American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate treatment for medication-related tardive dyskinesia?

1. Increase the dose of the antipsychotic

2. Switch to an atypical antipsychotic

3. Discontinuation of the causative dopamine blocker agent

4. Prescribe anticholinergics

The correct answer is: Discontinuation of the causative dopamine blocker agent

The most appropriate treatment for medication-related tardive dyskinesia is to discontinue the causative dopamine blocker agent. Tardive dyskinesia is a movement disorder that is often a side effect of long-term use of dopamine antagonists, such as traditional antipsychotics. The condition is characterized by involuntary, repetitive movements, particularly of the face, tongue, and extremities. Discontinuing the dopamine-blocking agent is crucial because this is the most direct way to prevent further worsening of the symptoms. In many cases, withdrawal from the antipsychotic may lead to an improvement in the dyskinetic symptoms, although this varies among individuals. Alternatives, such as switching to atypical antipsychotics or prescribing anticholinergics, may not address the underlying issue of dopamine blockade and could potentially prolong or exacerbate the dyskinetic symptoms. Increasing the dose of the antipsychotic would likely worsen the condition, as higher doses further inhibit dopamine activity. Therefore, stopping the offending medication is a fundamental first step in managing tardive dyskinesia.