How to tell if my patient has TD

TD involves specific types of uncontrollable movements in the face, torso, and limbs.1 Unlike other movement disorders, TD involves repetitive, stereotypical, athetoid (writhing) movements.2

Facial (oro-buccal-lingual) movements

Repetitive chewing movement, sometimes with smacking or puckering lips, sticking out tongue, puffing out cheeks, frowning or grimacing, and grunting3-5

Truncal movements

Axial pulling or twisting, shoulder shrugging, rocking and swaying, and rotating or thrusting hips3

Extremity movements

“Piano-playing” fingers, splayed or hyperextended toes, and foot tapping3

Signs of TD develop during antipsychotic exposure or within 4 weeks of withdrawal (or 8 weeks of withdrawal from a long-acting injectable). There must be a history of use of the agent for ≥3 months (or 1 month in individuals ≥60 years). Abnormal movements must persist for at least 4 weeks.1,6

Ask the Faculty

Robert A. Hauser, MD, MBA, FAAN

What kinds of truncal movements may be observed in patients with TD?

See the truncal movements associated with TD

The Everyday Impact of TD

Even mild TD movement severity has the potential to impact patients’ physical functioning, including mobility, pain/discomfort, self-care, and ability to perform usual activities. It can also affect their psychological wellbeing—decreasing confidence, self-esteem, and self-worth.5,7,8 Many patients may start skipping doses of their antipsychotic medication, or stop going to see a healthcare provider. Their uncontrolled movements may also impair their ability to work or may cause them to miss work.8

Expert Insights

Beyond Movement: Appreciating the Social Impact of Tardive Dyskinesia

Listen to Dr Greg Mattingly, a psychiatry expert in St. Louis, Missouri, and Tammy LeBlanc-Russo, a psychiatric nurse practitioner in Upstate New York, discuss the social impact of TD

Podcast

•

~3 mins

•

Feb 2022

0:00
0:00

Dr Mattingly: More than three-fourths of patients with possible tardive dyskinesia knew it was there when asked.1 And when asked if it bothered them, another three-fourths of patients with movements consistent with tardive dyskinesia admitted they were embarrassed.1 Patients might say, “I know something’s wrong but I don’t know quite what it is. Because of the way I look, I’m embarrassed to sit and eat at a dinner table with other people, and I’m embarrassed to be in public or to be with friends.”

Ms LeBlanc-Russo: That’s right. And when somebody’s embarrassed, what does that do to their social interactions? These patients are generally already struggling with other mental health issues, and now we might have to work on self-esteem and self-worth. It can add a whole other layer of illness, I think.

Dr Mattingly: Tammy, I have a family member with schizophrenia. She lives in a group home with other women with chronic mental health conditions. I’ve seen firsthand how tardive dyskinesia is not just having uncontrollable movements; patients might also be embarrassed to come out and interact, be part of a group, to sit at the dinner table, and join social activities.

Ms LeBlanc-Russo: Tardive dyskinesia can impact work life, too.1 I’ve seen folks leaving work early because they feel like somebody is looking at them or staring at them, and that can lead them down a rabbit hole of feeling bad about themselves. They can start getting tearful, and then they have to go home for the day.

Dr Mattingly: Our goal in treating mental health conditions is to get people back into life. Get them back holding a job, going to school, and interacting socially. That can be disrupted when you’re embarrassed by the way you look. Tardive dyskinesia can further complicate the mental health burden.

Ms LeBlanc-Russo: I hope we helped to raise tardive dyskinesia awareness among our colleagues, so we can improve the lives of people out there who are struggling with tardive dyskinesia. I want patients to know they’re not alone, and there are options that can help.

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

Reference

  1. 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.

Spotlight on the Impact of TD

Explore the full library

You've just learned:

  • How movement disorders are distinctive and require their own distinct treatments1
  • The symptoms of TD in the face, trunk, and limbs3-5
  • TD can have a social, emotional, and professional impact on patients5-8


Now learn about the tests used to screen for and diagnose TD.

Go to Screening and Assessment

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. American Psychiatric Association; 2022.

  2. Fahn S, et al, eds. Principles and Practice of Movement Disorders. 2nd ed. Saunders; 2011:415-446.

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

  4. Lumetti S, et al. Case Rep Dent. 2016;2016:7167452.

  5. McEvoy J, et al. Qual Life Res. 2019;28(12):3303-3312.

  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. American Psychiatric Association; 2022.

  7. Tanner CM, et al. J Patient Rep Outcomes. 2023;7(1):21.

  8. Jain R, et al. J Clin Psychiatry. 2023;84(3):22m14694.