Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia

Review highlights from 2 experts’ presentations on identifying and treating tardive dyskinesia. Quotes from actual patients illustrate the embarrassment that they feel and show why even mild movements should be treated if patients are distressed by them.

Abstract

Tardive dyskinesia (TD), a potentially irreversible condition that causes involuntary movements associated with dopamine receptor blocking agents, can substantially impair patients’ functioning and diminish their quality of life. While TD was expected to vanish due to more widespread use of second-generation antipsychotics than use of first-generation antipsychotics, in reality, more patients than ever are at risk for developing this condition. Early detection and accurate diagnosis of TD is critical to increasing chances that TD movements will be transient and reversible. Clinicians must be proactive in regularly screening patients for TD, educating the patient and family about risk factors, addressing psychosocial concerns related to the condition, and selecting one of the novel, FDA-approved medications—valbenazine or deutetrabenazine—to treat TD symptoms. Providing a clinical TD diagnosis as early as possible is crucial to implementing treatment strategies that may successfully reduce patients’ TD symptoms.

From the Series: Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia

To cite: McEvoy JP, Kremens DE. Early recognition and treatment of tardive dyskinesia in patients with mood disorders and schizophrenia. J Clin Psychiatry. 2020;81(1):NU18041AH5C

To share: https://doi.org/10.4088/JCP.NU18041AH5C

© Copyright 2020 Physicians Postgraduate Press, Inc.

Target Audience

  • Psychiatrists
  • Neurologists
  • Nurse practitioners
  • Physician assistants

Learning Objectives

  • Recognize early signs of tardive dyskinesia (TD) through regular screening and patient/family education about symptoms
  • Address psychosocial concerns related to TD in patients with mood disorders and schizophrenia
  • Select FDA-approved medication to treat TD symptoms, considering research on longer-term efficacy and safety
Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
01/28/2020
Activity expires: 
02/28/2022
Cost:
$0.00
Rating: 
0

Support Statement

Supported by an educational grant from Neurocrine Biosciences, Inc.

Learning Objective

After completing this educational activity, you should be able to:

  • Recognize early signs of tardive dyskinesia (TD) through regular screening and patient/family education about symptoms 
  • Address psychosocial concerns related to TD in patients with mood disorders and schizophrenia 
  • Select FDA-approved medication to treat TD symptoms, considering research on longer-term efficacy and safety

Release, Review, and Expiration Dates

This brief report activity was published in January 2020 and is eligible for AMA PRA Category 1 Credit™ through February 28, 2022. The latest review of this material was December 2019.

Statement of Need and Purpose

Because some clinicians underestimate the risk of TD, especially with newer antipsychotics, they do not advise patients and caregivers of the risk of TD or educate them about early signs to watch for and report. A substantial proportion of patients with TD do not have a timely diagnosis. Clinicians may not recognize early TD symptoms, as mild cases may be more easily missed. Due to TD movements, patients may stop taking their treatments for mood disorders or schizophrenia. Clinicians may inaccurately rate how bothersome side effects are to patients. New medications for TD are available, and evidence-based treatment recommendations have been published. Recent research has explored longer-term safety and efficacy with newer medications. Clinicians need up-to-date guidance on the prevalence of TD, risk factors for TD, recognition of early signs and symptoms of TD, and assessment tools that will help them diagnose and monitor TD. They also need education about discussing TD risk and signs with patients and family members and should be aware of the burden of TD for patients and families. Up-to-date, evidence-based, expert guidance should be provided on using new medications to treat TD in patients with mood disorders and schizophrenia, including longer-term use.

Disclosure of Off-Label Usage

The chair has determined that, to the best of his knowledge, benztropine is not approved by the US Food and Drug Administration for the treatment of tardive dyskinesia.

Review Process

The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.

Acknowledgment

This Academic Highlights section of The Journal of Clinical Psychiatry presents the highlights of the teleconference series “Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia,” which was held in April, May, and June 2019. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Neurocrine Biosciences, Inc. The teleconference was chaired by Joseph P. McEvoy, MD, from Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University. The faculty was Daniel E. Kremens, MD, JD, from Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Faculty Affiliation

McEvoy, Joseph P
Joseph P. McEvoy, MD
Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University


Kremens Daniel E.
Daniel E. Kremens, MD, JD
Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
 

Financial Disclosure

The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
 

Dr McEvoy has received grant/research support from Takeda, Alkermes, Boehringer Ingelheim, Teva, Neurocrine, and Otsuka; has received honoraria from Neurocrine; and is a member of the speakers/advisory boards for Merck, Neurocrine, and Alkermes. Dr Kremens is a consultant for Teva, UCB, Sunovion, Impax, Lundbeck, Acadia, USWorldMeds, Adamas, AbbVie, Merz, Allergan, Acorda, Kyowa, Neurocrine, GE Healthcare, and St Jude Medical; is a member of the speakers/advisory boards for Teva, UCB, Impax, Lundbeck, Acadia, USWorldMeds, and Adamas; and has received grant/research support from Acorda and Enterin.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.

MOC Approval Statement 

Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification DirectoryEarly Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:

MOC Part II CME Activity 

Psychiatry and Neurology

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
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