Tardive dyskinesia among patients using antipsychotic medications in customary clinical care in the United States

Abstract

Background Tardive dyskinesia (TD) is a movement disorder resulting from treatment with typical and atypical antipsychotics. An estimated 16–50% of patients treated with antipsychotics have TD, but this number may be underestimated. The objectives of this study were to build an algorithm for use in electronic health records (EHRs) for the detection and characterization of TD patients, and to estimate the prevalence of TD in a population of patients exposed to antipsychotic medications. Methods This retrospective observational study included patients identified in the Optum EHR Database who received a new or refill prescription for an antipsychotic medication between January 2011 and December 2015 (follow-up through June 2016). TD mentions were identified in the natural language–processed clinical notes, and an algorithm was built to classify the likelihood that the mention represented documentation of a TD diagnosis as probable, possible, unlikely, or negative. The final TD population comprised a subgroup identified using this algorithm, with ≥1 probable TD mention (highly likely TD). Results 164,417 patients were identified for the antipsychotic population, with1,314 comprising the final TD population. Conservatively, the estimated average annual prevalence of TD in patients receiving antipsychotics was 0.8% of the antipsychotic user population. The average annual prevalence may be as high as 1.9% per antipsychotic user per year, allowing for a more-inclusive algorithm using both probable and possible TD. Most TD patients were prescribed atypical antipsychotics (1049/1314, 79.8%). Schizophrenia (601/1314, 45.7%), and paranoid and schizophrenia‐like disorders (277/1314, 21.1%) were more prevalent in the TD population compared with the entire antipsychotic drug cohort (13,308/164,417; 8.1% and 19,359/164,417; 11.8%, respectively). Conclusions Despite a lower TD prevalence than previously estimated and the predominant use of atypical antipsychotics, identified TD patients appear to have a substantial comorbidity burden that requires special treatment and management consideration.

Antipsychotic-induced extrapyramidal side effects: A systematic review and meta-analysis of observational studies

“…Regarding the geographical distribution, the review included six studies from Europe [4,[25][26][27][28][29], five studies from Asia [30][31][32][33][34], two studies from Africa [35,36], one study from South America [37], and one study from North America [38]. Thirteen of these studies had employed cross-sectional design [4,26,[28][29][30][31][33][34][35][36][37] with two of which being a retrospective chart review [25,32] and the remaining two studies had employed cohort design [27,38]. The sample size of individual studies ranged from 28 [29] to 164,417 [38].…”

“…Thirteen of these studies had employed cross-sectional design [4,26,[28][29][30][31][33][34][35][36][37] with two of which being a retrospective chart review [25,32] and the remaining two studies had employed cohort design [27,38]. The sample size of individual studies ranged from 28 [29] to 164,417 [38]. Thirteen studies were conducted in hospital settings [4,[26][27][28][29][30][31][33][34][35][36][37][38] whereas two studies were conducted at rehabilitation centers [25,32].…”

Drug-induced tardive dyskinesia

“…Распространенность ТД на фоне приема атипичных антипсихотиков колеблется от 16 до 50% [31,32]. Однако в ретроспективном исследовании [33] базы данных Optum EHR, в котором участвовали 164 417 пациентов, получавших антипсихотики (при этом ТД отмечалась в 1314 случаях), было выявлено, что ежегодная средняя распространенность ТД в данной популяции составляет лишь 0,8%. В ряде работ ТД реже встречалась при приеме атипичных антипсихотиков, чем антипсихотиков первого поколения [34].…”

“…В исследовании A.M. Loughlin и соавт. [33] более чем у половины пациентов (57,5%) исходное ЛС было заменено на другое, а у 1,5% доза исходного ЛС была снижена.…”

Personalized treatments in neuropsychiatric disorders

“…Maes et al (2020) performed an association study between the dystrobrevin‐binding protein 1 gene ( DTNBP1 ) and tardive dyskinesia associated with antipsychotic treatment in patients with a diagnosis of schizophrenia or schizoaffective disorder. Tardive dyskinesia is one of the most detrimental side effects of antipsychotics, with an estimated lifetime prevalence of about 16%–50% of treated patients (Loughlin et al, 2019). DTNBP1 is a well‐known risk factor for schizophrenia, has been associated with cognitive defunctions and with altered dopamine and glutamatergic transmission (Papaleo & Weinberger, 2011).…”