Assessment of the Impact of Tardive Dyskinesia in Clinical Practice: Consensus Panel Recommendations

Abstract

Purpose: Tardive dyskinesia (TD) is a hyperkinetic movement disorder in which patients experience abnormal involuntary movements that can have profound negative impacts on physical, cognitive, and psychosocial functioning. Use of measures to assess the functional impact of TD in routine clinical practice is lacking. To address this gap, an advisory panel of experts in psychiatry and movement disorder neurology was convened to develop consensus recommendations on assessment of the impact of TD on patients' functioning that can be used in clinical practice. Methods: An advisory panel provided recommendations using an iterative process, beginning with a narrative literature review regarding current practices for assessing the impact of TD in clinical settings. A detailed summary was generated, and the advisory panel provided comments about the content and answered questions about assessing TD impact in clinical practice. The panelists' responses were discussed during a virtual meeting held on August 28, 2020. A second meeting on September 25, 2020, focused on developing and refining recommendations for assessment of the impact of TD in clinical practice. At the conclusion of the second meeting, general consensus was reached on all recommendation statements. Results: As part of routine clinical practice, it is imperative to assess the impact of TD on the patient's life to help guide treatment decisions. Key domains for assessing the overall impact of TD include social, physical, vocational, and psychological functioning and the impact of TD on the underlying psychiatric disorder. Assessment of TD impact should be performed at every patient visit. Impact assessments should include consultation with patients, caregivers, and family members. Shared decision-making to initiate TD treatment should consider impact. Conclusion:The impact of TD should be assessed routinely, including the key domains of social, physical, vocational, and psychological functioning and the impact of TD on the underlying psychiatric disorder.

Impact-Tardive Dyskinesia (Impact-TD) Scale

“…3,4 The physical symptoms of TD can negatively affect many aspects of a patient's health-related quality of life and/or functioning, including social interaction, employment and education, psychological condition, and self-care/ instrumental activities of daily living. [4][5][6][7] The impact of TD symptoms on a patient's daily life is variable and is not solely dependent on the severity of the movements. Mental health and wellness may be impacted by TD, and TD could potentially exacerbate existing psychiatric comorbidities.…”

Current perspectives on the epidemiology and burden of tardive dyskinesia: a focused review of the clinical situation in Japan

“…Many aspects of our recommendations are in line with the recommendations of US consensus panels published in 2020 107 and 2021. 108 These include the importance of frequent monitoring for TD and an understanding that patients may not be aware of journals.sagepub.com/home/tpp TherapeuTic advances in psychopharmacology their TD symptoms. The importance of involving caregivers and family members in discussions around TD, such as gathering information regarding symptoms and deciding on when and how to treat, was also noted by both US consensus panels.…”

Pathophysiology, prognosis and treatment of tardive dyskinesia

“…4 , 5 TD carries a debilitating social and functional burden for both patients and caregivers. 6 , 7 …”

“…4,5 TD carries a debilitating social and functional burden for both patients and caregivers. 6,7 Knowledge of TD among Japanese physicians is limited, and they may not fully understand the importance of monitoring for this drug-induced movement disorder among patients treated with antipsychotics. An understanding of how to effectively manage patients and when to initiate treatment once diagnosed may also be lacking.…”