Panel Study Investigates the Assessment and Treatment of Tardive Dyskinesia

(Part 1 of 2)

In this video, Rif El-Mallakh, MD, University of Louisville School of Medicine, Kentucky, discusses the methods of his study that sought to learn more about how clinicians diagnose, assess, and manage tardive dyskinesia (TD) in both in-person and telehealth settings and how TD impacts patients and their caregivers.

­­­Researchers presented the study in a poster at the recent Schizophrenia International Research Society (SIRS) 2021 meeting.

In the upcoming Part 2, Dr Rif El-Mallakh discusses the study’s findings and how they can impact TD treatment.

Read the transcript:

Hello, everyone. My name is Rif El-Mallakh. I'm one of the co-authors on a poster that was presented at the Schizophrenia International Research Society meeting recently in 2021. The poster's title was "What's Next for Tardive Dyskinesia: Expert Insights from a Cross-sectional Disciplinary Virtual Treatment Panel."

I'm one of the co-authors. I'm a psychiatrist at the University of Louisville. I have several co-authors. To acknowledge them briefly, doctors Chirag Shah, Leslie Lundt, Dawn Vanderhoef, Stephanie Michel, Timothy Dehony, Amy Belnap, and Sanjay Iyer. All of them worked on this project with me.

My colleagues and I were particularly interested in learning more about how clinicians diagnose, assess, manage tardive dyskinesia, commonly known as TD. This is particularly relevant at this point in time, because of all of the changes that have happened in how we interact with our patients with the COVID vaccine and all of the virtual stuff.

Also, at about the same time, we have two new VMAT inhibitors, valbenazine and deutetrabenazine, which have been introduced and approved by the FDA for the treatment of TD. This is a new treatment option that's now available. All of this happened more or less around the same time, within the same year or so.

During our panel discussions, we specifically wanted to discuss 3 main things. The challenges of differentiating TD from other drug-induced movement disorders that can be quite an issue. We wanted to look at the best practices for TD diagnosis and treatment in the real world setting.

It's nice to have all this idealized, this is what you're supposed to do, but then, how does it actually get applied, particularly since now, there is a lot of virtual medicine, telemedicine, going on? How does TD management work in that particular environment?

To do this, we followed pretty typical and accepted qualitative study methods. There is a very well-established methodology for doing qualitative research. This followed it, and I'll explain as we go on.

We created a panel of experts. Specifically, we had 6 neurologists, 3 psychiatrists, and 3 psychiatric nurse practitioners. We had this diverse panel of experts. Then we created a semi-structured interview that each panelist would answer independently.

Everyone would initially go through the semi-structured interview alone talking to the interviewer, and then all of that information would be transcribed, collated, and then we'd come back together after the data has been collected and summarized, and the common themes have been extracted.

We'd come back together and discuss whether we agree on the common themes, and how these common themes fit into the general theme of the things that we were discussing. This started in July of 2020. That's when we started the individual interviews. Then by November of 2020, we started the series of panel discussions.

We felt that this was important so that we can focus on the impact of TD on both patients and their caregivers. We wanted to focus specifically on how telemedicine, telepsychiatry were being implemented for the management of TD.

Remember that 50% of our panel was neurologists. One of the interesting things is the first thing that everybody agreed on was that maintaining psychiatric stability was essential for the management of TD. You really cannot treat TD if you have someone who is actively psychotic.

One of the nice things, the panel at least felt, that one of the nice things about having these new VMAT inhibitors was that they allowed the treating clinicians the freedom to use whatever antipsychotic they felt was the most effective for their patients.

Before availability of the VMAT2 inhibitors, if you found out that your patient, unfortunately, has developed tardive dyskinetic movements due to your treatment, you were essentially forced to either stop the treatment, certainly alter the treatment in some way to address the tardive dyskinesia.

Remember that in all of the VMAT2 studies, patients were allowed to continue their antipsychotic treatment, and that the tardive dyskinetic movements actually improved throughout the study, while it was about 80% of the patients continued taking the antipsychotic.

Dr. Rif El-Mallakh is currently a professor at the Department of Psychiatry of the University of Louisville School of Medicine.  He has been there since 1992.  He joined the faculty after completing a research fellowship at the National Institute of Mental Health to establish the Mood Disorders Research Program.  Over the past 30 years Dr. Rif El-Mallakh has focused on the ionic pathophysiology of bipolar illness, the deleterious consequences of antidepressants, and the tardive syndromes.  He has published over 300 peer-reviewed papers and chapters, 2 books, and has received over 5 million dollars in funding over his career from NIMH, Brain and Behavior Research Foundation (BBRF or NARSAD), other research foundations, and the pharmaceutical industry.

Shah C, Lundt L, Vanderhoef D, et al. What’s next for tardive dyskinesia? Expert insights from a cross-disciplinary virtual treatment panel. Poster presented at the Schizophrenia International Research Society 2021 Annual Meeting; April 17-21, 2021; Virtual