Introduction

The term ‘dystonia tarda’ was first used by Keegan and Rajput (1973) to draw attention to persistent dystonic postures, which, although mentioned in previous reports on tardive dyskinesia, had been largely ignored. Even this effort was less than successful, and it was only after a decade that the problem began to attract serious attention. However, interest has come largely from neurologists, and psychiatrists still seem to deal with the issue with either neglect or bewilderment.

The reasons for considering tardive dystonia separately from ‘classical’ tardive dyskinesia are threefold. This particular presentation has somewhat different associations, is much more functionally incapacitating, and may have somewhat different treatment characteristics. Indeed, the strong implication is that the pathophysiology may also differ, but as the details of this are unknown, no specific comments can be made on the underlying mechanisms. It must be emphasised though, that in terms of our present knowledge, tardive dystonia remains essentially just one rather specific subtype of the general disorder we call tardive dyskinesia.

However, one must in all frankness admit that the literature is not always clear about when the term tardive dystonia is appropriate, especially as mixed types of abnormal movements may be found together, as has already been suggested. The term (or diagnosis) is best reserved for situations in which chronic dystonia is either the sole or dominating manifestation of disorder in patients treated with antidopaminergic drugs.