Tardive dyskinesia — MRCPsych Paper A MCQ

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ModeratePsychopharmacologyTardive dyskinesiaMRCPsych Paper A

A 63-year-old woman with schizophrenia has received continuous antipsychotic treatment for 12 years. Over several months, she develops repetitive lip-smacking and chewing movements, intermittent tongue protrusion and choreiform “piano-playing” movements of her fingers. She has no bradykinesia, rigidity, fever or altered consciousness. Which antipsychotic adverse effect is the most likely diagnosis?

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Correct answer: D — Tardive dyskinesia

The diagnosis is tardive dyskinesia, a delayed hyperkinetic movement disorder associated with prolonged dopamine-receptor antagonist exposure. The characteristic pattern is repetitive orobuccolingual movements, including lip-smacking, chewing and tongue protrusion, often accompanied by choreiform distal-limb movements. Drug-induced parkinsonism instead causes bradykinesia, rigidity and usually a regular tremor. Acute dystonia typically develops shortly after treatment initiation or a dose increase and produces sustained spasms such as torticollis, trismus or an oculogyric crisis. Akathisia presents as subjective inner restlessness with an inability to remain still. Neuroleptic malignant syndrome is an acute systemic emergency featuring hyperthermia, severe rigidity, autonomic instability and altered consciousness.

Reference: Aurobindo Pharma–Milpharm Ltd. Amisulpride 100 mg Tablets, Summary of Product Characteristics, section 4.8 ‘Undesirable effects’, revised 2 June 2026. https://www.medicines.org.uk/emc/product/591/smpc