Authors of a recent review outlined barriers to tardive dyskinesia diagnosis and how neurologists and psychiatrists can collaborate to optimize care.
Tardive dyskinesia (TD) remains a significant concern in the management of patients treated with dopamine receptor-blocking agents, and greater efforts to diagnose and treat TD are crucial to optimize patient outcomes, according to the authors of a review published in Frontiers in Neurology.
Roongroj Bhidayasiri, MD, and colleagues conducted a systematic review to understand TD’s prevalence, causes, and treatment pathways, as “it is apparent from the global epidemiological data that TD is becoming a considerable public health concern.”
One study, titled RE-KINECT, indicated that one-quarter of patients treated with antipsychotic drugs exhibited involuntary movements consistent with TD. Despite this prevalence, the clinician-rated severity of TD did not always align with patient perceptions. The authors emphasized the need for improved screening and communication practices to bridge this gap.
Dr. Bhidayasiri and colleagues explained that routine screening for abnormal movements using validated scales like the Abnormal Involuntary Movement Scale (AIMS) is crucial. Yet, studies indicate suboptimal implementation, signaling a need for enhanced clinician training and awareness. They added that Impact-TD, a rating scale designed to assess TD’s functional impact, is a valuable tool for clinicians to better understand the movement disorder’s real-world implications.
The authors wrote that prescribing practices also play a pivotal role in TD prevention. Clinicians can minimize risk by employing minimum dose utilization and avoiding polypharmacy. However, clinicians often face pressure to maintain high doses to achieve rapid benefits or manage disruptive behaviors. Evidence-based treatment guidelines offer practical algorithms for dose titration, allowing clinicians to minimize patients’ long-term exposure to high doses.
The rise in off-label antipsychotic drug use for non-psychotic indications also contributes to the burden of TD. While antipsychotics are primarily indicated for psychotic disorders, their expanded use for conditions like depression and anxiety underscores the need for cautious prescribing and ongoing monitoring, Dr. Bhidayasiri and colleagues said.
Treatment of established TD involves careful differential diagnosis and personalized approaches, the authors wrote. VMAT2 inhibitors like deutetrabenazine and valbenazine offer promising avenues for symptom management.
“Research is ongoing to expand the range of treatment options and studies have been undertaken to evaluate the use of vitamins (eg, vitamin E, vitamin B6) and/or supplements (eg, melatonin, branched chain amino acids) to help manage TD. However, although the results from some small studies have been encouraging, more robust evidence is needed to support their widespread use in TD,” Dr. Bhidayasiri and coauthors said.
In addition, patient awareness of TD is crucial for early detection and intervention. Despite the obvious nature of TD symptoms, the authors wrote that studies have shown a concerning lack of patient awareness.
“Recent studies… have revealed that when patients are asked specific questions in simple descriptive terms, over half report being aware of the abnormal involuntary movements of TD and feel they have a significant negative impact on their quality of life. These observations suggest that there is a need to improve knowledge and awareness of TD among patients at risk, so they can report symptoms they experience to their clinician and seek prompt treatment, and that focused discussions are needed between clinicians and their patients regarding their experience of TD symptoms,” the team wrote.
The authors concluded that TD presents a multifaceted challenge that requires a comprehensive clinical approach. They advocated for collaborative efforts between psychiatrists and neurologists to optimize diagnosis, treatment, and long-term management.
“It is recognized, however, that there is no ‘one-size-fit-all’ approach to TD management, and a multidisciplinary approach may not be possible across all clinical practice settings. Some psychiatric clinics may have limited access to movement disorders specialist or involving them may be cost prohibitive. In those cases, it may be more practical to reserve neurology consultation for patients with atypical, severe, or treatment-refractory TD, or when underlying neurologic disorders are suspected,” the authors concluded.
