Tardive Dyskinesia Behavior Modification and Compensation

Behaviorism is a branch of neuroscience that studies the response of living organisms to external stimuli. A person who engages in undesirable habits can (in theory) be trained to abandon such habits using a "reward/punishment" mechanism. This would seem to be effective, because as talk-show host, author and psychologist Thom Hartmann has pointed out, all of us at any given time are either attempting to obtain pleasure or avoid pain.

When referring to an organic physiological condition such as tardive dyskinesia (TD), the effectiveness of behavioral conditioning should be evaluated. After all, this disorder pertains to the side effects of certain antipsychotic drugs. The resultant dyskinetic movements are involuntary and not a conscious behavioral choice.

It is interesting to note that symptoms of tardive dyskinesia can decrease when a patient is emotionally aroused or focused. Symptoms tend to increase when a patient attempts to relax. The implication could be that the dyskinetic movements associated with tardive dyskinesia may be consciously controlled, a behavior that can be modified. However, it should be remembered that physiological, chemical changes are involved with emotional arousal and sleep, both associated with the adrenal gland.

The bottom line is that tardive dyskinesia is a physiological disorder that cannot be controlled by any force of will or "behavioral modification" treatment. Nor does it appear that the involuntary movements can be "compensated for" by substituting another behavior, such as gum chewing for smoking.

Prevention

The overwhelming majority of research scientists and mental health professionals who have studied tardive dyskinesia agree that the best treatment for this disorder is prevention. Normally, such preventive steps require lowering the dose of the neuroleptic medication, taking "drug holidays," or withdrawing the medication altogether. However, increasing numbers of psychiatrists are debating the wisdom of using such medications at all.

Depending on the patient, dyskinetic symptoms can show up months or years after a medication has been discontinued – or within a few days of beginning such treatment. Although there have been cases in which symptoms of tardive dyskinesia have disappeared, for most patients they are irreversible. It would seem that the best way to prevent tardive dyskinesia is to avoid using neuroleptic medications altogether.

Psychotherapy for Schizophrenia

Schizophrenia is a condition for which neuroleptic medications are usually prescribed. It is characterized by delusional and chaotic thinking processes, paranoia and even auditory hallucinations. Why some people suffer from this condition is not completely known, although genetics and childhood environment seem to play a part. Substance abuse can also be a factor.

Although no two schizophrenia cases are exactly alike, all patients with this condition have been found to have excessive dopamine activity in the brain. Dopamine is a neurotransmitter that serves the body's nervous system much in the same way as electrical energy operates a mechanical wiring system. What appears to happen is that dopamine "overloads" the neural pathways, causing the symptoms associated with schizophrenia. The medications that cause symptoms of tardive dyskinesia are those that inhibit the activity of dopamine.

Alternative Treatments for Mental Illness

One of the most famous people to suffer from schizophrenia is mathematician and economist John Forbes Nash, whose life was the subject of the 2001 film A Beautiful Mind. Initially treated with electroshock, insulin therapy and medication, Nash ultimately rejected these treatments and learned to cope with the hallucinations that characterized his disorder. While this is a remarkable achievement, it is not unique.

Psychiatrists and psychologists alike are beginning to understand that not all cases of schizophrenia are hopeless downward spirals unless there is chemical intervention. A series of scientific studies of nearly 270 patients with a mental disorder from a Vermont State mental hospital, published in 1987, showed that over the course of 20 years, more than 60 percent of the patients had achieved recovery without medication after participation in a rehabilitation program of mainstreaming into the community and training in job and social skills.

Sources

Ashcroft Richard, et al. "Are Antipsychotic Drugs the Right Treatment for Challenging Behaviour in Learning Disability? The Place of a Randomised Trial." Journal of Medical Ethics, vol. 27 (2001).
Worldwide Education and Awareness for Movement Disorders. "Tardive Dyskinesia – Symptoms." http://www.wemove.org/td/td_sym.html