Explain why the occurrence of tardive dyskinesia in some patients who have never been exposed to antipsychotic medication is clinically significant.

If tardive dyskinesia occurred only as a consequence of antipsychotic exposure, its presence could be interpreted purely as a treatment side-effect, with the implication that stopping or changing medication should resolve it. But its documented occurrence in a proportion of neuroleptic-naïve patients with first-episode schizophrenia shows that the underlying illness itself, and not only its treatment, can give rise to this same movement pattern. This matters clinically because it means a clinician cannot assume that every case of tardive dyskinesia is medication-induced, and cannot always expect it to resolve simply by adjusting antipsychotic treatment; some cases reflect a feature of the illness process itself, which has implications for how the finding is explained to patients and for how treatment decisions are made around it.