A CASE OF TARDIVE DYSKINESIA (TD) IN A PATIENT WITH NON SQUAMOUS CELL CARCINOMA BEING TREATED WITH ARIPIPRAZOLE

Abstract

Introduction Aripiprazole is an atypical antipsychotic that is usually well tolerated. It is FDA approved for treatment for schizophrenia and mania in Bipolar Disorder. Off label use includes augmentation protocols for depression and anxiety disorders as well as aggression in the pediatric population. Properties include 5-HT1A partial agonism and 5HT1-A antagonism along with D2 and D3 agonism. Abilify is often preferred due to reduced risk of metabolic syndrome, extrapyramidal symptoms and minimal sedative profile. Second generation antipsychotics are usually preferred for their “better” side effect profile as far as extrapyramidal symptoms such as tardive dyskinesia is concerned. Methods This is a case study regarding an outpatient. Literature review regarding this topic is also provided.We describe a patient with history of Non Squamous Cell Carcinoma (NSCC) of lung who developed overt symptoms and signs of tardive dyskinesia secondary to initiation of aripiprazole which suggests need for monitoring for TD even with atypical antipsychotics Results Aripiprazole being a partial dopamine agonist rather than being a full dopamine agonist allows for increase dopamine release in areas of the brain which are hypofunctioningand for dampening of dopaminergic activity in areas which are hyperfunctioning.At a therapeutic dose, it is noteworthy that aripiprazole has one of the highest D2 receptor affinities; however because of its partial agonist properties, it has a lower risk of causing acute EPS and probably TD. Special considerations for medicating elderly patients with psychosis on antipsychotics should include utilization of a screening tool such as the abnormal involuntary movement questionnaire (AIMS) to detect TD at its earliest and take active measures to prevent worsening of symptoms. Conclusions Further research is required to identify the specific dopaminergic pathway responsible for induction of tardive dyskinesia in patients which can lead to more specific therapeutic targets without this side effect with aripiprazole. We suggest dosing for shorter periods of time especially when utilizing aripiprazole as an augmenting agent for depression or anxiety or off- clinical use. In theory, SGAs are safer in terms of tardive dyskinesia however our case study underlies the need for informed consent and psychoeducation regarding this side effect. This research was funded by: No funding was received