J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website https://jmc.elmerpub.com

Case Report

Volume 17, Number 6, June 2026, pages 244-250

Tardive Oropharyngeal Dyskinesia Associated With Antipsychotic Use in the Management of Behavioral and Psychological Symptoms of Dementia

↓ Figure 2. Multifactorial contributors to tardive dyskinesia in older adults with dementia. Conceptual model showing the multifactorial and cumulative contributors to tardive dyskinesia in older adults with dementia, including patient vulnerability, pharmacological exposure, and clinical/environmental factors.

↓ **Table 1.** Medications Associated with TD and EPS
Risk category	Medication class	Examples	Key notes
Medications associated with TD and EPS, categorized according to relative risk based on available literature. Risk stratification reflects general trends reported in the literature and may vary depending on patient factors such as age, comorbidities, duration of exposure, and polypharmacy. APDs: antipsychotic drugs; L-DOPA: L-3,4-dihydroxyphenylalanin; LID: L-DOPA-induced dyskinesia; MAO: monoamine oxidase; SSRIs: selective serotonin uptake inhibitors; TCAs: tricyclic antidepressants.
High risk	Typical antipsychotics	Haloperidol	Strong D2 blockade; highest association with TD and EPS
	Dopamine antagonist antiemetics	Metoclopramide, prochlorperazine	Significant TD risk, especially with prolonged use (> 12 weeks)
Moderate risk	Atypical antipsychotics	Risperidone, olanzapine, aripiprazole	Lower risk than typical APDs but still associated; some agents reported to induce TD
	Antidepressants	SSRIs (fluoxetine, sertraline), TCAs (amitriptyline, clomipramine)	Risk higher in older adults and with long-term exposure
	MAO inhibitors	Selegiline, rasagiline, phenelzine	Associated with dyskinesia, especially with dopaminergic interaction
	Mood stabilizers	Lithium (especially with APDs)	Increased risk when combined with antipsychotics
Low but notable risk	Anticholinergics	Procyclidine, trihexyphenidyl	May worsen TD and cognitive impairment
	Anticonvulsants	Phenytoin, carbamazepine, lamotrigine	Rare but reported; possibly underdiagnosed
	Antihistamines	Hydroxyzine	Risk with prolonged use, especially in older adults
	Antiparkinsonian drugs	L-DOPA	Dyskinesia (LID), dose- and duration-related
Rare/context-dependent risk	Decongestants	Pseudoephedrine, phenylpropanolamine	May exacerbate movement disorders
	Antimalarials	Chloroquine, amodiaquine	Mechanism unclear; possible neurotransmitter disruption
	Anxiolytics	Benzodiazepines (withdrawal), barbiturates	Withdrawal-emergent dyskinesia
	Stimulants	Amphetamines, methamphetamine	Dopaminergic neurotoxicity; persistent dyskinesia possible

↓ Table 1. Medications Associated with TD and EPS

Risk category

Medication class

Examples

Key notes

Medications associated with TD and EPS, categorized according to relative risk based on available literature. Risk stratification reflects general trends reported in the literature and may vary depending on patient factors such as age, comorbidities, duration of exposure, and polypharmacy. APDs: antipsychotic drugs; L-DOPA: L-3,4-dihydroxyphenylalanin; LID: L-DOPA-induced dyskinesia; MAO: monoamine oxidase; SSRIs: selective serotonin uptake inhibitors; TCAs: tricyclic antidepressants.

High risk

Typical antipsychotics

Haloperidol

Strong D2 blockade; highest association with TD and EPS

Dopamine antagonist antiemetics

Metoclopramide, prochlorperazine

Significant TD risk, especially with prolonged use (> 12 weeks)

Moderate risk

Atypical antipsychotics

Risperidone, olanzapine, aripiprazole

Lower risk than typical APDs but still associated; some agents reported to induce TD

Antidepressants

SSRIs (fluoxetine, sertraline), TCAs (amitriptyline, clomipramine)

Risk higher in older adults and with long-term exposure

MAO inhibitors

Selegiline, rasagiline, phenelzine

Associated with dyskinesia, especially with dopaminergic interaction

Mood stabilizers

Lithium (especially with APDs)

Increased risk when combined with antipsychotics

Low but notable risk

Anticholinergics

Procyclidine, trihexyphenidyl

May worsen TD and cognitive impairment

Anticonvulsants

Phenytoin, carbamazepine, lamotrigine

Rare but reported; possibly underdiagnosed

Antihistamines

Hydroxyzine

Risk with prolonged use, especially in older adults

Antiparkinsonian drugs

L-DOPA

Dyskinesia (LID), dose- and duration-related

Rare/context-dependent risk

Decongestants

Pseudoephedrine, phenylpropanolamine

May exacerbate movement disorders

Antimalarials

Chloroquine, amodiaquine

Mechanism unclear; possible neurotransmitter disruption

Anxiolytics

Benzodiazepines (withdrawal), barbiturates

Withdrawal-emergent dyskinesia

Stimulants

Amphetamines, methamphetamine

Dopaminergic neurotoxicity; persistent dyskinesia possible