"'We Need to Look, We Need to Ask.' Spotting Tardive Dyskinesia in Practice" is a promotional educational program sponsored and co-developed by Neurocrine Biosciences and is not certified for continuing medical education. The speakers are presenting on behalf of and are paid consultants for Neurocrine Biosciences. The information presented is consistent with FDA guidelines. 

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Dr Mattingly: Today, we are talking about tardive dyskinesia—particularly its impact on patients.


Ms LeBlanc-Russo: This is an important topic. Many of our colleagues may not be thinking about tardive dyskinesia, because they believe that, with the second-generation antipsychotics, it’s not a big deal anymore.1


Dr Mattingly: But the numbers tell us tardive dyskinesia is still prevalent,1 right Tammy?


Ms LeBlanc-Russo: Yes. We can’t say, “Oh, it’s rare,” when that’s not the case.2 It may be less noticeable, but we need to look for it.1

Dr Mattingly: Good point. We need to look, we need to ask! My patients don’t typically come in with a crisis of tardive dyskinesia, so it’s easy to miss.3 I think many patients are struggling in silence.

Ms LeBlanc-Russo: I’m frequently the one bringing up tardive dyskinesia with patients when I notice a symptom. For example, I mentioned to a patient that it looked like she was sucking on a piece of candy.4 After I said that, she told me that her sibling was refusing to sit next to her during meals because the sucking noises annoyed her.



That was an impactful problem, but if I hadn’t asked, the patient wouldn’t have mentioned it.



Any of the symptoms may not be obvious at the exam. I had a patient whose symptoms were with her feet and toes,4 and I missed it. Now with everything being virtual, it’s even more important to ask the right questions.



Dr Mattingly: It’s interesting because some studies have shown that patients don’t notice tardive dyskinesia. But if you ask the right questions, you find patients are very good reporters. So as we use telemedicine and digital tools, how do we ask the right questions?

Ms LeBlanc-Russo: Clinicians should have a few key questions to ask the patients that would get them thinking about red flags, and then maybe they can move to the Abnormal Involuntary Movement Scale, which is commonly known as the AIMS.5


Thanks for tuning in. There are more resources on tardive dyskinesia to explore, which have been created with your busy schedule in MIND.

Related Resources

References

  1. Carbon M, Hsieh CH, Kane JM, Correll CU. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264-e278.

  2. Cloud LJ, Zutshi D, Factor SA. Tardive dyskinesia: therapeutic options for an increasingly common disorder. Neurotherapeutics. 2014;11(1):166-176.

  3. Hansen TE, Brown WL, Weigel RM, Casey DE. Underrecognition of tardive dyskinesia and drug-induced parkinsonism by psychiatric residents. Gen Hosp Psychiatry. 1992;14(5):340-344. 

  4. Tarsy D. Curr Treat Options Neurol. 2000;2(3):205-214.

  5. Caroff SN, Yeomans K, Lenderking WR, et al. RE-KINECT: a prospective study of the presence and healthcare burden of tardive dyskinesia in clinical practice settings. J Clin Psychopharmacol. 2020;40(3):259-268.