Tardive Dyskinesia: A Comprehensive Look at the Condition and Its Management

There are approximately 600,000 people in the US who are living with TD—65% of them have not been diagnosed.

According to Sarayu Vasan, MD, MPH, and Ranjit K. Padhy, MD, from UCLA—Kern Medical, tardive dyskinesia (TD) is common among patients with schizophrenia or bipolar disorders who are treated with antipsychotic medications. However, they note that TD can ultimately occur in any disorder.¹

Physician’s Weekly (PW) spoke with Morgan Braun, PharmD, MS, HEOR director for Ingrezza at Neurocrine, to better understand the factors linked with the development and underdiagnosis of TD and receive an update for new treatment options.

PW: How do you suggest assessing and monitoring the factors associated with the development of TD for patients receiving long-term antipsychotic treatment?

Dr. Braun: Patients who take antipsychotic medications for a prolonged period have additional risk factors for TD, which are identified in the literature. Some of these are aspects like being older than 55 years, being postmenopausal, having a substance use disorder, and having a mood disorder.

Healthcare providers must monitor this over time. Having periodic screenings for abnormal movements if patients are taking an antipsychotic medication is essential. It’s easier to detect, diagnose, and have appropriate management.

There are approximately 600,000 people in the US who are living with TD—65% of them have not been diagnosed. Only a small portion of the total population with TD has been diagnosed. I think people would benefit if we could reduce this rate of undiagnosed TD through screenings.

In recent years, the American Psychological. Association (APA) created guidelines for the treatment of schizophrenia, and it recommends that healthcare providers screen for TD because they know that these patients are at risk. Screening should be every six months, especially in high-risk patients, and at least 12 months for those who are at risk of developing TD with those same risk factors.

How do you suggest approaching early detection of TD, and what specific symptoms do you look for?

Initiating conversations with patients on antipsychotic medications is important. Having that initial conversation of let’s look out for potential movements that you feel are uncontrollable, giving examples of what they are, and just being proactive in the recognition and treatment of those could be important to the patient. I think it’s also important to ask the patient and their families, “Are they aware that they have these movements?” If they are unaware, ask, “What have your family or friends said?”

Getting that conversation started is important, and letting patients know we will watch out for symptoms is also important.

Are there any updates or discoveries in the treatment of TD?

The FDA approved Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors to treat TD. Previously, that had not been the case. As I mentioned, the APA now has guidelines for patients with moderate to severe TD to be treated with VMAT2. That’s an advancement in this area, and as we noted earlier, approximately 65% of patients living with TD haven’t been diagnosed. This underscores the importance of increasing awareness and letting people know there are treatments and guidelines; there’s still space for diagnosis and providing tools.

Healthcare providers can visit sites, such as MIND TD, that provide information on how to identify TD and how to differentiate that from other movement disorders. These sites provide a big push in terms of just educating what TD is versus other movements that providers see.

Along with MIND TD, we have introduced DISCOVER TD. This interactive digital tool can be accessed at MIND TD and helps healthcare providers learn how to identify TD. This gamification and education tool also provides opportunities to ask questions. Using this tool, providers can screen, diagnose, and determine appropriate management while also receiving help distinguishing characteristics of TD’s movements versus other DMDs. Although these are just simulated exams, they can help physicians diagnose and manage TD properly.

How can collaboration with other healthcare professionals provide comprehensive care for patients with TD?

Mental health continues to be a significant challenge here in the US. Certainly, with what’s happened postpandemic, it’s important to include TD in the conversation. Yes, we know there’s movement, but there are other impacts, other functional impacts, social impacts, and socialization impacts that are so important now, especially postpandemic, and then there are emotional consequences that we’ve learned.

This disorder has a gamut of things that could happen to a patient. Having them maintain mental health stability with antipsychotic medications is important. But on the other hand, it’s also important to watch out for TD and to treat it appropriately.