Tardive Dyskinesia — MRCPsych Paper B MCQ

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EasySchizophrenia & PsychosisTardive DyskinesiaMRCPsych Paper B

A 55-year-old man with schizophrenia has taken haloperidol 15 mg daily for several years. Over the past few months, he has gradually developed repetitive involuntary orofacial movements, including lip-smacking and tongue protrusion. What is the most likely diagnosis?

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Correct answer: D — Tardive dyskinesia

The correct answer is **C. Tardive dyskinesia**. Long-term exposure to haloperidol followed by the gradual emergence of repetitive involuntary movements of the lips and tongue is characteristic. Tardive dyskinesia commonly affects the tongue, face, mouth and jaw and may persist despite treatment changes. Acute dystonia usually occurs within the first few days of treatment or after a dose increase and causes sustained muscle contractions, such as torticollis or an oculogyric crisis. Akathisia causes subjective inner restlessness and an inability to remain still. Antipsychotic-induced parkinsonism produces bradykinesia, rigidity and tremor. Neuroleptic malignant syndrome is an acute medical emergency involving hyperthermia, severe rigidity, autonomic instability and altered consciousness.

Reference: Essential Pharma Ltd. HALDOL 2 mg/ml oral solution: Summary of Product Characteristics, section 4.4, Tardive dyskinesia and extrapyramidal symptoms. Updated 2023. https://www.medicines.org.uk/emc/product/15252/smpc