I'm no expert, but here are some recent publications which I found with a search on MDConsult for "tardive dyskinesia" sorted by date.
What I found suggests atypicals do NOT have dramatically less risk of TD than typicals.
I'll be very interested to hear what those with more expertise and more recent academic involvement have to say.
1) Movement Disorders Induced by Antipsychotic Drugs: Implications of the CATIE Schizophrenia Trial
Neurologic Clinics - Volume 29, Issue 1 (February 2011)
Differences in liability for TD between FGAs and SGAs have been studied extensively. In contrast to the incidence of TD with FGAs, numerous industry-sponsored trials of SGAs found a significant 6- to 12-fold reduction in risk for TD. [12] , [27] , [102] , [103] , [104] Correll and colleagues, [12] , [27] in a meta-analysis, found a 4.6% reduction in the risk of TD for SGAs compared with studies using haloperidol, but later found only a 1.6% difference in attributable risk when studies using mid-potency FGAs were included.[27] It remains unlikely that clozapine causes TD.[105]
In contrast to industry studies using haloperidol, there were no significant differences among groups in the CATIE trial receiving perphenazine or 4 SGAs in the incidence of TD defined by scores of 2 or more on the AIMS global severity score (see Table 1).[28] In a second analysis, patients were considered to have persistent TD if they met full Schooler-Kane (S-K) criteria. [29] , [88] Analyses were also conducted using modified S-K criteria such that meeting the AIMS criteria on only one assessment was required, that is, "probable" TD. Few patients who had no evidence of TD at baseline met full S-K TD criteria during treatment (1.1%–4.5% receiving SGAs and 3.3% receiving perphenazine; see Table 2). The proportion of patients who met modified S-K TD criteria ranged from 8.3% to 9.6% with SGAs and 11.8% for perphenazine. There were no statistically significant differences between treatment groups on any TD indicator.
2) Tardive dyskinesia and other movement disorders secondary to aripiprazole. - Peña MS - Mov Disord - 01-JAN-2011; 26(1): 147-52
ABSTRACT:
The objective of this report is to draw attention to tardive dyskinesia (TD) caused by aripiprazole, a third generation antipsychotic. TD has been traditionally attributed to typical (first-generation) antipsychotics, but other dopamine receptor blocking drugs and atypical (second- and third-generation) neuroleptics are emerging as an important cause of TD. We reviewed the medical records of patients with TD seen at the Baylor College of Medicine Movement Disorders Clinic between 2002 and 2010 to identify patients with TD associated with aripiprazole. Among 236 patients with TD seen over the specified period, 8 (3.4%) were found to have aripiprazole-associated TD. In 5 patients, TD occurred after exclusive exposure to aripiprazole. The mean age at onset was 55.8 ± 14.8 years with a female predominance. The average duration of treatment with aripiprazole was 18.4 ± 26.4 months. Oro-bucco-lingual stereotypy was seen in all patients. In most patients, TD did not spontaneously improve after stopping aripiprazole. Of the 5 patients treated with tetrabenazine, 4 improved during follow-up. Although aripiprazole, a third generation antipsychotic, has been promoted to have a low risk of TD, the drug accounts for about 3.5% of patients with TD evaluated in a movement disorders clinic. This largest reported series draws attention to the growing incidence of TD and other drug-induced movement disorders associated with "atypical antipsychotics."
3) Incidence and persistence of tardive dyskinesia and extrapyramidal symptoms in schizophrenia. - Tenback DE - J Psychopharmacol - 01-JUL-2010; 24(7): 1031-5
Abstract:
Although it has been suggested that second-generation antipsychotics (SGA) may reduce the rate of prevalent tardive dyskinesia (TD), little is known about the incidence and outcome of TD in those exposed exclusively to SGA. The incidence and subsequent persistence of TD and extrapyramidal symptoms (EPS) was calculated in a cohort of patients with schizophrenia treated predominantly with SGA. This cohort of more than 10,000 patients with schizophrenia was seen six times over a period of two years. Dichotomous measures of EPS and TD were used to calculate the yearly incidence rates of TD and EPS as well as their subsequent cumulative persistence rate in a subset of 9104 and 6285 patients at risk for TD and EPS, respectively. Of 9104 individuals who did not present with TD at baseline, 138 developed TD, yielding a TD incidence rate of 0.74% (95% CI: 0.62, 0.87) and a subsequent cumulative persistence rate of 80%. Of 6285 individuals without EPS at baseline, 464 developed EPS yielding an incidence rate of 3.7% (95% CI: 3.4, 4.0) and a subsequent cumulative persistence rate of 82%. Incidence rates of TD and EPS may be low in the SGA era. However, once emerged, these disorders prove persistent, suggesting strong moderators effects of underlying predisposing factors.
4) Tardive dyskinesia: determinants of temporal dynamics of its emergence. - Latalova K - Neuro Endocrinol Lett - 01-DEC-2008; 29(6): 995-8
Abstract:
BACKGROUND: The second generation antipsychotics (SGA) is considered to have contributed to the decrease of the risk of TD in comparison with the first generation antipsychotics (FGA). Using the multiple regression analysis, we compared the predictive strength of the FGA/SGA distinction with the predictive strength of the duration of treatment, patients' age and sex. The difference between sedative (sed) and incisive (inc) antipsychotics was added as the fifth predictor. METHOD: A cohort of patients treated with antipsychotic drugs for less than 5 years and who were free from TD was followed for one year and examined regularly by the abnormal involuntary motor scale (AIMS). RESULTS: From a sample of 98 patients, 6 patients developed TD after six months. The duration of treatment, age and sex of the patients were the main determinants of its emergence. The drugs used did not play a statistically significant role. After one year, 15 patients developed TD. Age and sex lost their statistically provable influence on its emergence. The difference between the treatment with sedative or incisive antipsychotics became the variable with the highest statistical significance. The relationship of the risk of TD to the FGA/SGA distinction was not statistically significant. 14.4% of the variability in the increase of the risk of TD during the second half of the one year observational period could be explained by the predictors. The stepwise regression showed that both, SG/FG and sed/inc distinction remained statistically significant.
5) Tardive dyskinesia in children treated with atypical antipsychotic medications. - Wonodi I - Mov Disord - 15-SEP-2007; 22(12): 1777-82
Recent years have witnessed increased antipsychotic treatment of children despite limited long-term safety data in children. In this study, motor side effects associated with the use of antipsychotic drugs in children were examined in a sample of pediatric psychiatric patients. Child and adolescent psychiatric patients receiving antipsychotics (most were on atypicals) for 6 months or longer (n = 118) were compared with antipsychotic-naïve patients (n = 80) with similar age, sex ratio, and diagnoses. Only 19% of patients on antipsychotics had ever experienced psychotic symptoms. Eleven children (9%) on antipsychotics exhibited dyskinesia, when compared with 0 in the naïve group (P = 0.003, Fisher's exact test). Nine of 62 African-American children (15%) on antipsychotics exhibited dyskinesia, when compared with only 4% (2 of 52) of European-American children (P = 0.003, Fisher's exact test). Children treated with antipsychotic drugs might experience a significant risk of dyskinesia even when treated only with atypical antipsychotics. Ethnicity might also be a risk factor for dyskinesia in children. Side-effect profile of the atypical antipsychotic drugs in children may be much different than that in adults.(c) 2007 Movement Disorder Society.
6) A randomized controlled trial of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced tardive dyskinesia. - Chan HY - J Clin Psychiatry - 01-SEP-2010; 71(9): 1226-33
Abstract:
OBJECTIVE: To compare the efficacy of risperidone and olanzapine in schizophrenic patients with tardive dyskinesia on treatment with first-generation antipsychotics. METHOD: We conducted a 24-week, rater-blinded, flexible-dose study. Sixty patients with DSM-IV schizophrenia (n = 58) or schizoaffective disorder (n = 2) met the DSM-IV research criteria for neuroleptic-induced tardive dyskinesia and were randomly assigned to a risperidone or olanzapine group. The primary outcome was a comparison of the change in the total scores on the Abnormal Involuntary Movement Scale (AIMS) from baseline to study end point between the groups. The study was conducted from July 2000 to June 2004. RESULTS: The mean ± SD doses of risperidone and olanzapine from baseline to study end point were 1.9 ± 0.7 to 4.1 ± 1.4 mg/d and 8.1 ± 2.0 to 12.6 ± 5.4 mg/d, respectively. There were no statistically significant differences in demographic data, severity of tardive dyskinesia, or psychotic symptoms between risperidone and olanzapine groups at baseline assessment. Both groups showed significant improvement in mean ± SD AIMS total scores (risperidone: −7.4 ± 6.9, P < .0001; olanzapine: −6.2 ± 8.0, P = .0002). However, there was a more statistically significant change in the slope of AIMS total scores in the risperidone group than in the olanzapine group (P = .0001). CONCLUSIONS: Our findings demonstrated that olanzapine may not have better potential for tardive dyskinesia improvement than risperidone did. Double-blinded, fixed dose studies with a larger sample size on schizophrenic patients with tardive dyskinesia from different ethnic groups are needed to confirm the results of our study.
7) THIS I FOUND FASCINATING. SMALL "N", BUT FASCINATING
Ten year outcome of tardive dyskinesia during continuous treatment with first generation antipsychotics. - Rittmannsberger H - Psychiatr Danub - 01-DEC-2008; 20(4): 461-5
Abstract:
OBJECTIVE: The aim of this study is to determine the course of tardive dyskinesia (TD) during continuous medication with first generation antipsychotics. SUBJECTS AND METHODS: Patients of a psychiatric nursing home were assessed for TD by means of the AIMS on two occasions ten years apart. RESULTS: Out of 10 patients who met criteria for TD at baseline the global judgement of severity of the AIMS improved in 5, worsened in 4 and remained unchanged in one patient. The mean sum score of the AIMS slightly increased from 5.5 to 6.3. No patient developed movements that incapacitated him in his daily activities. CONCLUSION: In concordance with the available literature these findings support the view that under continuous treatment with antipsychotics there is an equal chance for improvement as for deterioration. Progressive worsening to severe forms of TD was not observed.
8) The effect of atypical versus typical antipsychotics on tardive dyskinesia: a naturalistic study. - de Leon J - Eur Arch Psychiatry Clin Neurosci - 01-APR-2007; 257(3): 169-72
Abstract:
OBJECTIVE: The aim was testing whether atypical antipsychotics (versus typicals) were associated with less risk of tardive dyskinesia (TD) in 516 severely mentally ill patients. METHODS: The sample included 11% (57/516) with no exposure before current treatment with atypicals; 9% (48/516) with prior and current treatment with atypicals but no exposure to typicals; 18% (94/516) with lifetime exposure to typicals for <5 years (plus atypicals); and 62% (317/516) with lifetime exposure to typicals for >or=5 years (plus atypicals). The Abnormal Involuntary Movement Scale (AIMS) was used to assess dyskinetic movements. Following Schooler and Kane's criteria TD was considered present when mild movements were present in at least two body areas or moderate movements were present in at least one body area. RESULTS: TD prevalences were 5% (3/57) in previously naïve patients, 19% (9/48) after exposure only to atypicals, 19% (18/94) after typical exposure of <5 years, and 42% (132/317) after typical exposure of >or=5 years. There was no significant effect comparing those taking only atypicals to those exposed to typicals for <5 years (OR = 1.0, CI 0.42-2.5). CONCLUSION: This study is limited by the naturalistic design, the relatively small samples in the first two groups, the lack of information on the duration of the atypicals and their relatively recent introduction to the market (ziprasidone and aripiprazole were introduced to the market in the middle of the study). This study raises the question that new TD studies need to establish whether decades of treatment with atypical antipsychotics make a difference.
