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Effectively treating both tardive dyskinesia and underlying psychiatric condition

Tardive Dyskinesia, or involuntary and uncontrolled movements in patients with psychiatric disorders, is not a symptom of underlying disease, but rather a side effect of their drug treatment, typically associated with antipsychotic therapies that inhibit dopamine receptors. As such, patients with psychotic disorders such as schizophrenia or bipolar disorder are commonly affected by TD, as well as those prescribed antipsychotics over a prolonged period for other conditions such as major depressive disorder.

In some cases, TD can cause functional impairment, interfering with a patient’s quality of life. It can be embarrassing, socially isolating, and can often add to the stigma related to their mental illness. Proper management of TD is therefore equally as important as managing the underlying psychiatric disorder, in order to provide the best treatment outcome possible. FDA-approved treatments for TD are available, allowing targeted improvement of involuntary movements while maintaining antipsychotic use. Lowering the antipsychotic dose may compromise the primary treatment goal and may result in a relapse with accompanying psychotic or depressive episode.

To what extent does a patient’s TD complicate their overall treatment? Knowing the potential functional, physical, and social stigma issues, how important would you consider managing TD for patient quality of life/outcomes?

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Tardive Dyskinesia – Patient Impact and Management

Tardive Dyskinesia (TD)– is characterized by involuntary and abnormal movements of the tongue, lips, face, trunk, and extremities. Cases of TD are most commonly reported in psychiatric patients with long-term use of dopamine antagonist antipsychotic medication. Typical antipsychotics are most associated with the presentation of TD, however most atypical antipsychotics are also linked to the perpetuation of TD symptoms.

Approximately 20-50% of patients receiving antipsychotics go on to develop TD symptoms. Though antipsychotics can help to alleviate psychosis symptoms, the frequent occurrence of TD and consequent high incidence rate in these patients, can be significantly disruptive to patients’ lives – often preventing successful reintegration.

Alteration or switching of antipsychotic medication is a common approach to managing TD, but specific TD drugs have entered the market over recent years and offer an alternative strategy.

If a patient’s underling psychiatric disorder has been effectively well-controlled and now exhibits TD, should the primary treatment be changed, or should TD symptomatic treatment be added and why? How exactly does TD impact patients’ quality of life?

_{Dhir et al., 2017. ESTIMATION OF EPIDEMIOLOGY OF TARDIVE DYSKINESIA IN THE UNITED STATES (P2.018) Neurology. April 18, 2017; 88 (16 Supplement).
NINDS Tardive Dyskinesia Information Page.3/2018. https://www.ninds.nih.gov/Disorders/All-Disorders/Tardive-Dyskinesia-Information-Page Accessed June 11, 2018.}

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