Using realistic diagnostic criteria will increase prevention of tardive dyskinesia.
Christoph U. Correll, MD
Monitoring patients from baseline throughout treatment, screening patients for tardive dyskinesia (TD) risk factors and using reliable diagnostic tools are key factors in identifying the disorder as early as possible, according to a new review. But understanding the risk factors in order to take steps to prevent TD is more valuable.
Researchers from Texas and New York investigated the prevalence and phenomenology of TD to shed light on the burden of the condition and explore early recognition techniques.
“We highlight the importance of proper screening, recognition and differential diagnosis to identify tardive dyskinesia early and adequately in order to then take steps towards improving this condition that has the potential to increase stigma, illness burden and poor quality of life and outcomes in people afflicted with tardive dyskinesia,” study author Christoph U. Correll, MD, told MD Magazine.
One literature review showed that incidence of TD remained relatively unchanged from the 1980s. The annualized rate of TD in another review showed 3.9% for secondary generation antipsychotics (SGAs) and 5.5% for first-generation antipsychotics (FGAs). Correll noted in the study that methodological reasons might be the explanation behind the differing incident and prevalence rates.
In a study of more than 11,000 patients, the global mean TD prevalence was 25.3%, while TD rates were lower with SGA treatment (20.7%) compared to FGA treatment (30%). Again, Correll said that methodological problems could contribute to these differences.
“Clinicians may have developed a false sense of security and become less vigilant about necessary safeguards against tardive dyskinesia, such as educating patients about the risk of tardive dyskinesia, obtaining informed consent prior to initiating treatment, and monitoring for early signs of abnormal movement,” researchers wrote
Awareness of the risk factors for tardive dyskinesia is important because it can often be reversible. The study authors said the best strategy to combat tardive dyskinesia is prevention. Beyond the debate over FGAs and SGAs, older age, being female, and non-white ethnicity can all contribute to tardive dyskinesia. Certain comorbidities also pose risk for developing tardive dyskinesia, such as psychosis (especially schizophrenia), mood disorders, diabetes or HIV.
The quality of life for a patient with TD can be greatly impacted in both medical and psychological realms. Impairments such as orolingual tardive dyskinesia can impact communication, breathing, and food intake and upper extremity tardive dyskinesia can prevent some patients from carrying out normal daily tasks. Gait and posture can also be affected after trunk and lower extremity TD.
Psychologically, anxiety can develop in patients with tardive dyskinesia; some patients have lower cognitive capacity. Additionally, between one half and two thirds of tardive dyskinesia patients are estimated not to even be aware of their involuntary movements. In some of these patients, this might be attributed to their severe mental illness. These patients may even feel suicidal and experience social isolation, Correll said in the study, when they feel scrutinized by those around them.
Symptoms of TD can develop after 3 months of antipsychotic treatment, or after several years, or after the medication is discontinued. They can be subtle and fluctuating, which can lead to misdiagnoses due to mental disorders. However, the American Psychiatric Association recommends that all patients on antipsychotics should be monitored for TD, the researchers reminded readers. Using the Abnormal Involuntary Movement Scale can be useful, which includes checks in the face, extremities, or trunk areas on the patient. Criteria published in 1993 suggested using that scale at the beginning and end of a clinical visit.
The paper, titled “Tardive Dyskinesia: Recognition, Patient Assessment, and Differential Diagnosis,” was published in The Journal of Clinical Psychiatry.