Although assessing and reducing the severity of tardive dyskinesia (TD)—a persistent and potentially disabling movement disorder linked with exposure to antipsychotics and other dopamine receptor blocking agents—is crucial for clinical management, it is also important to note TD’s impact on patients and their caregivers, explains Joseph McEvoy, MD, Professor Emeritus of Psychiatry and Behavioral Sciences at Duke University. “TD symptoms, such as impaired physical and social function, can cause embarrassment in many patients,” Dr. McEvoy says, “and can significantly reduce quality of life (QOL) for both patients and caregivers. Highly functioning patients who are aware of their symptoms—for example, those with mood disorders—may be especially bothered by their TD movement, even if the movements are ‘mild,’ in terms of amplitude and frequency.”
To better understand the impact of TD on well-being and health state in patients who are aware of their TD, data from the real-world RE-KINECT study were analyzed. Results were presented at the recent 2021 Annual Meeting of the American Psychological Association (APA).
Mental Health, Movement Disorders Most Worrisome
More than 200 adults with 3 months or more of antipsychotic exposure, one or more psychiatric disorders, and abnormal movements confirmed by a clinician as possible TD, were evaluated. Patient-reported assessments were as follows: impact of possible TD: “none”, “some”, or “a lot” on physical abilities; the Sheehan Disability Scale (0 to 30 (maximum disruption); and the EQ-5D 5-Level visual analog scale 0 to 100 (best possible health). Based on responses from 82 aware patients, mental health ranked highest as the most worrisome condition, followed by movement disorders. In addition, both mental health and movement disorders required the most time to manage.
Findings from the RE-KINECT study show the potential impact of possible TD on overall well-being. In patients who were aware of their possible TD, greater negative impact on physical abilities (“some” or “a lot” versus “none”) was associated with greater functional impairment and diminished overall health. These results indicate the importance of asking patients how TD affects their daily lives and monitoring treatment in areas of most concern.
Caregivers, Families Should Participate in Assessments
“In severe cases, balance and/or ambulation can be impaired by excessive movements in the arms, legs, or trunk,” Dr. McEvoy says. “In milder cases, TD may not be easily apparent during the visual assessment. For instance, toe or foot tapping may not be visible is a patient’s feet are covered by shoes or socks. Furthermore, some patients may not be aware of their abnormal movements due to cognitive impairment from underlying severe schizophrenia, while others may not report TD symptoms due to embarrassment or greater concern with other medical or psychiatric conditions. Therefore, caregivers and/or family members should be encouraged to participate in the patient’s assessments, as they can provide useful information about the location and severity of any abnormal movements, as well as the impact of these movements on the patient’s function and QOL.”
Poster Session 11 Monday, May 03, 2021 1:30 PM – 2:00 PM
ASTRACT: Stanley Caroff; Paul Lewis; Morgan Bron; Ericha Franey; Rahul Dhanda
https://www.psychiatry.org/psychiatrists/meetings/annual-meeting
