What is a recommended strategy for treating tardive dyskinesia?

• A. Switch to a second-generation antipsychotic
• B. Increase the dose of a first-generation antipsychotic
• C. Discontinue all antipsychotics without replacement
• D. Add a stimulant medication

Answer: (A)

Tardive dyskinesia arises from long-term dopamine D2 receptor blockade in the nigrostriatal pathway, which leads to receptor supersensitivity and involuntary movements. Switching to a second-generation (atypical) antipsychotic is a common and useful strategy because these agents generally cause fewer extrapyramidal symptoms and have different receptor binding profiles, resulting in less persistent D2 blockade in the motor pathways. In many patients, this switch can slow or improve TD by reducing ongoing motor system stimulation while still treating the underlying psychosis.

Options that increase the dose of a first-generation antipsychotic would worsen TD by increasing D2 blockade. Stopping antipsychotics without a replacement risks relapse of psychosis. Adding a stimulant would likely exacerbate movement disorders.