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Teresa Brown, Manoj Waikar Commented on a Post
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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?

  • 8 months 3 weeks
    As a Licensed Psychologist and a person in treatment for Bipolar Disorder, I think I can speak to the effects of tardive dyskinesia and the treatment of same. I have been in treatment for Bipolar Disorder for many years. I have worked as a counselor also for many years. For several years, I have struggled with mouth movements, where my jaw would move involuntarily from side to side. Under stress, I was very aware of facial grimacing. These movements did effect my participation in the work world. I recall an instance where my supervisor and a person under my supervision were in a meeting and I was very aware of my facial grimacing. I felt that my participation in the meeting was being misunderstood, therefore, I explained that I was on a medication that resulted in the facial movements. My supervisor thanked me for sharing that, indicating that my facial expressions were compromising the information that was being discussed. I have a very astute psychiatrist, whom addressed my mouth movements at each session. Various options were tried, but it wasn't until I was prescribed Ingrezza that I gained relief from the awful facial movements. I believe it was about three months of gaining gradual relief until I was free of that side effect. Notably, over a longer period of time, I also gained relief from an awful skin picking disorder, which I also attribute to the Ingrezza. Ingrezza is expensive, and I hope that persons insurances do cover the cost. I am able to stay on my mixture of medications, which have afforded me long term stability, due to the addition of Ingrezza in my medication regime.
  • 8 months 3 weeks
    I think it is essential to encourage treatment whenever we see TD regardless of how we or even the patient and caregivers might minimize it. Once we had a safe, FDA approved treatment (ingrezza) available I began to proactively treat TD and the psychosocial improvements were almost as profound as the mitigation of unwanted movements.
  • from Generation NP 8 months 3 weeks
    I have used Ingrezza for the treatment of tardive dyskinesia and parkinsonian traits. I did see a substantial decrease in involuntary movement and improvement in quality of life with my patients. I did continue the use of antipsychotics. I am a Psychiatric Nurse Practitioner and work in an inpatient psychiatric hospital. Antipsychotic therapy is essential with my population, as most are diagnosed schizophrenia or schizoaffective disorder. I have not personally used Astedo, but only Ingrezza. I felt that the medication was well tolerated in my patients, with no side effects. They each showed a decrease in their AIMS scoring and an increase in quality of life. I did not see any change in their psychiatric health, thus there was no impact on their antipsychotic medication's potency.
  • 8 months 4 weeks
    What a balancing act! Serious mental illness with often disastrous results for under treatment or no treatment VS. risks of SEs with aggressive treatment strategies, such as atypicals. Today, TD is pretty well controlled in most pts w/ Ingrezza or Austedo. In my experience, families most always opt for mood symptom relief over SE risks.
  • 8 months 4 weeks
    Does anyone use these for Tardive Parkinsonism? Do you continue Anti-psychotic? Which ones work best in combination with Ingrezza or Astedo?
  • 9 months 2 weeks
    TD is a debilitating condition for my patients both emotionally and physically. We, as physicians, need to be cognizant of the serious medication side effects and to screen our patients routinely via AIMS, labs...etc. It is also important to educate our patients to be vigilant in monitoring the side effects as they can be insidious and subtle in the beginning.
  • 9 months 2 weeks
    it is a debilitating side effect of treatment and in most cases in my opinion is irreversible even though Ingrezza and Austedo may offer some relief however subjectively patients' suffering will result in halting treatment specially in our system of health care .
  • 9 months 3 weeks
    I believe that TD is not given the attention warranted by the impact it has. Unfortunately neither the typical physician nor patient tends to appreciate the impact it has on the patient's biopsychosocial wellness. I've seen patients where significant TD abnormal movements were not noticed by the patient/family and other cases where somehow I failed to notice long-standing TD symptoms but the patient brought it to my attention after seeing advertising. We must all improve our proactive scrutiny of patients who have been exposed to antipsychotics.
  • 9 months 3 weeks
    The promise of the atypical antipsychotics introduced gradually during the past 3 decades or so, was to reduce the incidence of Tardive Dyskinesia or totally avoiding its occurrence altogether.However, lots of times patients with chronic mental illness and frequent relapses and hospitalizations end up with some restricted formulary and they are exposed to different conventional antipsychotics. Thus I continue to encounter patients who manifest wit the involuntary movements. The key here is the degree of impairment and distress. I find most of the times those patients who experience circumoral movements and complain of "swallowing their tongues" to be the most distressed and needing adequate treatment. Tardive Dyskinesia can also affect swallowing in general such as the case of Parkinson's disorder. Various known steps to reduce the impact such as switching to the more refined atypical antipsychotics, the use of Clozaril ( not very practical ) and use of various antiparkinson agents such as Amantadine, Cogentin and Artane should be attempted. The new agents VMAT-2 inhibitors limited use are due to being cost prohibitive and difficult accessibility.
  • 9 months 3 weeks
    I have diagnosed and offered medication to a few of my patients for TD (I only have a few). One of them had recovery when we changed medication. The others were not interested in medication, as the symptoms don't bother them. They happened to be retired people who are not out socializing that much, and the TD was not severe. I have yet to find someone who is interested in adding another medication to treat TD.
  • from Generation NP 9 months 3 weeks
    I've seen results with Vitamin B6 used for td, usually doses between 50-200 mg po q day. Look it up. Ingrezza and Austedo have studies by the pharm companies to support their use, but I've also read physician editorial lamenting their poor efficacy. I try changing the med, lowering the dose or trying B6 as first lines of management.
  • 10 months 1 week
    I have a number of patients with TD, many of whom are not aware of the symptoms. Those who are, often make excuses for same. More often than not, medication is refused. The few patients that have agreed to a medication trial of Ingrezza or Austedo do so because they are self conscious in public and this causes isolation. When treated, they feel better and are able to return to outside activities they like.
  • from Generation NP 10 months 1 week
    Managing TD is very important. I find many patients are non-compliant with medications due to side-effects. TD is very intrusive and embarrassing according to patients I have worked with. Treating TD can improve outcomes and decrease chances of non-compliance with medication regime, which can prevent relapses. Patients are very grateful and thankful when they notice improvement with their TD symptoms.
  • 10 months 4 weeks
    In speaking with patients who experience TD, it's almost a painful experience. Not necessarily severe physical pain, but psychic, mental pain that can easily impair daily functioning and leads to various inabilities and ultimately to disability.
  • from Neurologist Connect 10 months 4 weeks
    Awareness about TD among physician and patient is utmost important. Diagnosis and Management of TD is very rewarding from physician and patient point of view.

    We have more option available now to treat TD. Most important factor that determine success for the TD treatment is Communication with prescriber of offending agent and adjustment of medication.

  • 10 months 4 weeks
    I think more patients have TD than we can actually know, and my patients only complain about it when the symptoms are sever and debilitating, at which time treatments to reduce TD may not be fully effective.
  • 10 months 4 weeks
    I remember being a student and fearing that i would be sued due to TD.
    It was and is worse with the conventionals, so I think the warnings for atypicals are a bit excessive, especially since my experience is that it's very individualized, although higher risks are noted; and, that doesn't really matter what your risks are now that you have it. As we move away from D2 receptor blockade, hopefully, we naturally move away from TD.
    I'm glad that there are 2 FDA approved meds for TD; both since it adds credibility to patients symptoms, but also provides an option when antipsychotics are needed.
  • 10 months 4 weeks
    TD makes managing any patient taking any antipychotics difficult because lowering the dose to reduce TD may not work and may exacerbate the symptoms of the disorder requiring antipsyhotic treatment. In addition TD itself causes embarrassment and may impede socialization and interefere at times with ADLs
  • 11 months
    Ingrezza has made huge difference in some of our chronic patients who have been suffering from TDs for years and nothing has helped TV his far. With easy application for patient assistant program, things got much easier and encouraging, even in inpatient settings.
  • 11 months
    TD is still a major issue in treatment with Antipsychotic medications. This is why it is still important to do regular AIMS exams, especially in high risk patients.
  • 11 months
    Just one more comment. Prevalence of TD is still quite high. Originally we thought it was 10 X less with atypical APDs than with conventional 1st gen APDs. We know now it is higher than that. Let's not become complacent about this devastating condition. Remember, every strated muscle in your body is susceptible, including the diaphragm. Again, early detection and Tx is key.
  • 11 months
    Awareness and early Tx of TD is really just as important as ever. Just because it's no longer the # 1 reason for lawsuits in psychiatry doesn't mean it's less worthy of our attention. These VMAT 2 blockers really do seem to substantially improve this condition. Please don't be hesitant to use them if needed. Something else is germane to this discussion. How to pick up on early signs of TD during telemed appointment. Working on a modified AIMS that is made for telemed. Wish my mentor Dr Glazer (Yale TD clinic head and world leader) was here to work with again. Stay safe everyone.
  • 11 months
    Td is annoying very important to treat patient and care givers extremely stressful treatment improves quality of life
  • 11 months
    Now a days as we are using atypical antipsychotics the incidence of TD is very low as compare to the time when we were using typical antipsychotics. AS AIMS scale is not done thoroughly during pt's consultation due to fast paced practice trend especially in Community mental health clinic some of these mild cases probably are missed.
  • 11 months
    I've found many of my pts with TD, especially in pts treated for many yrs with atypical so. Often this is worsened with the augmentation strategies of newer atypical so in treating resistant depressions, both major and bipolar types. Since we have melds which help and allow pts to remain on their meds and preserve their well fought-for stability. ID and treatment allow for better QOL with much less embarrassment.
  • from Neurologist Connect 11 months
    TD can have highly variable effects on different patients, ranging as has been posted from no complaints up to substantial morbidity and social embarrassment. Sometimes the benefit from antipsychotic medication therapy on the previous condition(s), such as psychosis or depression, is so high that TD is a relatively minor consideration in care. Utilization of VMAT-2 inhibitors can compliment other therapies, such as switching antipsychotics. Sometimes botulinumtoxin therapies can be beneficial as well. As with all medical management issues, treatment should be individualized. Some patients may benefit greatly, while others may find time and expenses to be unjustified.
  • from Neurologist Connect 11 months
    I believe that TD is hugely important to my patients and their overall quality of life. I compare it to a severe essential tremor. It can be very limiting and embarrassing for patients. It can prevent them from completing ADLs as well as participating in social situations. I will most always recommend treatment with with Austedo or Ingrezza for these patients. My experience has been positive with these drugs and they have improved the patient’s overall quality of life.
  • 11 months
    In my experience few of patients I know have complaints, may be I don't have many with TD, but I think by definition it is chronic and the patients adapt to it , may be because they are not aware of the recent treatment available
  • from Neurologist Connect 11 months
    TD management is extremely important to improve social stigma, Quality of life without compromising underlying psych treatment & management. As of today we have to choice Ingrezza & Austedo, both effective & encouraging response as long as covered by insurance. Overall outcome is good with these treatment!