Are Second-Generation Antipsychotics Useful in Tardive Dystonia?

Objective To review the current evidence on the effectiveness of second-generation antipsychotics (SGAs) in the treatment of tardive dystonia (TDt) and give recommendations for treatment. Methods Medline/PubMed/Psyclit/Embase database searches were conducted in January 2015, and a manual review of references within the retrieved articles was done. All articles in English and those that had English abstracts and dealt with treatment of TDt were included. Results Our search and review yielded a total of 88 reports (none of them a controlled trial) involving 145 patients treated with one of the 5 SGAs. Clozapine has the maximum number of published reports (52 reports involving 90 subjects, whereas there were 36 reports involving 55 subjects treated with other SGAs, including olanzapine, risperidone, quetiapine, aripiprazole, and perospirone). Conclusions The available evidence points to the effectiveness of clozapine as monotherapy and in combination with clonazepam for the treatment of TDt. When clozapine is not an option, olanzapine and quetiapine are reasonable alternatives. Given the lack of controlled trials, future focus should be on conducting randomized, placebo-controlled, multicenter, collaborative controlled clinical trials of several years' duration.