Spotlight on the Psychosocial Impact of Tardive Dyskinesia
Tardive dyskinesia (TD) can cause significant impairments in quality of life and psychosocial functioning among patients receiving antipsychotic medications or other dopamine antagonists.1-3 In survey-based studies, 90% of patients with TD have reported impairments in physical functioning, and 75% and 80% of patients reported various social and psychologic impairments, respectively.4 Up to 60% of patients with TD reported feeling self-conscious or embarrassed about their movements.4
The substantial impact of living with TD underscores the importance of clinician awareness in ensuring timely diagnosis and treatment of TD.5
To get a better understanding of the psychosocial burden and management of TD, weinterviewed Danielle Nicole Larson, MD, assistant professor of neurology in the division of movement disorders at Northwestern University Feinberg School of Medicine in Chicago, Illinois.
[C]ounseling patients about the natural course of TD and setting certain expectations can help decrease the mental burden of TD.
Based on your observations in clinical practice, what do patients report as some of the biggest challenges of living with TD? Overall, how does TD affect quality of life and mental health?
Dr Larson: The largest impact of TD is on patients’ comfort levels in social situations, with patients often expressing concerns about social stigma. As a result, patients may avoid social situations, including more intimate group settings, leading to increased isolation, worsening anxiety, and depression.
Another impact of TD is on daily functions, such as eating and chewing. If buccal-oral TD is significant, it can interfere with chewing and swallowing, making it difficult for patients to eat, leading to weight loss in severe cases. This effect can also compound social isolation, if individuals avoid shared meals due to buccal-oral TD.
What are some of the typical treatment strategies to help manage TD? What approaches should be used to address the mental health impact of living with TD?
Dr Larson: An initial treatment approach for TD can be dose reduction of the antidopamine blocking agent – typically an antipsychotic agent – if deemed safe and tolerable by patients.
If the antipsychotic agents are not suitable for patients or in the event that TD symptoms do not improve, then a second treatment approach is considered. Typically, we use a vesicular monoamine transporter 2 (VMAT-2) inhibitor medication, such as tetrabenazine and newer formulations of valbenazine and deutetrabenazine.4 However, these medications may increase risk for suicidality, and therefore, must be prescribed with psychiatrist approval.
In addition, counseling patients about the natural course of TD and setting certain expectations can help decrease the mental burden of TD.
What are other key considerations for clinicians regarding diagnosis and treatment of TD?
Dr Larson: Diagnosis and treatment approaches for TD are optimal when there is multidisciplinary care with close communication between psychiatrist and neurologist.
Treatment approaches should typically include counseling patients on the cause of TD, expected symptoms of the condition, and the different therapeutic options. Treatment modality and approach should be determined in a shared decision-making between the provider team and the patient.
What is the focus of ongoing research regarding TD, and what further developments would you like to see in this area?
Dr Larson: I would like to see new treatment options with better safety profiles, so that concerns about worsening of psychiatric conditions can be addressed.
Several TD-specific drugs are in development, including longer-acting VMAT-2 inhibitor forms6 and drugs that target different molecular pathways and mechanisms.
This article originally appeared on Psychiatry Advisor
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