A Case of Aripiprazole Induced Tardive Dyskinesia in a Neuroleptic-Naïve Patient with Two Years of Follow Up

Abstract

Tardive dyskinesia (TD) is arguably the most serious and potential irreversible side effect of antipsychotic medication. Traditionallyfirst generation antipsychotics are the neuroleptics considered to have higher risk of TD as compared to second and third generationantipsychotics. Aripiprazole is a third-generation antipsychotic with a novel mechanism of action. Risk of developingTD with use of aripiprazole has been unknown. Recently many cases of aripiprazole associated TD have been reported. A caseof 52 year old Caucasian woman is discussed who presented to us with first manic episode. Patient had never been treatedwith any antipsychotic medication in her life before. During current episode, she was treated with aripiprazole 30 mg/day. Duringfollow up, patient was found to have developed dyskinetic oro-facial movements within 2 months of starting aripiprazole. Shewas not taking any other antipsychotic/anti-dopaminergic medication at that time. Patient’s abnormal oro-facial movements couldnot be reversed in spite of immediate discontinuation of aripiprazole. Multiple medications are tried over the next 2 years buther movement disorder never remitted. Above case (along with other recent reports) suggest that risk of movement disorderwith aripiprazole use could be higher than previously thought. Further studies are required to find out incidence of movementdisorder with aripiprazole. Aripiprazole use should be preferably restricted to FDA approved indications. Clinician needs to bevery vigilant about emergence of any movement disorder while using aripiprazole, especially in patients with risk factors forTD.