What’s Next for Tardive Dyskinesia? Expert Insights from a Cross-Disciplinary Virtual Treatment Panel

Purpose: To present findings from panel discussions with healthcare professionals who participated in virtual interviews regarding the diagnosis and treatment of tardive dyskinesia (TD) in real-world clinical settings.

Rationale: TD is a persistent and potentially disabling movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents (DRBAs). Despite the availability of approved TD medications (e.g., valbenazine), diagnosis of this disorder remains complex and appropriate treatment remains important.

Methods: In July 2020, 12 experts (6 neurologists, 3 psychiatrists, 3 psychiatric nurse practitioners) participated in individual semi-structured qualitative interviews about how TD is diagnosed and treated in the clinical practice setting. Topics included education, TD screening, diagnosis, assessment, and treatment; opportunities for improving TD diagnosis and treatment outcomes; barriers to treatment; and patient/caregiver perspectives. In November 2020, separate group discussions with the psychiatrists and neurologists were conducted to discuss the implementation of telehealth in diagnosing and treating TD. No quantitative or statistical methods were applied. The key findings presented at this meeting are intended to be narrative in nature.

Results: The panel generally agreed that any history of DRBA use raises suspicion of potential TD, and that all DRBA-treated patients should be monitored accordingly. More education is needed, particularly with regards to differential diagnosis; this may require more consistency in terminology across medical specialties. Telehealth with video can be an effective tool for TD diagnosis and monitoring, but the complexity of the TD patient population may present challenges. First-line treatment with an approved TD medication (e.g., valbenazine) is recommended; anticholinergics are not appropriate for treating TD. Barriers to treatment include clinicians’ misconceptions (e.g., TD as symptom of underlying disease), patients’ lack of awareness, lack of approved treatments until recently, and patients’ unwillingness to be treated.

Applicability to APN practice: Despite the availability of FDA-approved TD medications, differential diagnosis and misconception/misinformation about TD are key obstacles to adequate treatment and optimizing patient outcomes. These challenges could be addressed through healthcare professional education on the diagnosis/clinical presentation and treatment of TD, whether virtually or in-person. Telehealth with video could be used to diagnose TD and assess changes over time.