The prevalence of TD varies in studies, depending on the type of drugs the study populations were exposed to. For example, in a meta-analysis of 41 studies, 30% of patients with a history of exposure to typical (first-generation) antipsychotics had TD, whereas in studies that recruited patients with exposure only to atypical (second-generation) antipsychotics, the prevalence was only 21%.[8]Carbon M, Hsieh CH, Kane JM, et al. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017 Mar;78(3):e264-78.
http://www.ncbi.nlm.nih.gov/pubmed/28146614?tool=bestpractice.com
The mean prevalence of TD was 25.3% for all treatment groups.[8]Carbon M, Hsieh CH, Kane JM, et al. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017 Mar;78(3):e264-78.
http://www.ncbi.nlm.nih.gov/pubmed/28146614?tool=bestpractice.com
In another meta-analysis of 12 studies, the annual incidence rate of TD in patients taking typical or atypical antipsychotics was 5.4% and 0.8%, respectively.[9]Correll CU, Schenk EM. Tardive dyskinesia and new antipsychotics. Curr Opin Psychiatry. 2008 Mar;21(2):151-6.
http://www.ncbi.nlm.nih.gov/pubmed/18332662?tool=bestpractice.com
TD prevalence varies by geographic region, ranging from 17.3% in Asia to 31.8% in Australia, Africa, and the Middle East. The global prevalence ranges from 15% to 50% across studies. The prevalence in Japan is low, at approximately 6.5% to 7.7%.[10]Mori Y, Takeuchi H, Tsutsumi Y. Current perspectives on the epidemiology and burden of tardive dyskinesia: a focused review of the clinical situation in Japan. Ther Adv Psychopharmacol. 2022 Dec 26:12:20451253221139608.
https://journals.sagepub.com/doi/10.1177/20451253221139608
http://www.ncbi.nlm.nih.gov/pubmed/36601351?tool=bestpractice.com
Postmenopausal women may be at increased risk of developing TD.[2]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
https://www.psychiatry.org/psychiatrists/practice/dsm
The most robust risk factors for the emergence of TD are cumulative exposure to dopamine receptor-blocking agents (especially typical antipsychotics) and older age (>50 years). Other risk factors include postmenopause, African-American ethnicity, use of antiparkinsonian agents, diabetes mellitus, brain/central nervous system injury, dementia, smoking, and alcohol and substance misuse.[3]Friedman JH. Tardive syndromes. Continuum (Minneap Minn). 2019 Aug;25(4):1081-98.
http://www.ncbi.nlm.nih.gov/pubmed/31356294?tool=bestpractice.com
[4]Bashir HH, Jankovic J. Treatment of tardive dyskinesia. Neurol Clin. 2020 May;38(2):379-96.
http://www.ncbi.nlm.nih.gov/pubmed/32279716?tool=bestpractice.com
[5]Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (N Y). 2013 Jul 12:3:tre-03-161-4138-1.
https://tremorjournal.org/articles/10.5334/tohm.165
http://www.ncbi.nlm.nih.gov/pubmed/23858394?tool=bestpractice.com
[6]Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry. 2020 Sep 1;177(9):868-72.
https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.177901
http://www.ncbi.nlm.nih.gov/pubmed/32867516?tool=bestpractice.com
[11]Ricciardi L, Pringsheim T, Barnes TRE, et al. Treatment recommendations for tardive dyskinesia. Can J Psychiatry. 2019 Jun;64(6):388-99.
https://journals.sagepub.com/doi/10.1177/0706743719828968
http://www.ncbi.nlm.nih.gov/pubmed/30791698?tool=bestpractice.com
The exact reason for the increased risk associated with the factors mentioned above remains elusive.[3]Friedman JH. Tardive syndromes. Continuum (Minneap Minn). 2019 Aug;25(4):1081-98.
http://www.ncbi.nlm.nih.gov/pubmed/31356294?tool=bestpractice.com
[5]Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (N Y). 2013 Jul 12:3:tre-03-161-4138-1.
https://tremorjournal.org/articles/10.5334/tohm.165
http://www.ncbi.nlm.nih.gov/pubmed/23858394?tool=bestpractice.com