Long acting injectable (LAI) antipsychotics are an effective option in schizophrenia and increases treatment adherence in potentially non-compliant patients. Tardive dyskinesia is a potentially treatment resistant movement disorder that can be a problem after long term antipsychotic use. Atypical antipsychotics with long acting formulations offer a safer option for acute extrapyramidal side effects, but their effect in tardive dyskinesia is not clear. We report a case of tardive dyskinesia of perioral area and tongue in after long term use of zuclopenthixol decanoate, an LAI which is a potent dopamine (D2) receptor antagonist. The patient was a 45-year-old caucasian male with 25 years history of schizophrenia and he was using olanzapine and zuclopenthixol decanoate on the index consultation that the dyskinesia was recognized. Chlorpromazine, haloperidol, olanzapine and quetiapine were the antipsychotics which were used for differing periods in addition to zuclopenthixol decanoate in the last six months, before the emergence of tardive dyskinesia. Abnormal Involuntary Movements Scale was used in scoring the oropharyngeal dyskinesia. Because of the former non-compliance of the patient with oral medication and concerns of treatment adherence we planned to continue using LAI. After switching to paliperidone palmitate, a second generation LAI with receptor antagonist effects on dopamine (D2) serotonin (5HT-2) and noradrenaline (NE-alpha2) receptors, we observed the improvement of the tardive dyskinesia.
Key words: tardive dyskinesia, paliperidone palmitate, zuclopenthixol, long acting injectable antipsychotics, schizophrenia
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