Criteria

The most widely used diagnostic criteria are those from the Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR).[2] The Schooler-Kane criteria are largely used for research purposes.[38] The Abnormal Involuntary Movement Scale and Impact-TD scale may be used to monitor severity of symptoms over time and impact on a patient's quality of life, respectively.[39][40]

Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)[2]

DSM-5-TR describes the essential features of TD as abnormal, involuntary movements of the tongue, jaw, trunk, or extremities that occur in association with the patient using dopamine receptor-blocking agents. The involuntary movements must be present over a period of at least 4 weeks. The movements may vary in nature, but are distinct from the tremors seen in drug-induced parkinsonism.

The signs or symptoms develop during the patient's exposure to the dopamine receptor-blocking agent, within 4 weeks of withdrawal from an oral dopamine receptor-blocking agent, or within 8 weeks of withdrawal from a long-acting, injectable dopamine receptor-blocking agent.

The patient must have used the dopamine receptor-blocking agent for at least 3 months (or 1 month in patients ages >60 years).

Schooler-Kane criteria[38]

For research purposes, the Schooler-Kane criteria for TD require all four of the following to be met:

  • At least 3 months of cumulative antipsychotic exposure

  • Mild dyskinesias in 2 or more body areas or moderate dyskinesias in one body area

  • Presence of movements for at least 3 months, and

  • No other identifiable etiologies of involuntary dyskinesias.

Abnormal Involuntary Movement Scale (AIMS)[39]

A 12-item, validated rating scale to evaluate TD, developed by the National Institute of Mental Health.[39] It can be used to monitor the effects of long-term treatment with antipsychotics and the severity of TD over time. Items 1-7 assess involuntary movements across body regions. Score from 0 (no dyskinesia) to 4 (severe, maximal amplitude, and persistence during the observation of abnormal movements).[39]

Items 8-12 assess global judgments, dental status, and nocturnal occurrence of movements.[39]

Impact-TD[40]

A standardized clinician-rated instrument to assess the impact of TD on a patient's day-to-day life and functioning.[40] It includes 4 domains:

  • Social

  • Psychological/psychiatric

  • Physical

  • Vocational/educational/recreational.

Each domain is scored from 0 (no impact) to 3 (severe impact).[40]

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