This video is an instructional guide to help providers and patients identify the facial movements that are most commonly associated with tardive dyskinesia (TD). The movements that patients with TD experience are slow, irregular, and change their shape. Through real time demonstrations, Dr Rajnish Mago shows multiple examples of the most common facial movements found in patients with TD including pouting, puckering, and smacking of the lips as well as several tongue, perioral, and jaw movements.
This video follows the real-life story of a patient with tardive dyskinesia (TD), while also providing an overview of the disease. TD is a late-onset movement disorder that has been linked to long-term use of antipsychotic medications. The physical symptoms can impact the entire body but are often most noticeable in the facial region. Challenges for providers are discussed, including how to weigh the use of antipsychotic therapies with the potential of TD in patients who have a history of medications, including therapies unrelated to mental health medications that are also dopamine blockers, and the importance of early symptom recognition by both patients and providers.
A video from the Depression and Bipolar Support Alliance discusses information about tardive dyskinesia (TD), as well as how the nervous system works. Some people do not have enough, too much, or irregular neurotransmitters to bind to receptors that can cause irregular signaling, possibly explaining the symptoms of mental health conditions including schizophrenia, bipolar disorder, and depression. In order to treat mental health conditions, antipsychotics are often given, and much of these therapies are dopamine-receptor blocking agents. More signaling can occur when dopamine is binding to hypersensitive dopamine receptors, having an impact on areas of the brain that impact motor function, causing TD.
A study sought to determine if the Abnormal Involuntary Movement Scale (AIMS), which relies on visual judgements, can be a reliable measurement tool through video chat. AIMS scores were examined by 2 independent raters in face-to-face contact and 2 raters assessing remotely through audio-visual transmission. Intraclass Correlation Coefficient was used to determine inter-rater reliabilities. No considerable difference was found between the raters, which may be due to the condition while examining involuntary movements using the AIMS. Researchers noted that the results were dependable to the same degree.
A study from the Journal of the American Psychiatric Nurses Association showed that caregivers of those with tardive dyskinesia are significantly impacted and should be thought of when clinicians create treatment plans for these patients. Caregivers manage the health of these patients daily and have limited time and energy to take care of their own needs, which affect their relationships, social lives, work, and home tasks. In the study, 41 unpaid caregivers of TD completed questionnaires that included questions regarding the caregiver’s sociodemographic characteristics, view of the impact of abnormal involuntary movements on patients, and the effect of the movements on themselves as caregivers. Twenty of the caregivers were full-time or part-time employees, and 35 participants were either family members or friends of a patient with TD.
Fifty percent of the participants responded that the patient’s movement either had “some” or “a lot” of impact on their ability to “continue usual activities” (50%), and this group also reported that the movements had an affect on them being productive (58.4%), taking care of themselves (49.9%), and socializing (55.5%). They also reported that the TD movements of the patient required the caregiver to time manage, impact their overall life, and cause them to feel either frustrated or angry.
Since an increase in telehealth visits since the COVID-19 pandemic, assessing for tardive dyskinesia (TD) has been a challenge, but evaluation can be successful based on best practices that are described in this article. It is important for psychiatric nurses to educate patients and caregivers on the potential risks of antipsychotic-induced movement disorders including TD. Researchers of this article also note that nurses should be attentive that every patient taking antipsychotics should be monitored for the potential development of TD. After a TD diagnosis, nurses can educate patients about safe and effective treatments that are available and approved by the Food and Drug Administration.
The first description of tardive dyskinesia (TD) was in 1957, following the introduction of the first antipsychotic therapies, and while TD was mainly linked to first-generation antipsychotics, TD can also be associated with second-generation antipsychotics, but with a lower risk. Professor at the Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research and medical director of the Recognition and Prevention Program in the Department of Psychiatry at the Zucker Hillside Hospital in Manhasset, New York, Christoph Correll, MD, says that TD is underassessed, as there is little training and experience with TD in the current generation of psychiatrists. The initial onset of TD also presents with inconsistent symptoms that can be confused with symptoms of medication-induced adverse effects or other disorders, he explained. TD is usually diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Schooler-Kane criteria. Over the past few years, evidence-based guidelines have been developed for the treatment of TD.
Tardive Dyskinesia Impact on Quality of Life in Those With Bipolar Disorder, Major Depressive Disorder, and Schizophrenia
Investigators of a study looked to analyze the health-related quality of life (HRQoL) in patients diagnosed with bipolar disorder, major depressive disorder, or schizophrenia by comparing those with tardive dyskinesia (TD; n = 197) and patients without TD (n = 219). HRQoL in both groups were compared with the HRQoL of the general population as well. Using a cross-sectional web-based survey, HRQoL was measured using the SF-12 Health Survey, Version 2, Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form, the Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale, and 2 questions regarding movement disorders.
It was found that those with TD had considerably worse HRQoL and social withdrawal than patients without TD, and these differences were distinct with physical HRQoL domains vs mental health domains. Based on self- or clinician-based ratings, patients with more severe TD had considerably worse HRQoL vs those with less severe TD. TD impact was significantly greater in patients with schizophrenia compared with patients with bipolar disorder or major depressive disorder.
Investigators of a meta-analysis looked to compare the prevalence of tardive dyskinesia (TD) during the use of first-generation antipsychotics (FGAs) and/or second-generation antipsychotics (SGAs). Studies were screened from January 1, 2000, to September 30, 2015. Random effects meta-analysis and meta-regression were used for 41 studies that were selected. Among these studies, global mean prevalence of TD was 25.3% (95% CI = 22.7%-28.1%). TD rates were lower in those who had current SGA treatment (20.7%; 95% CI = 16.6%-25.4%, N = 5,103) compared with current FGA treatment (30.0%; 95% CI = 26.4%-33.8%, N = 5,062; Q = 9.17, P =.002). Lower prevalence of TD (7.2%; number of studies = 4) was seen in treatment groups with those who were FGA-naïve relative to those who were treated with SGA with likely previous exposure to FGA (23.4%; P <.001; 28 studies). TD severity, that was seen in 10 studies, was of insufficient quality for the meta-analysis. Overall, higher rates of TD were seen with FGA compared with SGA therapy. Because there were insufficient reports of TD severity, the clinical impact of identified TD cases with SGAs and FGAs were not investigated. High geographical variation that was found brings a need for future research on this subject matter.
Investigators provided a review that emphasizes a prevention-based focus on the treatment of TD through the clinical consideration of pharmacologic selections linked to individual patient history. They performed a search through PubMed with keywords and combined searches involving medication-induced TD in addition to therapies that are linked to causing or are used to treat TD. They aimed to use recent articles that were published no earlier than 2015. The findings indicated that the risk of TD remains with atypical antipsychotic drugs, but the incidence is reduced. In addition, various other classes of medications have a high prevalence of TD that are not particularly known to induce TD.