Rosh Psychiatry Board Practice Exam

What condition is indicated by facial tics, difficulty sticking out the tongue, and lip-smacking behavior in a patient on phenothiazines?

1. Gilles de la Tourette's syndrome

2. Huntington's disease

3. Schizophrenia

4. Tardive dyskinesia

The correct answer is: Tardive dyskinesia

The presence of facial tics, difficulty in protruding the tongue, and lip-smacking behavior in a patient on phenothiazines indicates tardive dyskinesia, which is a movement disorder often associated with long-term use of antipsychotic medications, particularly the typical ones like phenothiazines. This condition is characterized by repetitive, involuntary movements, which can include grimacing, tongue movements, and lip smacking—symptoms consistent with what is described in the question. Tardive dyskinesia typically emerges after prolonged exposure to antipsychotic medications and can be a debilitating side effect of treatment. It results from the upregulation of dopamine receptors as a response to chronic dopamine blockade caused by these medications. While other movement disorders like Tourette's syndrome and Huntington's disease can involve tics or abnormal movements, they are fundamentally different in etiology and presentation. Schizophrenia, on the other hand, is a mental health disorder that may warrant the use of phenothiazines but does not specifically describe the movement symptoms noted in the question. Thus, the defining symptoms and the association with phenothiazine use clearly point to tardive dyskinesia as the correct condition.