Prognosis

TD substantially worsens the patient's quality of life.[58] In a 6-year follow-up study in Asian patients with schizophrenia, the mortality rate was significantly higher in patients with TD than in those without TD.[59] In many patients, symptoms of TD directly relate to feelings of anger and social insecurity. Therefore, prevention through judicious use of dopamine receptor-blocking agents and adequate treatment of TD is of paramount importance.

Treatment response and remission of TD

The response to medical treatment is unpredictable in many patients. While treatment with vesicular monoamine transporter type 2 (VMAT2) inhibitors objectively (documented by the Abnormal Involuntary Movement Scale) and subjectively improves symptoms of TD, it is hard to predict if and when patients will be free of symptoms after discontinuing the VMAT2 inhibitor.[60] TD remains for years or decades after discontinuing the causative drug.[6][11] In some patients, TD may remit completely or partially even with the continuation of a dopamine receptor-blocking agent. There is considerable variation in the data on rate of remission of TD. One of the challenges when conducting studies on the natural history of TD is that in many patients, complete discontinuation of the dopamine receptor-blocking agent may not be possible. In addition, dopamine receptor-blocking agents could, paradoxically, mask TD in many patients; however, using high doses to mask TD is not a recommended treatment approach.[11] Previous studies have reported remission rates ranging from 2% to 33% after discontinuation of dopamine receptor-blocking agents.[61]

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