Objective: To underscore the rarity of tardive dyskinesia manifestation in a schizophrenic patient, prescribed second-generation DRBA agents, quetiapine and SSRI sertraline.

Background: Tardive dyskinesia is more common in patients with first-generation dopamine receptor-blocking agents (DRBA). Second-generation DRBA, such as quetiapine, is rarely associated with TD, ranging from 2% to 4%.[1] Additionally, SSRI-induced tardive dyskinesia-like states, are reported at a rate of 11.3%. [2] However, there is currently no data indicating the incidence of TD with concomitant use of specifically quetiapine and sertraline in schizophrenic patients.

Method: A case report.

Results: A 21-year-old Asian male presented with a chief complaint of uncontrollable movements for the past 1 month. He showed irregular flowing movements involving the neck, the trunk and all four extremities that consistent with chorea. The symptoms occurred when he was on the 7^th month of quetiapine and 3^rd month of sertraline treatment. He was diagnosed with schizophrenia 2 years ago and had a prior history of tardive dystonia due to risperidone, which was successfully managed post-botulinum injection and modification of antipsychotic medication using quetiapine.

Conclusion: Although is less common, second-generation DRBAs may induce TD. The changed phenomenology from dystonia to choreiform TD is uncommon clinical episode. Some studies revealed risperidone correlated with dose, while quetiapine did not dose-dependent for TD occurrence. In addition, TD could also be induced by longer DRBA treatment duration [5,6]. Much less frequently, SSRI may also induce TD.[8] SSRI increases the level of serotonin in the synapse, which may lead to inhibition of dopamine in affected ventral tegmentum area and induces hyperkinetic symptoms.[7,4] There is one case report of sertraline-induced hemichorea [3]. Further research is needed to confirm whether chorea-TD in our patient was induced specifically by SSRI or by DRBA, or by drug interactions between DRBA and SSRI, or by contribution of other factors.

References: 1. Leo RJ. Movement disorders associated with the serotonin selective reuptake inhibitors. J Clin Psychiatry.1996 Oct 57;10.
2. Bergman H, Weiser KS. Anticholinergic medication for antipsychotic‐induced tardive dyskinesia. Cochrane Database Syst Rev. 2018 Jan 17;1
3. Gatto EM, Aldinio, V, Parisi V, Persi G, Prat GD, Bullrich MB, Sanchez P and Rojas G. Sertraline-induced Hemichorea. Tremor Other Hyperkinet Mov (N Y).2017 Dec 18;7:518
4. Ozalp E, Soygur H, Cankurtaran ES,Turhan L,Cekic T,Akarsu,ES,Palaoglu O,Ayhan IH. Sertraline,escitalopram and tianeptine related abnormal movements but not with bupropion: A Case Report. Neuro-Psychopharmacology and Biological Psychiatry. 2006 Sep 30(p 1337-1339)
5. Musco S, Ruekert L,Myers J, Anderson D,Welling M, Cunningham E. Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy.Journal of Clinical Psychophramacology. 2019 July 8(p 336-343)
6. Musco S, McAllister V, Caudle I. Dopamine-receptor blocking agentassociated akathisia: a summary of current understanding and proposal for a rational approach to treatment. Ther Adv Psychopharmacol. 2020, Vol 10:1-13
7. Lambert, M. Trutia C, Petty F. Extrapyramidal adverse effects associated with sertraline. Neuro-Psychopharmacology and Biological Psychiatry.1998 July vol 22 issue 5;741-748
8. Mergl R,Mavrogiorgou P,Juckel G,Zaudig M and Hegerl U. Effects of sertraline on kinematic aspects of hand movements in patients with obsessive–compulsive disorder. Psychopharmacology. 2003 August 30 vol 171;179-185

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/rare-clinical-manifestation-of-tardive-dyskinesia-in-schizophrenic-patient-on-quetiapine-and-sertraline-a-case-report/