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Treatment Strategies for Tardive Dyskinesia
Overview
What steps do you take when patients exhibit tardive dyskinesia? Are you familiar with treatment guidelines and data on approved and non-approved strategies? Explore recommendations from Dr Daniel Kremens.
Abstract
Tardive dyskinesia (TD), a condition of potentially irreversible abnormal involuntary movements that is associated with dopamine receptor blocking agents (DRBAs), produces significant impairment of functioning and quality of life for patients. Contrary to expectations, TD has not vanished despite the introduction of SGAs. Instead, changing prescription practices and increased off-label prescription of DRBAs have placed more patients than ever at risk of this potentially dangerous and disabling condition. This activity provides an overview of treatment strategies for TD as part of an individualized management plan, including DRBA medication adjustment and antidyskinetic treatment.
From the Series: Early Recognition and Treatment of Tardive Dyskinesia in Patients with Mood Disorders and Schizophrenia
To cite: Kremens DE. Treatment strategies for tardive dyskinesia. J Clin Psychiatry. 2020;81(1):NU18041BR4C.
To share: https://doi.org/10.4088/JCP.NU18041BR4C
© Copyright 2019 Physicians Postgraduate Press, Inc.
Target Audience
Psychiatrists, Neurologists, nurse practitioners, and physician assistants
Learning Objectives
Use evidence ratings, consensus recommendations, and FDA guidance when devising treatment strategies for patients with
Support Statement
Supported by an educational grant from Neurocrine Biosciences, Inc.
Learning Objective
After completing this educational activity, you should be able to:
Use evidence ratings, consensus recommendations, and FDA guidance when devising treatment strategies for patients with TD
Release, Review, and Expiration Dates
This brief report activity was published in November 2019 and is eligible for AMA PRA Category 1 Credit™ through November 30, 2021. The latest review of this material was October 2019.
Statement of Need and Purpose
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. A substantial proportion of patients with TD do not have a timely diagnosis. Clinicians may not recognize early TD symptoms, as mild cases may be more easily missed. Due to TD movements, patients may stop taking their treatments for mood disorders or schizophrenia. Clinicians may inaccurately rate how bothersome side effects are to patients. New medications for TD are available, and evidence-based treatment recommendations have been published. Recent research has explored longer-term safety and efficacy with newer medications. Physicians need up-to-date guidance on the prevalence of TD, risk factors for the development of TD, how to recognize early signs and symptoms of TD, and assessment tools that will help them diagnose and monitor TD. They also need education about discussing TD risk and signs with patients and caregivers. Physicians need awareness of the burden of TD and need up-to-date, evidence-based, expert guidance on using new medications in the treatment of TD in patients with mood disorders and schizophrenia, including longer-term use. 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 TD.
Disclosure of Off-Label Usage
Dr Kremens has determined that, to the best of his knowledge, tetrabenazine, levetiracetam, zonisamide, piracetam, propranolol, vitamin B6, botulinum toxin, clonazepam, gingko biloba, pallidal DBS, and ECT are not approved by the US Food and Drug Administration for the treatment of tardive dyskinesia.
Review Process
The faculty member(s) agreed to provide a balanced and evidence-based presentation and discussed the topic(s) and CME objective(s) 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.
Acknowledgment
This Brief Report is derived from the teleconference series "Early Recognition and Treatment of Tardive Dyskinesia in Patients with Mood Disorders and Schizophrenia," which was held in April, May, and June 2019 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.
Faculty Affiliation
Daniel E., Kremens, MD, JD
Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
Financial Disclosure
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 CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships.
Dr Kremens is a consultant for Teva, UCB, Sunovion, Impax, Lundbeck, Acadia, USWorldMeds, Adamas, AbbVie, Merz, Allergan, Acorda, Kyowa, Neurocrine, GE Healthcare, and St Jude Medical; is a member of the speakers/advisory boards for Teva, UCB, Impax, Lundbeck, Acadia, USWorldMeds, and Adamas; and has received grant/research support from Acorda, and Enterin. The Chair for this activity, Joseph McEvoy, MD, has received grant/research support from Takeda, Alkermes, Boehringer Ingelheim, Teva, Neurocrine, and Otsuka; has received honoraria from Neurocrine; and is a member of the speakers/advisory boards for Merck, Neurocrine, and Alkermes.
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 0.50 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, Treatment Strategies 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
Available Credit
- 0.50 AMA PRA Category 1 Credit™
- 0.50 Participation