Psychosocial Implications of Tardive Dyskinesia in Patients With Mood Disorders Versus Schizophrenia
How does tardive dyskinesia affect patients' work and relationships? Should TD be treated even if patients lack insight into its presence? Learn from this CME.
Dopamine receptor blocking agents—including antipsychotics—can produce tardive dyskinesia (TD). First-generation antipsychotics were effective in treating schizophrenia and severe forms of bipolar disorder; however, they were associated with substantial extrapyramidal effects, especially at high doses. Second-generation antipsychotics are effective and produce fewer adverse movement effects; nevertheless, the risk for TD was not eliminated. Tardive dyskinesia can be distressing to patients with good insight into their illness and the movements, especially if they are working and in relationships, and should be treated to improve psychosocial outcomes. In patients with poor insight into their illness and lack of awareness of their TD symptoms, clinicians should treat TD if it causes severe impairment.
From the Series: Early Recognition and Treatment of Tardive Dyskinesia in Patients With Mood Disorders and Schizophrenia
To cite: McEvoy J. Psychosocial implications of tardive dyskinesia in patients with mood disorders versus schizophrenia. J Clin Psychiatry. 2019;80(6):NU18041BR2C.
To share: https://doi.org/10.4088/JCP.NU18041BR2C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Psychiatrists, neurologists, nurse practitioners, and physician assistants
Address psychosocial concerns related to TD in patients with mood disorders and schizophrenia
Supported by an educational grant from Neurocrine Biosciences, Inc.
After completing this educational activity, you should be able to:
- Address psychosocial concerns related to TD in patients with mood disorders and schizophrenia
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. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on TD.
Release, Expiration, and Review Dates
This brief report activity was published in October 2019 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2021. The latest review of this material was August 2019.
Disclosure of Off-Label Usage
Dr McEvoy has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this activity.
The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) 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 a peer reviewer who is without conflict of interest.
This activity is derived from the teleconference series "Early Recognition and Treatment of Tardive Dyskinesia in Patients with Mood Disorders and Schizophrenia," which was held in April—July 2019 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.
Joseph P. McEvoy, MD
Medical College of Georgia, Augusta
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 CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships.
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.
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.
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.50 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 Directory, Psychosocial Implications of Tardive Dyskinesia in Patients With Mood Disorders Versus 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
- 0.50 AMA PRA Category 1 Credit™
- 0.50 Participation