Pathology of the Dark Knight
Video Challenge: Can you identify the classic pathology brilliantly displayed by Heath Ledger in this classic movie clip?
What’s your guess?
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Tardive dyskinesia
What is Tardive dyskinesia(TD)?
Tardive dyskinesia is a movement disorder that may occur as a side effect of the long-term use of antipsychotic drugs (neuroleptics). It is most associated with the dopamine antagonists neuroleptic drugs that have high affinity for the D2 dopamine receptor. Other drugs that affect dopamine may also cause it. Obviously, there is a very good chance that the Joker might have been on antipsychotic drugs.
What are the symptoms of tardive dyskinesia?
Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements especially in the oral and facial regions. Hopefully, you saw Heath Ledger brilliantly illustrate many of the classic features such as:
- Facial grimacing
- Tongue protrusion or twisting
- Lip smacking
- Sucking or chewing movements
- Puckering and pursing of the lips
- Jaw opening / closing
- Rapid eye blinking.
The onset of symptoms may be delayed, hence the term “tardive”. Intitially the patient may be unaware of the movements until noticed by family and friends….. or Batman!
What is the risk factor?
The risk of tardive dyskinesis appears to be related to the dose and duration of the antipsychotic. It occurs more commonly in females, in smokers, and in the elderly.
What is the therapy?
The primary therapy is prevention by using the lowest effective dose and shortest duration of neuroleptic possible.
When tardive dyskinesia occurs, the offending drug should be discontinued if possible. Unfortunately, the tardive dyskinesia may persist for months, years, or even permanently.
What are some of the other “test-worthy” side effects of antipsychotic medications?
1. Neuroleptic malignant syndrome (NMS) = A potentially fatal side effect characterized by the development of fever (hyperthermia), muscular rigidity, elevated creatine phosphokinase (CPK), autonomic system instability, and confusion or altered consciousness.
2. Hyperprolactinemia – Remember that prolactin secretion by the pituitary gland is normally suppressed by dopamine. Therefore, any drug that blocks the effects of dopamine or deplete dopamine stores may result in an increased release of prolactin by the pituitary gland.
Thank you for participating in this challenge. If you have other ideas for movie clip pathology, send me a message!
Special Thanks to Dr. Amin Ali Mohiyuddin.
Comments
Barone Rocks !!!