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![Health-related quality of life in patients with and without TD. a SW-ISMI score for patients without TD vs those with TD. For the SW-ISMI scale, higher values indicate worse social withdrawal. b SF-12v2 score and c Q-LES-SF score for patients without TD vs those with TD. For the SF-12v and Q-LES-Q SF scales, higher scores indicate better quality of life status [21]. *Not significant when model includes severity of BD, MDD, or SZ as measured by CGI on a seven-point scale. BD bipolar disorder, CGI clinical global impression, SW-ISMI Social Withdrawal subscale of the Internalized Stigma of Mental Illness scale, MCS mental component summary of the SF-12, MDD major depressive disorder, PCS physical component summary of the SF-12, PF physical functioning of the SF-36v2, Q-LES-Q SF Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, SF-12 SF-12v2 Health Survey, SZ schizophrenia, TD tardive dyskinesia. The data show group mean ± standard error, represented by the error bars](publication/335312686/figure/fig4/AS:962159467065367@1606408101933/Health-related-quality-of-life-in-patients-with-and-without-TD-a-SW-ISMI-score-for.png)
Health-related quality of life in patients with and without TD. a SW-ISMI score for patients without TD vs those with TD. For the SW-ISMI scale, higher values indicate worse social withdrawal. b SF-12v2 score and c Q-LES-SF score for patients without TD vs those with TD. For the SF-12v and Q-LES-Q SF scales, higher scores indicate better quality of life status [21]. *Not significant when model includes severity of BD, MDD, or SZ as measured by CGI on a seven-point scale. BD bipolar disorder, CGI clinical global impression, SW-ISMI Social Withdrawal subscale of the Internalized Stigma of Mental Illness scale, MCS mental component summary of the SF-12, MDD major depressive disorder, PCS physical component summary of the SF-12, PF physical functioning of the SF-36v2, Q-LES-Q SF Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, SF-12 SF-12v2 Health Survey, SZ schizophrenia, TD tardive dyskinesia. The data show group mean ± standard error, represented by the error bars
Source publication
Purpose
Tardive dyskinesia (TD) is a common but serious hyperkinetic movement disorder and side effect of antipsychotic medications used to treat bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ). The purpose of this study was to evaluate health-related quality of life (HRQoL) in a population with diagnoses for BD, MDD,...
Citations
... [4][5][6][7][8] Furthermore, EPSs are associated with impaired quality of life, medication non-adherence, increased morbidity, mortality, caregiver burden, utilisation of healthcare resources and higher medical costs. [8][9][10][11][12][13][14][15][16] This has resulted in some advocating for 'better monitoring … to assess their true effect on patients' quality of life and functioning and to prevent underascertainment', 17 something especially important in higher risk populations, for instance, children, adolescents and the elderly. [18][19][20] The ...
Introduction
Given the increasing rates of antipsychotic use in multiple psychiatric conditions, greater attention to the assessment, monitoring and documentation of their side effects is warranted. While a significant degree of attention has been provided to metabolic side effect monitoring, comparatively little is known about how clinicians screen for, document and monitor the motor side effects of antipsychotics (ie, parkinsonism, akathisia, dystonia and dyskinesias, collectively ‘extrapyramidal side effects’, EPS). This review aims to systematically assess the literature for insights into current trends in EPS monitoring practices within various mental health settings globally.
Methods and analysis
An electronic search will be performed using the OVID Medline, PubMed, Embase, CINAHL and APA PsycINFO databases for studies published in the last quarter century (1998 to present day). Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. A third reviewer will resolve disagreements if consensus cannot be reached. If selected for inclusion, full-text data extraction will then be conducted using a pilot-tested data extraction form. Quality assessment will be conducted for all included studies using a modified version of the Quality Improvement Minimum Quality Criteria Set. A narrative synthesis and summary of the data will be provided. All stages of the review process will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Ethics and dissemination
Ethical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print with interested clinicians and will also be presented as posters or talks at relevant medical conferences and meetings.
PROSPERO registration number
CRD42023482372.
... Moreover, around 20-35% of people who have been prescribed antipsychotics for a minimum of three months encounter TD [6]. TD symptoms can significantly affect a patient's quality of life and lead to significant physical disability in severe cases [7]. With the expanded use of SGAs for additional on-label and off-label indications, the trend for TD may continue to rise even with fewer FGA prescriptions [5]. ...
Background
Tardive Dyskinesia (TD) is a neurological disorder characterized by involuntary movements, often caused by dopamine receptor antagonists. Vesicular Monoamine Transporter 2 (VMAT2) inhibitors, such as valbenazine and deutetrabenazine, have emerged as promising therapies for TD and several clinical trials have shown their efficacy. This study aims to compare the efficacy and safety profile of VMAT2 inhibitors, focusing on a recent trial conducted in the Asian population.
Methods
We reviewed the PubMed, Cochrane Library, Embase database, and clinicaltrials.gov between January 2017 and October 2023, using the keywords “tardive dyskinesia” AND (“valbenazine” [all fields] OR “ deutetrabenazine “ [all fields]) AND “clinical trial”. The reviewed articles were studied for efficacy and side effects.
Results
An initial search yielded 230 articles, of which 104 were duplicates. Following the title and abstract screening, 25 additional articles were excluded. A full-text review resulted in the exclusion of 96 more articles. Ultimately, four double-blind clinical trials met the inclusion criteria. The deutetrabenazine studies demonstrated significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores compared to placebo, with no difference in adverse events. The valbenazine studies showed favorable results in reducing TD symptoms and were well-tolerated.
Discussion
The studies reviewed in this analysis underscore the potential of deutetrabenazine and valbenazine as valuable treatment options for TD in diverse populations. Both medications demonstrated significant improvements in AIMS scores, suggesting their effectiveness in managing TD symptoms. Additionally, they exhibited favorable safety profiles, with low rates of serious adverse events and no significant increase in QT prolongation, parkinsonism, suicidal ideation, or mortality.
Conclusion
The studies reviewed highlight the promising efficacy and tolerability of deutetrabenazine and valbenazine as treatments for Tardive Dyskinesia, providing new hope for individuals affected by this challenging condition.
... Tardive dyskinesia (TD), a severe symptoms that develops after longterm exposure to dopamine-blocking antipsychotics, 1 can negatively affect the treatment of the primary disorder and reduce a patient's activity of daily life (ADL) and Quality of Life (QoL). 2,3 Several risk factors for TD have been identified, including older age, female gender, longer use of antipsychotics, higher dosages of antipsychotics, a history of extrapyramidal symptoms (EPSs), and the use of first-generation antipsychotics (FGAs). [4][5][6][7][8][9][10] Although the risk of TD with second-generation antipsychotics (SGAs) is lower compared with FGAs, 11 it still exsists. ...
Aim The aim of this study is to summarize the spontaneous reports of tardive dyskinesia (TD) and extrapyramidal symptoms (EPSs) that occurred in Japan over the past decade.
Methods The study analyzed TD and EPS cases reported in the Japanese Adverse Drug Event Report database between April 2011 and March 2021. The cases were stratified by the diagnoses of schizophrenia, bipolar disorders, and depressive disorders.
Results In total, 800 patients including a total of 171 TD cases and 682 EPS cases were reported in the JADER database across psychiatric diagnosis. The cases were caused by first‐generation antipsychotics (FGA, TD: n = 105, EPS: n = 245) and second‐generation antipsychotics (SGA, TD: n = 144, EPS: n = 598). The SGA were categorized based on Neuroscience‐based Nomenclature (NbN) regarding pharmacological domain and mode of action, which were reported evenly as the offending agents. Among reported treatment and outcome in TD cases ( n = 67, 37.6%) and EPS cases ( n = 405, 59.3%), the relatively limited number of TD cases were reported as recovered/improved was also limited ( n = 32, 47.8%) compared to those of EPS cases ( n = 266, 65.7%). Some cases still had residual symptoms or did not recover fully (TD: n = 21, 31.3%, EPS: n = 77, 19.0%).
Conclusion
Tardive dyskinesia and EPS have been widely reported in Japan over the past decade across psychiatric diagnoses and antipsychotic classes.
Limitations
It is important to acknowledge the presence of reporting bias and the lack of comparators to accurately assess risks. Owing to the nature of spontaneous reporting, the estimation of prevalence is not feasible.
... 2,3 Similarly, individuals with severe TD have significantly worse QoL and social withdrawal compared with those with less severe TD and those without TD. 4 Vesicular monoamine-transporter 2 (VMAT2) inhibitors are the only class of drugs approved by the United States (US) FDA for treatment of chorea associated with HD and TD. Deutetrabenazine, a selective VMAT2 inhibitor, was approved by the US FDA in 2017 5-7 based on phase 3 clinical trials for treatment of chorea associated with HD 8 and treatment of TD. 9,10 Treatment with deutetrabenazine significantly reduced abnormal involuntary movements and improved patient QoL. ...
Introduction
Deutetrabenazine is approved for treatment of Huntington disease (HD)-related chorea and tardive dyskinesia (TD) in adults. Factors associated with deutetrabenazine persistence and adherence are not well understood.
Methods
Claims data from the Symphony Health Solutions Integrated Dataverse (2017-2019) were analyzed to identify real-world predictors of deutetrabenazine persistence and adherence in adults with HD or TD in the United States. Predictive models for persistence and adherence that considered patient demographics, payer type, comorbidities, treatment history, and health care resource use were developed.
Results
In HD, use of anticonvulsants (HR = 2.00 [95% CI = 1.03, 3.85]; P < .05), lipid-lowering agents (2.22 [1.03, 4.76]; P < .05), and Medicaid versus Medicare insurance (2.27 [1.03, 5.00]; P < .05) predicted persistence, whereas only comorbid anxiety disorders predicted discontinuation (0.46 [0.23, 0.93]; P < .05). Of these patients, 62.5% were adherent at 6 months. Use of ≤2 treatments for chronic diseases (OR = 0.18 [95% CI = 0.04, 0.81]; P < .05) and Medicaid versus Medicare insurance (0.27 [0.09, 0.75]; P < .05) was associated with lower odds of adherence. In TD, use of lipid-lowering agents (HR = 4.76 [95% CI = 1.02, 20.00]; P < .05) predicted persistence, while comorbid schizoaffective disorder and/or schizophrenia (0.16 [0.14, 0.69]; P < .05) and sleep-wake disorders (0.18 [0.04, 0.82]; P < .05) predicted discontinuation. Of these patients, 46.7% were adherent at 6 months. Comorbid schizoaffective disorder and/or schizophrenia was associated with lower odds of adherence (OR = 0.26 [0.07, 0.91]; P < .05).
Discussion
Identifying factors predictive of discontinuation and/or nonadherence to deutetrabenazine may facilitate the development of personalized support programs that seek to improve outcomes in patients with HD or TD.
... Smoking might be a potential self-treatment for SCZ [11] . For instance, this hypothesis was raised to elucidate the relationship between smoking and tardive dyskinesia (TD) [12] . A recent study observed a difference in negative symptom severity between SCZ patient groups with or without TD [13] . ...
Smoking is commonly observed in patients with schizophrenia (SCZ). However, the relationship between smoking and SCZ-related risk factors remains unclear. In addition, whether smoking works as a self-treatment to alleviate SCZ symptoms is unknown. Our study aimed to investigate the complex relationship between smoking behavior and specific SCZ symptoms. We conducted a literature search on PubMed using the keyword "smoking self-treatment and SCZ" and identified 191 studies. After screening for relevance, 47 studies were included in the study. Most studies confirmed a correlation between smoking status and the severity of negative, positive, and cognitive symptoms in SCZ. In addition, most studies investigated the association between cognitive symptoms and SCZ with inconsistent findings. We confirmed that smoking status is associated with symptom severity, including cognitive, negative, extrapyramidal, and positive symptoms. These findings support the theory of self-treatment and highlight the importance of addressing smoking behavior in SCZ patients.
... Smoking might be a potential self-treatment for SCZ [11] . For instance, this hypothesis was raised to elucidate the relationship between smoking and tardive dyskinesia (TD) [12] . A recent study observed a difference in negative symptom severity between SCZ patient groups with or without TD [13] . ...
Smoking is commonly observed in patients with schizophrenia (SCZ). However, the relationship between smoking and SCZ-related risk factors remains unclear. In addition, whether smoking works as a self-treatment to alleviate SCZ symptoms is unknown. Our study aimed to investigate the complex relationship between smoking behavior and specific SCZ symptoms. We conducted a literature search on PubMed using the keyword “smoking self-treatment and SCZ” and identified 191 studies. After screening for relevance, 47 studies were included in the study. Most studies confirmed a correlation between smoking status and the severity of negative, positive, and cognitive symptoms in SCZ. In addition, most studies investigated the association between cognitive symptoms and SCZ with inconsistent findings. We confirmed that smoking status is associated with symptom severity, including cognitive, negative, extrapyramidal, and positive symptoms. These findings support the theory of self-treatment and highlight the importance of addressing smoking behavior in SCZ patients.
... 6 These underlying psychiatric conditions are known to impair patient functioning in psychological, social, and professional domains in and of themselves, 7 and the involuntary movements associated with TD further disrupt functioning. [8][9][10] Patients are negatively affected by TD, especially in terms of daily activities, work productivity, social life, and selfcare. 9 Previous work has shown that the greatest impacts are on social functioning and physical well-being, particularly for patients with schizophrenia. ...
... The physical health effects of TD are also compounded by the presence of schizophrenia, BD, or MDD. 8 This study endeavored to provide a more detailed assessment of the type of burden TD has on patients, particularly in the workplace and daily life. In addition, previous studies have utilized measurements that were not specific to TD, whereas the fit-for-purpose survey for this study was created/tailored to the TD disease state. ...
... The severity of physical, psychological, and social impact of TD was greater among patients with schizophrenia than among those with BD or MDD, consistent with reports assessing health-related quality of life in patients with these underlying conditions. 8 In addition, patients reported that negative reactions of strangers and acquaintances are common, consistent with a recent survey of the general population examining the stigma associated with TD movements. 2 The impact of TD reported via the WPAI on work absenteeism (29.1%), presenteeism (68.4%), and overall work impairment (73.5%) were greater than those reported for lung cancer (absenteeism, 15%; presenteeism, 31%; overall work impairment, 37%) 13 and for locally recurrent or metastatic breast cancer (20%, 30%, and 40%, respectively). ...
Objective: To assess the physical, psychological, social, and professional impact of tardive dyskinesia (TD) on patients in the United States. Methods: An online survey (April 2020-June 2021) to assess patient burden of TD was developed using targeted literature review and interviews with clinicians, patients, and caregivers. Survey participants (aged ≥ 18 years) with current diagnoses of TD and schizophrenia, bipolar disorder, or major depressive disorder rated the 7-day impact of TD on their physical, psychological, and social functioning via Likert scales (scored from 1 [least impact] to 5 [most impact]). Impact scores were calculated and summarized descriptively overall by self-reported disease severity and underlying disease. Participants also completed the Work Productivity and Activity Impairment Questionnaire and reported the impact of TD on their underlying psychiatric condition. Results: Overall, 269 patients (mean [SD] age = 40.6 years [9.9]; 74.7% employed) responded to the survey. Mean (SD) impact scores of 3.1 (0.9), 3.5 (1.0), and 3.2 (1.1) were reported in the physical, psychological, and social domains, respectively, and scores increased with reported TD symptom severity. Patients with underlying schizophrenia reported the highest burden for all domains. Patients reported 66.2% activity impairment because of TD. Employed patients (n = 193) indicated 29.1% absenteeism, 68.4% presenteeism, and 73.5% overall work impairment. Over one-third of patients reported skipping/reducing (48.4%) or stopping (39.3%) their antipsychotic medication and stopping visits to clinicians treating their underlying condition (35.7%) because of TD. Conclusion: TD imposes a substantial burden on patients' physical, psychological, social, and professional lives and impacts management of their underlying condition.
... TD can negatively affect motor functions such as speech, gait, and respiration, as well as cognitive functions such as verbal memory and processing [11,13,14]. TD can also lead to feelings of stigmatization, social withdrawal, loss of employment, and higher healthcare resource utilization [12,15,16]. ...
Background:
Tardive dyskinesia (TD) is a persistent and potentially disabling movement disorder associated with antipsychotic use. Data from RE-KINECT, a real-world study of antipsychotic-treated outpatients, were analyzed to assess the effects of possible TD on patient health and social functioning.
Methods:
Analyses were conducted in Cohort 1 (patients with no abnormal involuntary movements) and Cohort 2 (patients with possible TD per clinician judgment). Assessments included: EuroQoL's EQ-5D-5L utility (health); Sheehan Disability Scale (SDS) total score (social functioning); patient- and clinician-rated severity of possible TD ("none", "some", "a lot"); and patient-rated impact of possible TD ("none", "some", "a lot"). Regression models were used to analyze the following: associations between higher (worse) severity/impact scores and lower (worse) EQ-5D-5L utility (indicated by negative regression coefficients); and associations between higher (worse) severity/impact scores and higher (worse) SDS total score (indicated by positive regression coefficients).
Results:
In Cohort 2 patients who were aware of their abnormal movements, patient-rated TD impact was highly and significantly associated with EQ-5D-5L utility (regression coefficient: - 0.023, P < 0.001) and SDS total score (1.027, P < 0.001). Patient-rated severity was also significantly associated with EQ-5D-5L utility (- 0.028, P < 0.05). Clinician-rated severity was moderately associated with both EQ-5D-5L and SDS, but these associations were not statistically significant.
Conclusions:
Patients were consistent in evaluating the impacts of possible TD on their lives, whether based on subjective ratings ("none", "some", "a lot") or standardized instruments (EQ-5D-5L, SDS). Clinician-rated severity of TD may not always correlate with patient perceptions of the significance of TD.
... TD affects the social functioning of patients and their compliance with treatment. McEvoy et al. [13] demonstrated in a cross-sectional survey that patients with TD had significantly worse health-related quality of life and increased social withdrawal as compared to patients without TD and general population. ...
Background:
People with serious mental illness exhibit higher morbidity and mortality rates of chronic diseases than the general population.
Aims:
The aim of this study was to establish a dedicated clinic for patients with chronic mental illness to monitor physical health and quality of life in accordance with best practice guidelines.
Methods:
Patients were invited to attend the clinic. The following areas were examined: personal and family history of cardiovascular disease, diet, exercise, and smoking. Mental state examination, waist circumference, BP, pulse, ECG and BMI. Laboratory tests including U + E, LFTs, HbA1c, Lipid profile and other tests as appropriate such as serum lithium. AIMS scale, HoNOS and WHOQOL-BREF scales as additional indicators of global health.
Results:
A total of 80 patients attended during 3.5 years of clinic. Mean age was 54.9 years (SD: 13.81) at first contact and 45% were females. Mean years in the service was 19.66 (SD: 11.54) and mean number of previous hospital admissions was 4.4 (SD: 5.63). Metabolic syndrome was present in 42% at first assessment. A statistically significant improvement was found for the psychological domain of the WHOQOL-BREF and the HoNOs, particularly at third assessment. (β = 4.64, Wald x2 = 7.38, df:1, p = 0.007, CI:1.3-8.1, β = - .889, Wald x2 = 4.08, df:1, p = 0.043, CI: - 1.752 to - .026) respectively.
Conclusion:
The results show a high prevalence of physical health conditions in this cohort, some of which represent a new diagnosis. This implicates better allocation of existing resources for screening and early detection, and potential to run joint clinics with primary care.
... [14][15][16][17][18][19][20] To that end, a panel of experts was convened to better understand how telehealth may be applied to assessing, diagnosing, and treating patients with tardive dyskinesia (TD), a hyperkinetic movement disorder associated with prolonged exposure to antipsychotics and other dopamine receptor blocking agents, such as metoclopramide. TD can impair a patient's physical, mental, and emotional wellbeing, leading to feelings of embarrassment, anxiety, and social withdrawal/isolation. [21][22][23][24][25] Patients' TD can also negatively impact their caregivers, who are often their family or friends. 26 Despite the availability of approved TD medications (e.g., vesicular monoamine transporter 2 [VMAT2] inhibitors, valbenazine and deutetrabenazine), identification, diagnosis, and assessment of this disorder remains complex, and these complexities can be compounded when care is delivered via telehealth. ...
Introduction: Publications on the integration of telehealth in the care of patients with movement disorders are increasing, but little has been presented regarding its use in tardive dyskinesia (TD), a drug-induced movement disorder associated with prolonged exposure to dopamine receptor blocking agents. This study was conducted to address that knowledge gap, based on insights from a panel of TD experts. Methods: In 2020, six neurologists, three psychiatrists, and three psychiatric nurse practitioners participated in individual semistructured interviews about in-person and virtual TD assessment and management in their practices. Two virtual roundtables were then conducted to consolidate findings from these interviews. Results: The panel agreed that despite the challenges of virtual TD assessment (e.g., technology issues, difficulty observing entire body, inability to conduct thorough neurological examinations), telehealth can offer benefits (e.g., fewer missed appointments, reduced time/cost, easier access to family/caregiver feedback). The panel also agreed that telehealth should be combined with periodic in-person visits, and they recommended an in-person TD assessment within 6 months before the first virtual visit and at least one in-person assessment every 6 months thereafter. Additional best practices for TD telehealth included implementing video, involving family/caregivers, and providing preappointment instructions to help patients prepare their technology and environment. Conclusions: Telehealth is not a substitute for in-person visits but can be a helpful complement to in-person clinical care. Clinicians can optimize virtual visits in patients at risk of TD by using targeted questions to identify TD and evaluate its impact and by providing education about approved TD treatments.
