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Tardive Dyskinesia: Subtle Symptoms and the Huge Impact of Early Recognition and Intervention
Overview
Clinicians should screen regularly for signs and symptoms of tardive dyskinesia and educate patients and caregivers on what to look for and report, leading to earlier intervention and better quality of life.
Learning Objectives
After completing the educational activities, learners will be able to:
- Conduct regular screenings for signs of TD during follow-up visits after treatment initiation
- Educate patients and family members about TD, including how to recognize the symptoms
- Use best practices that are based on evidence and expert consensus to manage TD
- Select FDA‐approved medication to treat TD
Target Audience
Psychiatrists and psychiatric nurse practitioners and physician assistants; primary care clinicians
Program Description
Tardive dyskinesia (TD) is a medication-induced movement disorder that can last decades and is often a permanent condition. TD affects 25% to 30% of patients taking antipsychotic medications and 26% to 67% of patients on long-term dopamine antagonists. Clinicians should regularly screen patients with a history of neuroleptic use for signs and symptoms of TD, such as dystonia, buccolingual stereotypy, chorea, akathisia, tics, or other abnormal involuntary movements, particularly if they appear within 1 to 2 years of continuous exposure to the medication. However, TD can appear earlier, especially in the elderly population. A differential diagnosis requires excluding other involuntary movements such as habits, mannerisms, paroxysmal dyskinesias, and benign hereditary chorea and other disorders, including myoclonus, dystonia, tics, and chorea. Structured instruments for TD assessment include the Abnormal Involuntary Movement Scale (AIMS) and the Dyskinesia Identification System: Condensed User Scale (DISCUS). These screenings should be administered at the time of new onset or exacerbation of an existing movement disorder as well as every 6 months to patients at high risk of developing TD and every 12 months to other patients. Educating patients and families about the risk of TD associated with chronic neuroleptic use as well as signs and symptoms of the disorder are an important piece in earlier invention of this distressing disorder, improving quality of life and leading to better patient outcomes.
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Support Statement
Supported by an educational grant from Teva Pharmaceuticals.
Learning Objective
After completing this educational activity, you should be able to:
- Conduct regular screenings for signs of TD during follow-up visits after treatment initiation
- Educate patients and family members about TD, including how to recognize the symptoms
- Use best practices that are based on evidence and expert consensus to manage TD
- Select FDA‐approved medication to treat TD
Release, Review, and Expiration Dates
This CME activity was published in November 2022 and is eligible for AMA PRA Category 1 Credit™ through November 30, 2023.
Statement of Need and Purpose
Clinicians who treat patients with dopamine receptor blocking agents—such as antipsychotics for schizophrenia, bipolar disorder, or major depression—need to consider the risk for tardive dyskinesia (TD), educate patients and their families about the risk and early signs, recognize early symptoms, and provide treatment. 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 about the risk of TD, educate them about early signs to watch for and report, or conduct routine screenings. Effective medications for TD should be implemented as appropriate, incorporating data on the functional impact of TD on the patient. Clinicians need education on evidence‐based, expert‐consensus care for TD.
Unlabeled and Investigational Usage
The faculty of this educational activity may include discussions of products or devices that are not currently labeled for use by the FDA. Faculty members have been advised to disclose to the audience any reference to an unlabeled or investigational use.
No endorsement of unapproved products or uses is made or implied by coverage of these products or uses.
Please refer to the official prescribing information for each product for discussion of approved indicators, contraindications and warnings.
Review Process
The faculty members agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives 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.
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
© Copyright 2022 Physicians Postgraduate Press, Inc.
Faculty Affiliation
Martha Sajatovic MD
University Hospitals Cleveland Medical Center
Cleveland, OH
Joseph McEvoy MD
Medical College of Georgia
Augusta, GA
Faculty Disclosure
The CME Institute adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME). Any individuals in a position to control the content of a continuing education activity, including faculty, content developers, reviewers, staff, and others, are required to disclose to learners the presence or absence of any relevant financial relationships with an ACCME-defined ineligible company within the preceding 24 months of the activity. The ACCME defines an “ineligible company” as one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
The CME Institute has mitigated all relevant conflicts of interest prior to the commencement of the activity. None of the individuals involved in the content have relevant financial relationships with ineligible companies except the following:
Individual Financial Disclosures
Dr Sajatovic receives consulting fees from Alkermes, Otsuka, Sunovion, Janssen, Lundbeck, Teva, Clinical Education Alliance, and Health Analytics; has conducted research sponsored by Nuromate, Otsuka, and International Society for Bipolar Disorders (ISBD); and has received publication royalties from Springer Press, Johns Hopkins University Press, Oxford Press, and UpToDate.
Dr McEvoy has received consulting fees from Clarion Healthcare and Neurocrine Biosciences; and has conducted research sponsored by Alkermes, Biogen, Boehringer Ingelheim, Millennium Pharmaceuticals, Otsuka, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), and National Institute of Mental Health (NIMH).
Michael R. Page, PharmD, RPh
Independent Medical Director/Medical Writer
Plainsboro, New Jersey
Dr. Page is a consultant for BioCentric, Inc. and American Medical Communications, Inc.
None of the other planners, reviewers, and CME Institute staff for this educational activity have relevant financial relationships with ineligible companies to disclose. All relevant financial relationships have been mitigated.
Accreditation Statement
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.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 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.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation