At number two, it can be functionally disturbing. A tardive dyskinesia, particularly a bad tardive dyskinesia can cause significant problems with swallowing, can cause significant problems with speech. The third point is they can be painful. If you have continual movement, particularly with the classic tardive dyskinesia in which movements around face, tongue, and a mouth, it can be painful. The muscle spasms, the secondary muscle spasms, the grinding of the teeth, the chewing on the tongue at times, this can be quite painful.
All those things add up to a tremendous emotional problem as well. There is assumption at times I think from the patient that somehow they caused this. It's their fault that this happened. And of course, it's not. I personally spent a lot of time trying to explain it, trying to note that the problem here is that the medications that you are using, neuroleptic medications, medications which block dopamine probably cause a secondary hypersensitivity of the dopamine receptors, and therefore, they're overactive and that's where the hyperkinetic movement comes from. I think that's a very important point to explain that.
There can be two different assumptions I believe. An assumption on whoever they're dealing with that the cause of this is number one, purely psychiatric, or number two, related to something else, such as use of drugs, or medications, or something like that. And I think that there is an opposite one is as well, the patient's part that they're continually worrying about that, and that can be a really big deal as well and can at times begin to cause the patient to withdraw at same time.
I think that talk therapy, psychotherapy as it would can be helpful to some degree for the emotional issues surrounding it, for the anxieties, and frankly, the depressions surrounding it. It's going to do very little for the movement disorder itself otherwise. Clearly, like all movement disorders, it doesn't matter what type of movement disorder we're dealing with. Anxiety is going to tend to make it worse.
I think trying as much as possible to remove not necessarily the movement, obviously decrease that as much as we can, but to remove the other parts of it. Try to help the anxiety engendered by it, try to help the discomfort and pain engendered by it, try to help the functional abnormalities in speech and swallowing engendered by it, and trying to explain as much as possible the cosmetic social interaction difficulties, which may arise, but to also let the patients know that if they do arise, they didn't cause it, which I think is a really big deal.