Tardive Dyskinesia Clinical Case Review

Christoph U. Correll, MD, professor of psychiatry at The Zucker School of Medicine at Hofstra/Northwell and professor and chair of the department of child and adolescent psychiatry at Charité University Medicine in Berlin, Germany, introduces the second case.

Editor’s note: The following is an automatically generated transcript of the above video.

"This is case number two. This is Ida. Ida is a 26-year-old female with bipolar disorder since age 19. She had two manic episodes, but five depressive episodes, as we unfortunately often see that in bipolar disorder, the depressive phases are more common. Yet she had two before the onset of full mania, which is bipolar I disorder, and three since living with a boyfriend of three years, and she's working as a secretary.

During the prior admissions, Ida was treated with a combination of lithium and various antipsychotics that caused in her akathisia and also Parkinsonism, and she was responding to an anticholinergic. During her last admission for bipolar depression, after she had stopped all medications, and after surviving a suicide attempt with 70 paracetamol pills, she finally stabilized with olanzapine (Zyprexa, Eli Lilly) 15 milligrams, which seems to keep her stable the most, and that is given together with biperiden (Akineton, Par Pharmaceutical Inc.), and anticholinergic, 2 milligrams, and lithium 1200 milligrams.

She's now an outpatient for seven months, mostly euthymic, occasionally has transient irritability and some mild hypomania, but she can control that. She's complaining of six and a half kilograms of weight gain, that's about 14 pounds, daytime sleepiness, a BMI of 31, which is obese, 30 is the threshold, and she has also elevated fasting glycerides and a glucose that is in the diabetic range. Anything higher than 126 milligrams per deciliter would be in that range, and her lithium level is 0.6, which would be consistent with maintenance dosing of lithium.

She's now seeking help from the psychiatrist as she and her boyfriend, as well as people at work, noticed about eight weeks ago gradually worsening horrible movements that interfered with her interacting with others and typing on the computer, which is upsetting to her because she is a secretary, has to actually face other customers and coworkers, but also type."