An Experimental Study to Assess the Professional and Social Consequences of Tardive Dyskinesia

Abstract

Objective: Antipsychotic medications may cause tardive dyskinesia (TD), an often-irreversible movement disorder characterized by involuntary movements that are typically stereotypic, choreiform, or dystonic and may impair quality of life. This study evaluated others' perceptions of abnormal TD movements in professional and social situations. Methods: This was an experimental, randomized, blinded, digital survey in a general population sample. Participants were randomized 1:1 into a test or control group to view a video of a professional actor simulating TD movements or no TD movements prior to completing surveys on employment, dating, and friendship domains. Assessments for mild-to-moderate and moderate-to-severe TD movements were conducted separately. Authenticity of abnormal movements and Abnormal Involuntary Movement Scale (AIMS) scores were evaluated by physician experts. Results: Surveys were completed by 2,400 participants each for mild-to-moderate and moderate-to-severe TD. In all domains, participants responded significantly less favorably to persons with TD movements (both mild-to-moderate and moderate-to-severe) than those without TD movements. Fewer participants in the test versus control group for mild-to-moderate and moderate-to-severe TD, respectively, considered the candidate as a potential employee (29.2% and 22.7% fewer), found him/her attractive (20.5% and 18.7% fewer), and were interested in becoming friends with him/her (12.3% and 16.5% fewer). Conclusion: Professional actors simulating TD movements were perceived more negatively than those without TD movements in employment, dating, and friendship domains. To our knowledge, this is the first randomized study to quantify professional and social stigma associated with TD movements that may reduce opportunities for gainful employment, marital status, and an effective support system.

The Clinical and Economic Burden of Tardive Dyskinesia in Israel

“…Outcome measures included (1) the physician specialty at first diagnosis of TD, (2) the proportion of patients receiving medications for TD (Supplemental Table 1, http://links.lww.com/JCP/ A820, which shows all medications considered), (3) the relative TD treatment coverage calculated by dividing the period of treatment for TD by TD duration from diagnosis to end of follow-up, (4) temporary discontinuation of TD treatment defined as a gap between purchases greater than the number of days of medication supplied by the last purchase plus a grace period of 120 days, and (5) permanent discontinuation of TD treatment defined as a gap between last purchase and end of follow-up greater than the number of days of medication supplied by the last purchase plus a grace period of 120 days.…”

“…It is characterized by involuntary hyperkinetic movements in the oral/lingual/buccal area, trunk, or extremities. Although the social stigma caused by TD is obvious, 1 in some cases, TD also leads to impaired speech or swallowing, dental damage, and difficulties with gait and posture that affect activities of daily living 2–4 . As a consequence, patients with TD experience significantly impaired health-related quality of life and increased morbidity compared with non-TD patients with mental illness 2,3,5–7 …”

A new era in the diagnosis and treatment of tardive dyskinesia

“…120,127 While severe TD may impair functioning in all affected people, even mild TD may have profound effects on an individual. 128 Recent studies have documented the impact of TD and piloted the use of rating scales that incorporate functional measures. Additional evidence is needed on the predictive validity of AIMS scores in determining the effect of TD on functioning and quality of life.…”

“…The impact of TD is critical in determining how severity and changes in abnormal movements affect functioning and quality of life 120 127 While severe TD may impair functioning in all affected people, even mild TD may have profound effects on an individual 128 . Recent studies have documented the impact of TD and piloted the use of rating scales that incorporate functional measures.…”

Analysis of Antipsychotic Dosage in Patients With Tardive Dyskinesia: A Case-Control Study Using the Claims Database of the Corporate Health Insurance Association

“…In addition to physical discomfort, TD often results in low productivity, stigma, social alienation, increased mortality, and nonadherence to treatment for the underlying disease. [4][5][6][7][8][9][10][11] Because the impact of TD on the patient, including the quality of life, is significant, identifying the risk of TD and early detection are essential. 12 The recommended dosage of antipsychotics is the minimum effective dose, carefully considering the benefits of prescribing antipsychotics to each patient and the risk of developing TD.…”