Panel Recommendations for Assessing Tardive Dyskinesia
A panel addresses the gap of knowledge for providers around the use of standardized measures to assess the functional impact of tardive dyskinesia (TD) in a routine clinical practice setting. Key points found include assessing social, physical, vocational, and psychological functioning to determine the impact that TD is having on a patient’s quality of life. These should be conducted at every patient visit, with also considering the experiences of the patient’s caregivers and family.
How to Identify and Manage Side Effects of Antipsychotics in Elderly Populations
In this paper, the frequent use of antipsychotics in facilities for the elderly is addressed, in addition to the increased cases of persistent drug-induced movement disorders in elderly patients. The elderly population are especially prone to falls and other quality of life issues as a result of these side effects. To combat this issue, recommendations for a prevention-based strategy are outlined, including a more limited use of the treatment. This includes the education of both patients and caregivers to recognize the early warning signs of drug-induced movement disorders.
TD Frequency and Antipsychotics
Researchers of a study examined the incidence of tardive dyskinesia (TD) between long-acting injectable antipsychotics (LAI-APs) and equivalent oral antipsychotics (O-APs), LAI first-generation antipsychotics and LAI second-generation antipsychotics (LAI-SGAs), as well as individual LAI-APs using the Japanese Adverse Drug Event Report with data from April 2004 to February 2021. Researchers included 8,425 patients in the study. It was found that LAI-APs, especially LAI-SGAs, compared with O-APs may be linked to a lower TD risk.
Exploring the Prevalence of Tardive Dyskinesia Through Electronic Medical Records
Researchers aimed to establish the prevalence of tardive dyskinesia (TD) that is recognized by clinicians in a real-world therapeutic setting. To do this, data from electronic medical records were examined from a large community mental health center. Researchers focused on clinician-identified TD in patients who have been prescribe antipsychotics, and they looked at psychiatric provider meetings of 120,431 distinct adult and child patients from January 2013 to December 2017.
Their results showed that 50% of patients who were prescribed antipsychotics had Abnormal Involuntary Movement Scale (AIMS) data reported in their medical records, with just 1% of the patients who had a positive AIMS recognizing TD. Testing with AIMS represented the greatest amount of all recognized TD in this set of patients; however, just one-third of the patients with reported positive AIMS had a clinical TD diagnosis that was recorded through the prescriber’s diagnostic impression list using billing code information. The researcher’s finding of just 1% of patients who were prescribed antipsychotics with TD is significantly lower than the known prevalence estimates of TD seen in prior research.
The researchers note the importance of identifying and treating TD with the newer availability of treatments that are approved by the US Food and Drug Administration. Policies and procedures for TD assessments can be put in place to confirm more regular and accurate identification of TD among patients who are prescribed antipsychotics.
Possibly Reducing Patient Chances of Tardive Dyskinesia
This recent article from the National Organization for Tardive Dyskinesia discusses reducing tardive dyskinesia (TD) rates by protecting the brain while patients take antipsychotics, which is notable when treating those who are at highest risk of TD. One of the main hypotheses of why TD develops is the major role of oxidation, and it may play a part in the severity of the disorder. Antioxidant levels slowly start to decrease as age increases, which leaves neurons more vulnerable to damage. Rodent studies have shown brain protection and reduction of the incidence of TD when taking particular antioxidants along with antipsychotics. Multiple studies have looked into certain antioxidants reducing the risk of TD, but the article points out that many psychiatrists do not know the potential neuroprotective benefits of some antioxidants. If this becomes part of standard practice, the incidence of drug-induced brain damage and TD may considerably decrease.
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.
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.
Insights on Identifying and Managing Tardive Dyskinesia
In a Case-Based Psych Perspectives from Psychiatric Times, Leslie L. Citrome, MD, MPH, a psychiatry specialist, and Rose Mary Xavier, PhD, MS, RN, PMHNP-BC, a research scientist and psychiatric nurse practitioner, shared their clinical experiences and perspectives on the recognition, diagnosis, and management of tardive dyskinesia (TD). In recognizing symptoms, family members or case managers frequently report symptoms that include facial grimacing, random tongue protrusion, and shoulder shrugging. It was noted that patients with schizophrenia can become aware of these movements, and it may cause greater amounts of anxiety, paranoia, and social isolation, emphasizing that it is crucial to recognize the level of distress patients face from TD.
The “gold standard” for diagnosing TD is the Abnormal Involuntary Movement Scale, which helps to differentiate symptoms of TD from drug-induced parkinsonism and other drug-induced movement disorders. Treatment guidelines from the American Psychiatric Association advises the use of VMAT2 inhibitors for the treatment of moderate-to-severe TD. The experts concluded that a diagnosis of TD should be centered around a formal and structured evaluation of abnormal movements, and treatment should be based on how the symptoms are impacting the patient.
