Tardive dyskinesia can lead to feelings of stigmatization and social withdrawal, as well as a higher utilization of healthcare resources.

Tardive dyskinesia (TD) has negative effects on the health and well-being of patients with psychiatric disorders, explains Caroline M. Tanner, MD, PhD. “Some patients are aware of [their] TD, while others are not,” she says. “For those who are aware, their self-reported ratings of the impact of TD correlate with formal measures of HRQOL. In contrast, physician ratings of TD severity did not show good correlations, highlighting the importance of patient input in making treatment decisions.”

The cumulative impact on patients with a serious mental illness may include worsened psychopathology, poorer treatment outcomes, higher comorbidity rates, and increased risk for mortality, according to Dr. Tanner. “In addition to negatively affecting gait, motor function, and speech, [TD] can also lead to feelings of stigmatization, social withdrawal, and loss of employment. Additionally, patients with TD have higher utilization of healthcare resources.”

Although most patients, caregivers, and clinicians are aware of these negative impacts, quantitative evaluations of HRQOL in TD are extremely limited, according to Dr. Tanner.

To address this knowledge gap, Dr. Tanner and colleagues utilized data from RE-KINECT, a prospective, real-world, observational, multicenter study conducted at 37 outpatient psychiatry clinics in the United States from April 2017 to January 2018. The study, which was published in the Journal of Patient-Reported Outcomes, examined the effects of TD on patient health, social functioning, and HRQOL.

Patient-Reported Outcomes Were Worse in Those with Possible TD

A total of 1,148 patients were divided into two cohorts. Cohort 1 consisted of patients with no abnormal involuntary movements, while Cohort 2 consisted of patients with possible TD per clinical judgement. Assessment tools included Sheehan Disability Scale (SDS) total score (social functioning); EuroQoL’s EQ-5D-5L utility (health); patient-rated impact of possible TD (“none,” “some,” “a lot”); and patient- and clinician-rated severity of possible TD (“none,” “some,” “a lot”).

Additional analyses were conducted via regression models for associations between higher (worse) severity/impact scores and lower (worse) EQ-5D-5L utility (indicated

by negative regression coefficients) and correlations between higher (worse) severity/impact scores and higher (worse) SDS total score (indicated by positive regression coefficients).

“In these analyses, patient-reported outcomes regarding health and physical wellness were generally worse in patients with clinically confirmed possible TD (Cohort 2) than in those with no abnormal involuntary movements (Cohort 1),” Dr. Tanner says. “Patients in Cohort 2 were older, mostly male, had a higher prevalence of schizophrenia or schizoaffective disorders, worse overall health, and less ability to work or study than patients in Cohort 1 (Table). In models adjusting for the contribution of these potential confounders, TD had the most adverse impact in patients who were aware of their TD (Cohort 2A).”

Patient-rated TD impact was significantly linked with EQ-5D-5L utility (regression coefficient: −0.023; P<0.001) and SDS total score (1.027; P<0.001) in the patients with TD who were aware of their abnormal movements (Cohort 2A). Patient-rated severity was notably correlated with EQ-5D-5L utility (−0.028; P<0.05).

The study team found that patients’ perceptions of their condition did not always correlate with clinician-rated severity of TD.

Clinicians Need to Ask Patients Pertinent Questions

“Social functioning and physical wellness were reduced in patients with possible TD,” Dr. Tanner says, “particularly in those who rated their movements as having ‘a lot’ of impact on daily activities. In addition to assessing the presence and severity of patient’s abnormal movements during usual care visits, these outcomes suggest that clinicians should also ask patients about the influence of TD. Patient reports showed a strong correlation with formal measures of HRQOL. Therefore, when making a treatment plan, patient reports of TD impact should be considered.”

This preliminary analysis highlights the importance of the patient and care partner experience, she adds. “What may appear to the clinician to be mild movement disorders may have significant impact on [a patient’s] social functioning and/or activities of daily living and affect QOL,” Dr. Tanner says. “For future research, studies incorporating patient and care partner reports along with formal clinician-rated judgements of movement severity will be important.”

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