Informing patients about tardive dyskinesia : a survey of clinicians' attitudes in three countries

There is a general increase in awareness amongst clinicians of the need to inform patients about the risks and benefits of treatments offered. Neuroleptic drugs have proven effectiveness in the treatment of schizophrenia, but side effects are common and potentially serious (Johnstone, 1993). These include tardive dyskinesia (TD) an involuntary movement disorder associated with the long-term administration of neuroleptics. TD has an overall prevalence of 20–25% in neuroleptic-treated patients, and is potentially irreversible. The introduction of “atypical” neuroleptics in recent years may have reduced the risk of TD, but evidence for this is currently limited (Simpson, 2000). The American Psychiatric Association (APA) has recommended, via two Task Force reports, regular examination of at-risk patients for TD using the Abnormal Involuntary Movement Scale at least six monthly (APA, 1992). The APA also recommends that informed consent for neuroleptic treatment be obtained and documented.According to the Code of Practice of the United Kingdom Mental Health Act 1983 (Department of Health and the Welsh Office, 1993), consent is the “voluntary and continuing permission of the patient to receive a particular treatment, based on an adequate knowledge of the purpose, nature, likely effects, and risks of that treatment, including the likelihood of its success and any alternatives to it.” Permission given under unfair undue pressure is not consent. Ensuring valid and informed consent amongst psychiatric patients, and particularly those with a psychotic illness can be problematic. We have investigated the attitudes of consultant psychiatrists in three countries to informing their patients about the long-term risks of neuroleptic medication, in particular TD.