Tardive Dyskinesia: Impacts, Assessment, and Treatment Options

Gain fresh insights into the multifaceted impacts of tardive dyskinesia (TD) with Psych Congress Steering Committee Member Desiree Matthews, PMHNP-BC, as she explores the physical, social, and emotional consequences faced by patients living with TD. Matthews describes key assessment strategies and the differences between VMAT2 inhibitors, offering valuable insights for health care professionals in managing this condition.

For more TD treatment insights and resources, visit our Tardive Dyskinesia Excellence Forum.

Read the Transcript:

Desiree Matthews, PMHNP-BC: Hello, my name is Desiree Matthews. I am a psychiatric nurse practitioner, and I work at a community mental health center in Charlotte, North Carolina.

Question: What are the non-physical consequences individuals with TD may face, and why is it crucial health care professionals understand these impacts?

Nurse Matthews: When it comes to patients living with tardive dyskinesia, we unfortunately know this can have a physical impact on patients. For example, falls risk and changes in their strength and mobility.

But, sometimes what we don't talk about is the impact on social and emotional wellbeing. We know through various surveys and studies that patients certainly do recognize these movements. They can feel embarrassed and withdraw from social activities.

If you ask care partners or caregivers, they too share a burden with patients living with tardive dyskinesia, including having to help patients make appointments and feeling worried about a patient not being able to do something at home. Also, they're coming home early from work because they need to help console a patient or help make appointments—communication needs.

Really, tardive dyskinesia is very pervasive in terms of its impact on all domains. Again, we have a lot of studies and new growing evidence for that.

Q: What are the key assessment strategies for TD detection and evaluation, and how can they benefit health care professionals?

Nurse Matthews: When it comes to screening for tardive dyskinesia, it is really important for us as providers to understand the recommendations for our screening tools. Number one, the American Psychiatric Association (APA) recommends that we do an abnormal involuntary movement scale every 6 to 12 months for patients at high risk and then at least once a year for patients at usual risk.

It's also important to note that [the APA] wants to step further beyond the AIMS scale and make sure that we clinicians do a clinical assessment for TD and other movement disorders at every single encounter or visit.

So, what does that mean? What does a clinical assessment look like?

For me and other clinicians in practice, a clinical assessment includes looking for TD by briefly using a few activation maneuvers to see if we can uncover any movements, for example, watching them when they're walking down the hall to our appointment. Also asking key targeted questions.

We have a few tools out there now, one being the Impact TD scale, to help us ask questions in very patient-centric language—asking them about movements, asking if there's impact to their daily activities. We also have the MIND-TD questionnaire that we can use as a brief screener. The great thing about that is anybody that trained in the office can use this very helpful tool.

Q: Can you briefly highlight the differences between the VMAT2 inhibitors approved for the treatment of TD?

Nurse Matthews: For our options here in the US, we have 2 VMAT2 inhibitors approved for the treatment of tardive dyskinesia in adults—deutetrabenazine and valbenazine. There are no head-to-head studies when it comes to efficacy or safety, but what I can tell you is that the differences lie in the pharmacodynamics and the pharmacokinetics.

I think the most important thing to understand is that these 2 molecules are different. They both block VMAT2 and the important thing is we understand that they are both FDA approved.

They are both efficacious and very well tolerated in most individuals. Because they are different, I do recommend to patients and their families that if they do not do well on one VMAT2 inhibitor, we can try the other. When you're conforming a treatment plan, you have to understand pathways in terms of metabolism and drug-drug interactions.

I approach VMAT2 inhibitors and look at the patient as a whole on their needs and their current medical medications because this may have me go to one VMAT2 inhibitor over the other.

Thank you all for joining me today, my name is Desiree Matthews and check back for more updates.

Desiree Matthews, PMHNP-BC, is a board certified psychiatric nurse practitioner with expertise in treating patients living with severe mental illness. Beyond clinical practice, Desiree has provided leadership in advocating for optimal outcomes of patients and elevating health care provider education. Desiree is the founder and owner of Different MHP, a telepsychiatry practice founded with the mission of providing affordable, accessible precision focused, integrative psychiatry to patients through a rich and comprehensive mentorship of the health care providers within the company.