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How does tardive dyskinesia (TD) impact your patients?

Take on TD—start the conversation with your patients and their caregivers about TD.

To support you in your conversations, we’ve prepared clinical resources to help you identify, understand, and manage TD.

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TD can be a burden on patients and disrupt their lives, whether they have mild, moderate, or severe TD1-5,a

EmbarrassmentAbnormal and involuntary movements may cause embarrassment in public
Exacerbation of StigmaPsychiatric patients may already have difficulty gaining stability and social acceptance
IsolationLoss of physical control may make patients more likely to withdraw from social situations

aResults based on a survey of 267 people diagnosed with TD (n=74) or suspected of TD (n=193) who were asked, “Tardive dyskinesia may impact you in many different ways. To what extent has tardive dyskinesia impacted you in each of the following areas?” Responses were based on a 7-point Likert scale of “Not at all impacted” to “Extremely impacted.”

I think there are a lot of patients that are living with TD that are afraid and ashamed of what other people may think.”

Terrylin

Real patient living with depression and TD

Of patients with mild to severe TD (n=127)a >50% reported meaningful negative emotional, social, and psychological impact1,b

Of patients with major depressive disorder and TD (n=64)a 90% reported low to medium ability to perform daily tasks1,b

  • a Self-reported as diagnosed by a physician.

  • b Question from research: Tardive dyskinesia may impact you in many different ways. To what extent has tardive dyskinesia impacted you in the following areas? Responses were based on a 7-point Likert scale of “Not at all impacted” to “Extremely impacted.” Results shown include responses of ≥6.

  • b Question from research: How would you rate your current ability to undertake your regular daily activities? Responses were based on a 3‑point scale selection of “Low,” “Medium,” or “High.”

Patient Survey Design

The blinded online survey was conducted between April 26 and November 20, 2017.1 There were 2 versions of the survey:

  • Sample A, for antipsychotic patients (n=2419)
  • Sample B, for TD-diagnosed patients (n=127) and symptomatic, undiagnosed patients (n=44)

Screening criteria

  • Sample A (n=2419)1
  • 18 years or older
  • Diagnosed with psychiatric or gastrointestinal disorder requiring treatment with a dopamine receptor blocking agent (DRBA)
  • Have taken a DRBA within the past 2 years
  • Not diagnosed with TD
  • Sample B (n=171)1
  • Currently taking a DRBA or have taken a DRBA in the past 12 months
  • Self-reported as diagnosed with TD by a physician (with the exception of the symptomatic, undiagnosed patients)
  • Experienced TD symptoms (involuntary, repetitive movements) after initiation of DRBA therapy

TD can affect anyone taking or who has taken DRBAs6,7

drbas-chat-bubbles

Patients often don’t proactively talk about the signs of TD,8 so it’s important to identify those at risk.

drbas-calendar

Signs of TD can develop in as early as a few months after starting dopamine receptor blocking agent (DRBA) treatment.6

drbas-hand

For some patients, signs of TD may persist even after stopping or switching DRBA treatment.6

Looking back, I think I kind of tried to ignore the symptoms at first because I didn’t even want to acknowledge them.”

Shelly

Real patient living with bipolar disorder and TD

TD may be more prevalent than you think 500,000 people in the United States are estimated to be affected by this chronic condition1,9,10

TD clinical guidelines and recommendations

2020 American Psychiatric Association (APA) guidelines2

  1. Screen for TD before starting or changing patients’ DRBA treatment
  2. Monitor for signs of TD at each visit
  3. Conduct structured TD assessment every 6 to 12 months, depending on patient’s risk, and if new or worsening movements are detected at any visit
  4. Consider a diagnostic evaluation

2013 American Academy of Neurology (AAN) guidelines11

The 2013 American Academy of Neurology (AAN) guidelines indicate that there is a lack of clear evidence to support or refute withdrawing causative agents or switching from first-generation to second-generation antipsychotics to treat TD.11

2018 systematic review of new evidence12

Consider a new treatment algorithm for patients with TD.12

I travel by public transportation, and kids turn around and stare at me because they don’t understand why this man’s making faces.”

Jeff

Real patient living with schizophrenia and TD

Identify the signs of TD in your patients who take DRBAs

The signs of TD have distinct characteristics6,13

checked

Athetoid (slow, snake-like, and writhing) and/or choreiform (rapid and jerky)

checked

Variable frequency and amplitude

Involuntary movements are often seen in the face, trunk, and extremities6,14

Talk to your patients about managing their TD

There are treatment options

Learn more

REFERENCES: 1. Data on file. Neurocrine Biosciences, Inc. 2. Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American Psychiatric Association Publishing, 2020. https://psychiatryonline.org/doi/pdf/10.1176/appi.books. 9780890424841. Accessed September 1, 2020. 3. Boumans CE, de Mooij KJ, Koch PA, et al. Is the social acceptability of psychiatric patients decreased by orofacial dyskinesia? Schizophr Bull. 1994;20(2):339-344. 4. Othman Z, Ghazali M, Razak AA, Husain M. Severity of tardive dyskinesia and negative symptoms are associated with poor quality of life in schizophrenia patients. Int Med J. 2013;20(6):677-680. 5. Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992. 6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013:712. 7. Kenney C, Hunter C, Davidson A, et al. Metoclopramide, an increasingly recognized cause of tardive dyskinesia. J Clin Pharmacol. 2008;48(3):379-384. 8. Macpherson R, Collis R. Tardive dyskinesia: patients’ lack of awareness of movement disorder. Br J Psychiatry. 1992;160:110-112. 9. Cloud LJ, Zutshi D, Factor SA. Tardive dyskinesia: therapeutic options for an increasingly common disorder. Neurotherapeutics. 2014;11(1):166-176. 10. Dhir A, Schilling T, Abler V, Potluri R, Carroll B. Estimation of tardive dyskinesia incidence and prevalence in the United States [abstract]. Mov Disord. 2017;32(suppl 2). https://www.mdsabstracts.org/abstract/estimation-of-tardive-dyskinesia-incidence-and-prevalence-in-the-united-states/. Accessed July 11, 2019. 11. Summary of evidence-based guidelines for clinicians: treatment of tardive syndromes. American Academy of Neurology website. https://www.aan.com/Guidelines/Home/GetGuidelineContent/613. Published 2013. Accessed August 22, 2018. 12. Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn OS. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018;389:67-75. 13. Lane RD, Glazer WM, Hansen TE, Berman WH, Kramer SI. Assessment of tardive dyskinesia using the Abnormal Involuntary Movement Scale. J Nerv Ment Dis. 1985;173(6):353-357. 14. Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.

This is an educational site for healthcare professionals about a drug-induced movement disorder called tardive dyskinesia (TD).