This is a competing renewal of the project on neuroleptic- induced tardive dyskinesia (TD) in older patients. The original study demonstrated that: l) patients older than 45 had a 26% annual incidence of TD: 2) the risk factors for TD among older patients were cumulative neuroleptic exposure, especially to high-potency neuroleptics, history of alcohol abuse or dependence, and subtle motor dysfunction at baseline; 3) the incidence of TD was non-significantly higher in men than in women, and in African Americans than in Caucasians; 4) the course of TD was fluctuating in the early stages. The primary goals of the proposed investigation in middle-aged and elderly patients include: examining the incidence and risk factors for the development and persistence of TD; identifying the clinical, neuropsychological and instrumental motor changes that accompany the course of TD; and determining the predictors of remission vs. persistence of TD. The ongoing study of TD will clarify the relative contributions of individual risk factors to the development and persistence of TD. The study is expected to assist in the understanding of some of the mechanisms underlying TD. Most importantly, it is expected to have clinical implications for the use of neuroleptics in older adults. The proposed continuation research will add neuroleptic-treated psychiatric patients over the age of 45 years who do not have TD at study-entry. The patients will be assessed with clinical, neuropsychological and instrumental motor measures at baseline. The clinical and instrumental motor measures will be repeated one month and three months later, and every three months thereafter. The neuropsychological measures will be completed annually. Patients will be treated with the lowest effective doses of neuroleptics.
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