Prevalence and risk factors associated with tardive dyskinesia among Indian patients with schizophrenia Rashmin M. Achalia a,c , Santosh K. Chaturvedi a , Geetha Desai a , Girish N. Rao a , Om Prakash b, * a National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India b Institute of Human Behaviour & Allied Sciences (IHBAS), New Delhi, India c Government Medical College, Aurangabad, India 1. Introduction A considerable number of patients with schizophrenia require long-term treatment with antipsychotics, which may produce movement disorders and may therefore impair functional outcome (Lindstro ¨m et al., 2007). Among the drug-induced movement disorders, tardive dyskinesia (TD) is one of the most distressing side effects of antipsychotic treatment (Chouinard and Steinberg, 1982; Guy et al., 1985). The reported prevalence of TD ranges widely between 23.4% and 43% (Kane et al., 1986; Halliday et al., 2002; Patterson et al., 2005). Studies from non-western countries are scarce. Literature from China, Japan and the Philippines (Leung et al., 2003; Itoh et al., 1984; Go et al., 2009) reported TD prevalence rates of 6.7%, 19.1% and 20.3%, respectively. Doongaji et al. (1982) reported a 9.6% prevalence rate of TD in inpatient population using first generation antipsychotics (FGAs), whereas, one decade later, Datta et al. (1994) reported 25.5% prevalence rate of TD in outpatients using FGAs. Reported risk factors for TD are age, gender, duration of treatment, type of antipsychotic, cumulative antipsychotic dose, intermittent antipsychotic treatment, acute movement disorders, negative symptoms, diabetes mellitus and anticho- linergic medication (Miller et al., 2005; Sachdev, 2004; Kane et al., 1988; Greil et al., 1984; 1998). However, a meta-analysis suggests that older age is a probable risk factor for TD, but other risk factors have little meta-analytic support (Tenback et al., 2009). Given the above considerations, the aim of this cross-sectional study of movement disorders was to assess the frequency and risk factors of TD in Indian patients with schizophrenia receiving antipsychotic treatment. Asian Journal of Psychiatry 9 (2014) 31–35 ARTICLE INFO Article history: Received 16 July 2013 Received in revised form 29 November 2013 Accepted 26 December 2013 Keywords: Tardive dyskinesia Prevalence Risk factors First generation antipsychotics Second generation antipsychotics ABSTRACT Background: Tardive dyskinesia (TD) is one of the most distressing side effects of antipsychotic treatment. As prevalence studies of TD in Asian population are scarce, a cross-sectional study was performed to assess the frequency of TD in Indian patients with schizophrenia and risk factors of TD. Method: Cross-sectional study of 160 Indian patients fulfilling the DSM-IV TR criteria for schizophrenia and who received antipsychotics for at least one year, were examined with two validated scales for TD. Logistic regression analyses were used to examine the relationship between TD and clinical risk factors. Results: The frequency of probable TD in the total sample was 26.4%. The logistic regression yielded significant odds ratios between TD and age, intermittent treatment, and total cumulative antipsychotic dose. The difference of TD between SGA and FGA disappeared after adjusting for important co-variables in regression analysis. Conclusion: Indian patients with schizophrenia and long-term antipsychotic treatment have a high risk of TD, and TD is associated with older age, intermittent antipsychotic treatment, and a high total cumulative antipsychotic dose. Our study findings suggest that there is no significant difference between SGAs with regards to the risk of causing TD as compared to FGAs. ß 2014 Elsevier B.V. All rights reserved. Abbreviations: TD, tardive dyskinesia; AIMS, abnormal involuntary movement scale; FGAs, first generation antipsychotics; SGAs, second generation antipsycho- tics. * Corresponding author at: Department of Psychiatry, Institute of Human Behaviour & Allied Sciences (IHBAS), Dilshad Garden, New Delhi 110095, India. Tel.: +91 9868396843. E-mail addresses: drjhirwalop@hotmail.com, drjhirwalop@yahoo.co.in (O. Prakash). Contents lists available at ScienceDirect Asian Journal of Psychiatry journal homepage: www.elsevier.com/locate/ajp 1876-2018/$ – see front matter ß 2014 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.12.010