Helping Patients Navigate Psychopharmacological and Social Challenges in Tardive Dyskinesia

In Part 2 of this interview with Kevin Williams, MS, MPAS, PA-C, Psych Congress Steering Committee Member, at the 2024 NP Institute, Nurse Williams details how clinicians can more closely incorporate caregivers into patient treatment plans, as well as how to navigate a conversation with a patient who has stopped taking their medications for tardive dyskensia. 

Don't miss Part 1 of this interview: Unpacking the Patient Experience of Living With Tardive Dyskinesia

For more expert insights on optimizing tardive dyskinesia treatment, visit our Excellence Forum.

Read the Transcript

Psych Congress Network: What strategies can clinicians use to prevent patients from altering their medication or discontinuing visits due to TD symptoms?

Nurse Williams: First, for me, discussing treatment options with VMAT2 inhibitors is a tool with motivational interviewing that I try to utilize much early on in treatment. If the patient begins to have movements, we've already discussed this, so we can revisit that conversationl but I've already advised them that this could happen and if it does happen, that treatment was there. It begins to build a trust between me and my patient and the family in regards to how we're going to treat and what we can do knowing that I was able to give foresight to those things.

Another approach that I use is what I call the individualized approach. If a patient is sharing that they are stopping medication—whether that be an anti-psychotic or the treatment that I have them on with a VMAT2—we pause and begin to really ask the question as to why. Not in a general sense, "Well, clearly I don't want to take the medicine," I get that. But why are you not wanting to do this, and then what can we do to begin to utilize the education that we have to begin to motivate the patient that this behavior is not necessarily the best option, and then moving through a treatment plan of getting them back on the medication, ensuring that they're adhering to taking it consistently, and getting them better.

Psych Congress Network: How can clinicians help TD patients manage social challenges highlighted in the recent Journal of Clinical Psychiatry while maintaining overall well-being?

Nurse Williams: So, we saw in the study that 3 out of 4 patients began to express self-consciousness or embarrassment reagrding their symptoms of TD, and that caused for a social withdrawing and then also a worsening of quality of life. I believe that as we begin to manage the challenges that our patients have, we must remember that we're not treating two separate conditions. The patients are having one experience in lif, so understanding and communicating that TD can produce challenges which also begins to affect their social implications and how they perceive things and how others perceive them, along with some of their mental health disorders which could be doing this very same thing, is so key so that the patient understands that all of this encompassing really affects their way of life. If we are able to communicate that effectively, then patients will be more agreeable to starting medication to treat their TD along with their mental health disorders.

Psych Congress Network: What actionable recommendations can clinicians take from this study to improve the treatment and support of TD patients? How can caregivers be a part of this conversation?

Nurse Williams: So, I feel there are 3 actionable items that we as clinicians can take.

First, screen your patients. Whether that’s with the AIMS or the IMPACT-TD, a scale that we have, we must screen our patients and feel convicted to do that screening. I have worked with training my team, my clinical team, my front office team, anyone that I work with to understand what TD is, that we could see it in the office,and that we are all responsible for ensuring that we as clinicians are aware of it and how to treat it.

Talking about treatment, I believe when we're starting and initiating the antipsychotic that we know that there's potential prevalence of having TD, so starting that conversation early in treatment. Befpre 2017 we didn't have treatment, so now that we have appropriate treatment, we should ensure that we're moving and shaping the way our patients are treated is so important for us to be able to do that. So that's action item number 2.

Lastly, when it’s appropriate and when we can, include caregivers in our treatment. Utilizing shared decision-making allows for the patient, the caregiver, and you as the clinician, to really be able to utilize a powerful tool in treatment. Then they become our allies—they are the eyes and ears while we're not with the patient and being able to help us to understand what's taking place at home and in social environments.

Utilizing these 3 tools really helps us to not only identify TD but treat TD for the duration of the condition.

Thank you so much for tuning in today and learning how this study really can impact us as clinicians, along with the impact that TD has on our patients.

Listen, please return back at any time, check out what we have available to you in regards to content and more information for not only TD but other conditions as well. Thanks so much.

Kevin N. Williams MS, MPAS, PA-C is the CEO and Lead Clinician at OnPoint Behavioral Health. He is a Physician Associate that specializes in Psychiatry as well as 2 master degrees in Interdisciplinary Medical Sciences and Physician Assistant Studies from the University of South Florida and South University respectively. He has gained experience treating children, adolescents, and adults for the past 9 years in the areas of inpatient, outpatient, and long-term care.