Distinguishing Tardive Dyskinesia From Other Movement Disorders
When a patient presents with a movement disorder, what key signs can help clinicians determine whether it is tardive dyskinesia (TD)? In this video, filmed at the 2025 NP Institute, Psych Congress Co-Chair Greg Mattingly, MD, provides an insightful overview of the telltale signs that can help clinicians distinguish TD from other movement disorders. While walking through common presentations of the disease, Dr Mattingly also points out symptoms that are commonly missed or misdiagnosed, offering guidance for clinicians to more accurately and effectively diagnose patients.
For more TD insights, visit the Tardive Dyskinesia Excellence Forum.
For more conference coverage, visit the NP Institute newsroom.
Read the Transcript
Greg Mattingly, MD: I'm Greg Mattingly, an associate clinical professor at the Washington University School of Medicine, president of the Midwest Research Group in St. Louis, Missouri, and co-chair of Psych Congress.
I'm here to talk today about a group of patients that I find really interesting. It's those patients that have mental health challenges but are also ticky-twitchy. They have various types of movement disorders.
What's going on in the brain of our patients that have movement disorders? It could be a primary movement disorder such as Tourette's or an essential tremor. It could be a medication-induced movement disorder such as a dystonic reaction, or medication-induced Parkinsonism. What I'm here to focus on today, though, is a group of patients that quite often get missed—and that's patients struggling with tardive dyskinesia.
Psych Congress Network: What signs may help clinicians distinguish tardive dyskinesia from other movement disorders?
Mattingly: Tardive dyskinesia, by the very definition, is tardy. It shows up late. It shows up late in your practice and gradually builds over time. So unlike medication-induced Parkinsonism or a dystonic reaction, which quite often show up during one of the first visits, this is something that builds over time. That's why I think it's easy for us as clinicians to miss it. Patients come back for that first visit, you don't see any tremor. They come back for the second visit, you notice a little something. They come back for the third visit, it's a little more, and you gradually get used to seeing this tremor that's building over time.
We know that TD primarily involves the places where we have the most motor nerve cells in the brain, the homunculus. So the most commonly affected areas tend to be the lips and tongue, the eyes, the fingers and the thumb. But remember, every body part can be at risk for tardive dyskinesia.
The place that I've missed it the most is TD involving the feet. Sometimes I've thought that was restless legs syndrome and I forgot to examine, “Could this be tardive dyskinesia?”
Greg Mattingly, MD, is a physician and principal investigator in clinical trials for Midwest Research Group. He is also a founding partner of St. Charles Psychiatric Associates where he treats children, adolescents, and adults. A St. Louis native, he earned his medical degree and received a Fulbright scholarship while attending Washington University. Dr Mattingly is board certified in adult and adolescent psychiatry and is a Diplomat of the National Board of Medical Examiners. He is an Associate Clinical Professor at Washington University where he teaches psychopharmacology courses for the 3rd year medical students. Dr Mattingly has been a principal investigator in over 400 clinical trials focusing on ADHD, anxiety disorders, major depression, bipolar disorder and schizophrenia.
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