Motor Symptoms of Schizophrenia: Is Tardive Dyskinesia a Symptom or Side Effect? A Modern Treatment Vladimir Lerner & Chanoch Miodownik Published online: 26 April 2011 # Springer Science+Business Media, LLC 2011 Abstract Abnormal involuntary dyskinetic movements in schizophrenia patients have been documented for more than 140 years. Clinicians should distinguish between two kinds of disturbances—spontaneous dyskinetic movements and movements induced by psychotropic medications—which may look familiar clinically. As a modern term, tardive dyskinesia (TD) is a potentially permanent neurological hyperkinetic movement disorder that occurs after months or years of taking psychotropic drugs. Several distinct forms of TD exist, specifically tardive akathisia, tardive blepharo- spasm, tardive dystonia, tardive gait, tardive myoclonus, tardive tremor, and tardive tics, and they have different pathophysiologies and treatment. The pathogenesis of TD remains unclear, and the pathophysiology is complex and multifactorial. Moreover, there is solid evidence of a genetic predisposition to TD. This article summarizes recent relevant publications concerning TD and the most recent studies regarding treatment of this disorder with antioxidative agents. Keywords Tardive dyskinesia . Schizophrenia . Schizoaffective disorders . Psychotropic agents . Antipsychotics . First-generation antipsychotics . Second- generation antipsychotics . Treatment . Antioxidants . Symptoms . Motor symptom . Side effect “Who does not know the truth, is simply a fool … yet who knows the truth and calls it a lie, is a criminal.” —From Galileo Galilei by Berthold Brecht (1898–1956) “Not all the moves is tardive dyskinesia” [1]. Introduction Tardive dyskinesia (TD) in a modern sense is an iatrogenic, neurological, hyperkinetic movement disorder characterized by repetitive, involuntary, purposeless movements in the oral/lingual/buccal area, or choreoathetoid movements of the extremities. TD is caused by medications often used to treat schizophrenia and other major mental disorders. It appears with a delayed onset, usually after prolonged use of neuroleptics, which are used for psychiatric, gastrointesti- nal, and neurological disorders such as Parkinson’s disease. The term tardive differentiates this kind of dyskinesia from acute dyskinesia, parkinsonism, and akathisia, which appear shortly after psychotropic drugs are started. The word tardive descends from the French tardif, meaning “late” [2]. TD is a clinical diagnosis; however, before the diagnosis is made, the clinician should exclude other causes of the patient’s movement disturbances. The term dyskinesia is derived from Greek kinein (“to move”); the word kinesia refers to “motion,”“movement,” or “action,” while the prefix “dys” means “insufficient” or “disturbed.” Typical involuntary movements include “tongue thrusting, lip smacking, lip pursing, grimacing and chewing movements, rocking of the trunk, pelvic thrusting, rotation of the ankles or V. Lerner (*) : C. Miodownik Be’er-Sheva Mental Health Center, Ben-Gurion University of the Negev, P.O. Box 4600, Be’er-Sheva 84170, Israel e-mail: lernervld@yahoo.com C. Miodownik e-mail: chanoch_m@yahoo.com Curr Psychiatry Rep (2011) 13:295–304 DOI 10.1007/s11920-011-0202-6