Historical Perspective on Movement Disorders

Before atypical antipsychotics were developed, neuroleptics given to patients for the treatment ofpsychosis often caused movement disorders. Although the role of neuroleptics in the development oftardive dyskinesia was never certain, this adverse effect was of great concern to physicians because itseffects could be irreversible and devastating to the patient. It is important to understand whether involuntarymovement disorders are an intrinsic part of schizophrenia, because if so, then a certain percentageof patients will develop the dyskinetic syndromes whether they are treated or not. To uncoverthe role of antipsychotic medications in tardive dyskinesia, it is necessary to examine the descriptionsof abnormal movements made by those who were first researching schizophrenia, as well as moderndescriptions of neuroleptic-naׯve individuals with schizophrenia. The physicians who initially describedthe syndrome of tardive dyskinesia had observed preneuroleptic schizophrenia firsthand andsaw a difference in the movements of treated and untreated patients. Nevertheless, the idea of achronic movement disorder caused by treatment with neuroleptics would become controversial formany years. With the development of the atypical antipsychotics, the incidence and prevalence of tardivedyskinesia have dropped remarkably, suggesting that psychosis, its treatment, and dyskinesiasare not inextricably linked.