Measurement-Based Diagnosis and Treatment for Tardive Dyskinesia
Experts offer a review of the fundamentals of diagnosing and treating tardive dyskinesia.
Tardive dyskinesia (TD) is an involuntary movement disorder associated with agents that block dopamine receptors, particularly antipsychotics. TD commonly involves the orofacial muscles and extremities, and, because these movements are out of the patient’s control, they can have serious physical and psychological effects. An accurate and early diagnosis of TD is crucial because the risk of permanence increases over time. To minimize the risk of TD development, clinicians should use the lowest necessary doses of dopamine receptor blocking agents, and, if allowed by the treated condition, the dopamine receptor blocking agents should be stopped after the shortest necessary time. Clinicians should try to avoid parkinsonian adverse effects and akathisia and prefer second-generation antipsychotics over first-generation antipsychotics. Moreover, clinicians should differentiate between TD and other drug-induced movement disorders, particularly drug-induced parkinsonism, as anticholinergic treatment can worsen TD. To facilitate measurement-based care, clinicians should use the Abnormal Involuntary Movement Scale examination to screen for and routinely monitor TD, especially when providing treatments intended to decrease the symptoms and impact of TD. Two vesicular monoamine transporter-2 (VMAT2) inhibitors, deutetrabenazine and valbenazine, are approved by the US Food and Drug Administration to treat TD. For patients who have moderate to severe or disabling TD, the American Psychiatric Association recommends treatment with the VMAT2 inhibitors. Clinicians should communicate with patients and care partners about risk factors for and signs of TD, as well as available treatment options for TD and what they can expect in terms of short- and long-term results.
From the Series: Revisiting the Fundamentals of Diagnosing and Treating Tardive Dyskinesia
To cite: Correll CU, Citrome LL. Measurement-based diagnosis and treatment for tardive dyskinesia. J Clin Psychiatry. 2021;82(5):NU20016AH2C.
To share: https://doi.org/10.4088/JCP.NU20016AH2C
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- Primary Care Clinicians
- Psychiatric Nurse Practitioners
- Psychiatric Physician Assistants
Select appropriate treatment for patients diagnosed with tardive dyskinesia
Supported by an educational grant from Neurocrine Biosciences, Inc.
After completing this educational activity, you should be able to:
- Select appropriate treatment for patients diagnosed with tardive dyskinesia
Release, Review, and Expiration Dates
This brief report activity was published in August 2021 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2023. The latest review of this material was July 2021.
Statement of Need and Purpose
TD must be detected early to minimize the risk of the movements becoming permanent. But many clinicians are unable to identify risk factors for this condition, are unfamiliar with diagnostic criteria, and do not regularly assess patients for TD. Clinicians, therefore, need education on the risk factors that should alert them to monitor certain patients especially closely for TD and strategies to assess all patients being treated with dopamine-blocking agents and provide an accurate diagnosis. In addition, while treatment for TD is available, with evidence-based recommendations and research on long-term safety and efficacy, clinicians may be slow to implement treatment strategies due to underestimation of the social and occupational impact that TD has on patients’ lives and uncertainty about what to do.
Disclosure of Off-Label Usage
The chair has determined that, to the best of his knowledge, vitamin E, vitamin B6, ginkgo biloba, eicosapentaenoic acid, melatonin, clonazepam, amantadine, donepezil, branched-chain amino acids, reserpine, and tetrabenazine are not approved by the US Food and Drug Administration for the treatment of tardive dyskinesia.
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.
This activity is derived from the teleconference series “Revisiting the Fundamentals of Diagnosing and Treating Tardive Dyskinesia,” which was held in March 2021 and supported by an educational grant from Neurocrine Biosciences, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Christoph U. Correll, MD
Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and Charité Universitätsmedizin Berlin, Germany
Leslie Citrome, MD, MPH
New York Medical College, Valhalla
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 Correll has received grant/research support and honoraria from AbbVie, Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mitsubishi Tanabe Pharma, Mylan (Viatris), Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; has received grant/research support from Janssen and Takeda; is a member of the speakers/advisory boards for Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedInCell, Merck, Mylan (Viatris), Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva; and is a stock shareholder of LB Pharma. Dr Citrome is a consultant for AbbVie, Acadia, Alkermes, Allergan, Avanir, Axsome, BioXcel, Cadent Therapeutics, Eisai, Impel, Intra-Cellular Therapies, Janssen, Karuna, Lundbeck, Luye, Merck, Neurocrine, Noven, Osmotica, Otsuka, Sage, Shire, Sunovion, Takeda, and Teva; is a member of the speakers/advisory boards for AbbVie, Acadia, Alkermes, Allergan, Eisai, Intra-Cellular Therapies, Janssen, Lundbeck, Merck, Neurocrine, Noven, Otsuka, Sage, Shire, Sunovion, Takeda, Teva; is a stock shareholder of Bristol-Myers, Squibb, Eli Lilly, J&J, Merck, and Pfizer; and has received royalties from Wiley, UpToDate, Springer Healthcare, and Elsevier.
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