Introduction

Few topics have so dominated the psychopharmacological literature as has tardive dyskinesia. By any appraisal, however, it was not a topic that psychiatry came to with alacrity or enthusiasm. What, by the 1980s had become a torrent of publications, started life as a little trickle and built only gradually, reflecting the profession's reticence in acknowledging the potential deluge to come.

In the field of tardive dyskinesia, aficionados demonstrate their ‘aficionado-dom’ by debating on whom priority should be bestowed for publication in the field. The candidate favoured by some is the German psychiatrist Schonecker. In 1957, he described a syndrome of abnormal movements in three elderly chronic psychiatric patients with cerebral arteriosclerosis. The abnormalities consisted of ‘automatisms with licking and smacking movements of the lips’ (Schonecker, 1957). They were, therefore, orofacial in distribution and complex and recurrent in nature, and occurred in subjects who had all been on chlorpromazine. However, these disorders were reported in patients whose duration of exposure ranged from ‘the first days of treatment’ to a maximum of only eight weeks. It, therefore, seems likely that Schonecker's patients had acute or initial dyskinesias and not tardive dyskinesia, as this subsequently came to be conceive.

On the basis of conceptual purity it is probably once again Dr Sigwald and his colleagues who should be credited with priority. In 1959, they published a report of four cases of orofacial movement disorder which had remained persistent for up to 27 months after stopping antipsychotic medication.