered, and ways of resolving such inconsistencies are suggested. The relationship of these various orofacial phenomena to dopaminergic and non-dopaminergic function, and to clinical syndromes, is critically evaluated.

Rich and mad in Victorian England

Clinical analyses of 19th century psychiatric practice have been limited by the paucity of available records. Using the richly detailed casebooks of Ticehurst House Asylum, it was possible to study over 600 admissions and assess them using the Research Diagnostic Criteria. Over 80% of cases conformed to recognizable psychiatric illness, mainly schizophrenia and manic-depressive psychosis. Movement disorder, often equivalent to tardive dyskinesia, was noted in nearly one-third of schizophrenics. Violence, masturbation and severe psychopathology were also common features. The implications of these findings in terms of treatment, diagnosis and the rise of the asylum are discussed.