How to Evaluate Patients for Tardive Dyskinesia
Although clinicians are pressed for time, diligence in assessing for tardive dyskinesia in patients taking antipsychotics is crucial, especially now that treatment is available. In this brief CME activity, Dr Nierenberg describes the evaluation process.
- Nurse practitioners (NPs)
- Physician assistants (PAs)
Conduct regular screening for signs of TD
Tardive dyskinesia (TD) is a serious and potentially irreversible movement disorder that occurs in 20%–50% of patients taking antipsychotic drugs. TD is also associated with several other classes of medications, including antidepressants, antihistamines, decongestants, mood stabilizers, and stimulants. As more people are prescribed medications that can increase the risk for TD, it is important that clinicians learn how to systematically and reasonably evaluate their patients for this potentially dangerous and debilitating condition.
From the Series: JCP Fundamentals: Getting Back to the Basics—Diagnosing, Treating, and Educating Patients With Tardive Dyskinesia
To cite: Nierenberg AA. How to evaluate patients for tardive dyskinesia. J Clin Psychiatry. 2021;82(1):NU19047BR1C.
To share: https://doi.org/10.4088/JCP.NU19047BR1C
© Copyright 2020 Physicians Postgraduate Press, Inc.
Supported by an educational grant from Neurocrine Biosciences, Inc.
After completing this educational activity, you should be able to:
- Conduct regular screening for signs of TD
Release, Review, and Expiration Date
This brief report activity was published in November 2020 and is eligible for AMA PRA Category 1 Credit™ through November 30, 2022. The latest review of this material was September 2020.
Statement of Need and Purpose
Clinicians may not recognize early TD symptoms, as mild cases may be more easily missed. A substantial proportion of patients with TD do not have a timely diagnosis, meaning that treatment is delayed and the chance for a poor outcome is increased. Because some clinicians underestimate the risk of TD, especially with newer antipsychotics, they do not advise patients and caregivers of the risk of TD or educate them about early signs to watch for and report. Therefore, clinicians need education on the rates of TD with SGAs and FGAs; risk factors for the development of TD; how to use assessment tools that will help them diagnose and monitor TD; and discussing TD risk and signs with patients and caregivers. In addition, physicians need awareness of evidence-based, expert guidance on using approved medications in the treatment of TD, because effective medications for TD are available, and evidence-based treatment recommendations have been published. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on tardive dyskinesia.
Disclosure of Off-Label Usage
Dr Nierenberg has determined that, to the best of his knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.
The faculty member agreed to provide a balanced and evidence-based presentation and discussed the topic and CME objective during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
This activity is derived from the teleconference series “JCP Fundamentals: Getting Back to the Basics—Diagnosing, Treating, and Educating Patients With Tardive Dyskinesia,” which was held in March–September 2020 and supported by an educational grant from Neurocrine Biosciences, Inc. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Andrew A. Nierenberg, MD
Dauten Family Center for Bipolar Treatment Innovation, and the Depression Clinical and Research Program, Massachusetts General Hospital; and Department of Psychiatry, Harvard Medical School, Boston
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosures are as follows:
Dr Nierenberg is a consultant for Acadia Pharmaceuticals, Eisai Inc., and Myriad Genetics and is a member of the speaker/advisory boards for Alkermes, Jazz Pharmaceuticals, Safe Pharmaceuticals, Otsuka Pharmaceuticals, and Neuronetics Inc. The Chair for this activity, Joseph P. McEvoy, MD, has received grant/research support from Biogen, Alkermes, Boehringer Ingelheim, Takeda, Auspex (Teva), and Lundbeck and is a member of the speaker/advisory boards for Intracellular and Sunovion.
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
MOC APPROVAL STATEMENT
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, How to Evaluate Patients for Tardive Dyskinesia has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC PART II CME ACTIVITY
Psychiatry and Neurology
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation