Tardive Dyskinesia Diagnosis

The movement disorder known as tardive dyskinesia is actually a collection of symptoms that can mimic other types of disorders such as conditions related to the side effects of antipsychotic (neuroleptic) medications and congenital disorders. Accurate diagnosis can be challenging as there is no single test for tardive dyskinesia. The diagnostic process may involve more than one physician and requires the review of a thorough medical history, a physical examination and a neuro-psychological evaluation in order to determine whether one is indeed suffering from tardive dyskinesia or a different neurological disorder. The diagnostic process is complicated further by the fact that tardive dyskinesia symptoms can come and go, or may be more apparent at some times than at others. An accurate diagnosis may require several office visits.

Tardive Dyskinesia Symptoms and Related Disorders

Those with tardive dyskinesia engage in repetitive, involuntary movements without purpose. These may consist of any or all of the following:

Movement of the lips and tongue (grimacing, smacking, pursing, sticking out the tongue)
Rapid blinking
Impaired finger movement or "fluttering"
Rapid movements of the arms
Toe tapping, moving the leg up and down
Twisting and bending of the torso (in extreme cases)


There are also other similar, but unrelated movement disorders which are sometimes mistaken for tardive dyskinesia:

Dystonia: Dystonia is characterized by sustained muscular contractions which can result in the entire body twisting into abnormal and sometimes painful positions. It is usually congenital, but can occur as a result of injury, a bacterial infection, lead poisoning or drug side-effects. However, while most types of dystonia may pass, the tardive variety is usually irreversible.
Akathisia: This particular condition manifests itself as a compulsive need to move about, driven by inner feelings of anxiety or even terror. This is sometimes related to symptoms of Parkinson's disease, but is most often caused by drugs that block dopamine receptors (dopamine being the neurotransmitter that carries instructions from the brain over the nervous system). Unfortunately, this condition is often misdiagnosed as a psychological problem, leading to the prescription of yet more drugs, thus exacerbating the problem.
Tourettism: This is similar to Tourette's Syndrome, a set of tic disorders that range from facial jerks and spasms to sudden uncontrollable exclamations. In most cases, the only way to determine if such symptoms are indeed true Tourette's syndrome or related to tardive dyskinesia is to obtain a thorough medical examination and review of psychiatric history.
Myoclonus: Myoclonus is exceedingly rare, consisting of involuntary muscle twitching. It is actually a symptom of several neurological disorders, including multiple sclerosis, Parkinson's disease, Alzheimer's, epilepsy and tardive dyskinesia.


According to Dr. John Kane, writing for the American Psychiatric Association, these diseases can be distinguished from tardive dyskinesia by their outward appearance plus the muscle groups involved. True tardive dyskinesia is characterized by slow movements of the orofacial muscles, limbs and digits. Occasionally tremors may occur, but rapid, jerky, spasmodic movements are absent.

Diagnostic Process

Following a complete physical exam and neuropsychiatric evaluation, the physician may wish to run several tests to rule out pathogens, environmental toxins or genetics. The doctor may order a blood cell count and well as screening for serum electrolytes (ions that regulate various bodily functions) and copper and ceruloplasmin (the protein that carries copper in the bloodstream, enabling the metabolism of iron). The thyroid may be tested as well as connective tissues, and the patient may undergo medical imaging tests (MRI or CAT scans) of the head in order to rule out the presence of a tumor.

In the next step of the diagnosic process, the physician will attempt to elicit tardive dyskinesia symptoms by having a conversation with the patient, or providing distractions that tend to bring out such symptoms. During this process, the doctor will make careful notes of what parts of the patient's body show signs of tardive dyskinesia. Sometimes, the results will not be conclusive, and will require another examination in order to confirm the symptoms.