Strategies for Detecting and Treating Tardive Dyskinesia
ORLANDO—The availability of new drugs for tardive dyskinesia (TD) means mental health clinicians have an increased responsibility to proactively screen for the movement disorder and treat it when detected, attendees of a Psych Congress Regionals meeting here were told.
Psych Congress cochair Rakesh Jain, MD, MPH, strongly urged the audience to administer the Abnormal Involuntary Movement Scale (AIMS) exam to any patient who is taking an atypical antipsychotic, and to maintain documentation of the test. “You’ve got to do it. It is not open to negotiation,” he said.
The occurrence of TD in the United States is expected to increase for the next 10 to 20 years because atypical antipsychotics are being used more frequently, including in females (who are at higher risk of mood disorders and TD) and younger people. While the rate of schizophrenia is not increasing, depression and autism—2 other conditions which antipsychotics can be used to treat—are becoming more common.
There are no atypical or typical antipsychotics that do not carry a risk of TD, said Dr. Jain, a psychiatrist in private practice and Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center School of Medicine, Midland.
“The risk to patients and…the medical and legal risk to you and me is substantial and growing, so do watch out,” he said. “No longer should you and I pretend it doesn’t exist, (that) it won’t happen to me. It can and will happen to all of us.”
An estimated 500,000 Americans have TD, but less than 5000 are receiving any type of treatment for it, according to Dr. Jain.
He recommended that clinicians avoid using antipsychotics when possible, and when they are needed, to choose the medication which causes the fewest extrapyramidal symptoms (EPS). The induction of EPS is a marker for later developing TD, he said.
For patients in whom chronic and impairing TD develops, Dr. Jain urged clinicians to become acquainted with 2 drugs approved this year for treatment of the condition: valbenazine and deutetrabenazine.
Dr. Jain said he does not favor one of the drugs over the other, and each is worth trying in patients with TD. They are fairly different, and no studies have compared the 2 to each other, he said. In clinical trials, they both had large effect sizes with minimal side effects, according to Dr. Jain.
Both drugs are selective vesicular monoamine transporter 2 (VMAT2) inhibitors, and, Dr. Jain said, have an approach which is much more precise than that of many psychiatric drugs.
“VMAT2 inhibition is a new mechanism of action in psychiatry,” Dr. Jain said. “We haven’t had a new mechanism of action in psychiatry in a long time. It’s time to embrace it.”
Psych Congress cochair Charles Raison, MD, called the newly approved compounds “profoundly effective,” saying he could not believe how the field of TD treatment has “exploded” in the last year.
See more highlights from the Orlando meeting: #PsychCongressOrlando Tweets
“Advances in the Management of Tardive Dyskinesia.” Presented at the Psych Congress Regionals meeting: Nov, 18, 2017; Orlando, FL.