A 30-year-old woman has been on haloperidol for six months. She now presents with involuntary, repetitive chewing movements and tongue protrusion that persist even when she is resting. She has no current psychotic symptoms. What is the most appropriate next step in management?

• A Switch to valbenazine or clonazepam and consider transitioning to a second-generation antipsychotic ✓
• B Increase the haloperidol dose to suppress the abnormal movements
• C Add an anticholinergic such as trihexyphenidyl
• D Discontinue all antipsychotics immediately and observe

Explanation

The clinical picture describes tardive dyskinesia (TD), a late-onset movement disorder caused by prolonged dopamine antagonist exposure. Increasing the causative drug temporarily masks TD but worsens long-term prognosis. Anticholinergics exacerbate TD. VMAT2 inhibitors such as valbenazine or deutetrabenazine are FDA-approved treatments for TD; switching to a second-generation antipsychotic with lower D2 affinity is also recommended to reduce ongoing risk.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.