Tardive Dyskinesia Effect on Caregivers
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.
Nurse Impact on Tardive Dyskinesia
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.
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.
Meta-Analysis of Tardive Dyskinesia Prevalence With Use of Second-Generation Antipsychotics
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.
A Review on Tardive Dyskinesia
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.
Treating Tardive Dyskinesia
A meta-analysis showed that approximately 1 in 4 patients who have been on a second-generation antipsychotic after 10 years will develop tardive dyskinesia (TD), while the rate of those on first-generation antipsychotics is 1 in 2. The 2 greatest risk factors for TD are the duration and dose of treatment. Two FDA-approved treatments for TD are VMAT2 inhibitors deutetrabenazine and valbenazine. When using one of these therapies to treat TD, it will likely need to be put in place for the duration that the antipsychotic is being used, or else the TD may come back within a month of discontinuation.
