An understanding of the multifaceted neurological disorder known as tardive dyskinesia, including its association with cognitive deficits, requires a global conceptualization. In this context, we must view tardive dyskinesia as an illness, the etiology of which follows the well-established biological scheme of a host (having various degrees of predisposing factors), a noxious agent (the neuroleptic drug), and an environment in which the first two components interact. Although studies abound concerning the roles of vulnerability factors, as well as antipsychotic agents, in the development of tardive dyskinesia (Kane & Smith, 1982; Singh & Simpson, 1988), research on environmental factors is scarce. Thus, before turning to our main review, we shall first briefly examine two sociological studies: one conducted in an inpatient setting, the other in an outpatient setting.

Two Sociological Studies

In the inpatient setting, it was the nursing staff who initially resisted our attempts to implement the recommendations of the American Psychiatric Association (1979) task-force report on the late neurological effects of antipsychotic drugs. The nurses were opposed to instituting the APA's suggested drug-free periods for patients on long-term neuroleptic treatment. We conducted many extra meetings and workshops to convince staff personnel on all shifts that such intervention was medically sound, safe, and feasible. But the nurses feared, even expected, that patients would experience clinical decompensation, and in the beginning they tended to consider any change in a patient's behavior during drug discontinuation to be indicative of deterioration.