By: Cecilia Peterson; Amanda Glazar; Chirag Shah; Prakash Masand; Michael Lemon
Introduction: Tardive Dyskinesia (TD) refers to abnormal, involuntary, choreoathetoid movements of the tongue, lips, face, trunk, and extremities and is associated with long-term exposure to dopamine-blocking agents, such as antipsychotic medications. The movements are disfiguring and can bring unwanted attention to affected individuals. When severe, especially if the respiratory muscles are affected, the movements can be disabling, limit activity, and reduce quality of life. The prevalence is 7.2% in individuals on newer antipsychotics who have never been exposed to older neuroleptics. Until recently, there were no effective treatments for TD. In recent years, many new treatments have been investigated, including valbenazine, deutetrabenazine, and branched chain amino acids. A virtual broadcast was developed to assess the ability of continuing medical education (CME) to improve awareness of the recognition and treatment of TD among psychiatrists.
Methods: The virtual broadcasts (May 9, 2020 & August 13, 2020) consisted of a two-hour, live-streamed discussion between two expert faculty. Impact of the activity was assessed by comparing learners’ responses to four identical questions presented before and directly after activity participation. A follow-up survey was sent to all learners six-weeks post-activity to measure performance in practice changes. A chi-square test identified significant differences between pre- and post-assessment responses while a Cohen’s d test calculated the effect size of the virtual broadcast.
Results: Activity participation resulted in a noticeable educational effect among learners (n=1,159; d=2.57, P<.001). The following areas showed significant (P <0.05) pre- vs post-educational improvements: recognition of movements in patients with TD, differential diagnosis of TD, rate of TD in SGA exposed patients, treatment options for TD (on and off-label), and treatment of TD using VMAT2 inhibitors. Additionally, 54% of learners reported a change in practice performance as a result of the education, including utilizing a standard scale to evaluate movement disorders and educate patients and family members about potential for TD and how to recognize symptoms.
Conclusions: The results indicated that a CME-certified two-hour virtual broadcast was effective at improving knowledge among learners for the recognition and treatment of TD. This knowledge also resulted in positive changes in practice performance post-activity. However, despite significant educational improvements in these key areas, there remains an opportunity to educate on appropriate evidence-supported TD treatment strategies. Although, recommendations from APA guidelines suggesting there is a lack of evidence supporting changes to antipsychotic dosing and evidence suggesting anticholinergic use may exacerbate dyskinesias, these treatment options continue to be used inappropriately in the management of TD.
Poster Session 11 Monday, May 03 1:30 PM – 2:00 PM
https://www.psychiatry.org/psychiatrists/meetings/annual-meeting
