Provider Misconceptions About Tardive Dyskinesia

Tardive dyskinesia is one of the significant challenges that both mental health care providers and patients encounter when seeking to manage serious mental illness with medication.

Psych Congress Network sat down with Desiree Matthews, PHMNP-BC, at Psych Congress Elevate 2021 in Las Vegas, Nevada, to discuss her clinical experience handling cases of tardive dyskinesia. In this video, she addresses common misconceptions about the condition among health care providers, stressing the way it impedes everyday functioning for patients and creates an even greater care burden for caregivers. Matthews details how VMAT2 inhibitors alongside a couple other FDA-approved treatment options can assuage the symptoms of tardive dyskinesia.

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Read the Transcript:

Desiree Matthews, PMHNP-BC: So one of the biggest misconceptions that I find regarding tardive dyskinesia with providers is that tardive dyskinesia (TD) is just a cosmetic problem, that it doesn't go beyond what the movements look like.

One of the biggest things in my assessment of tardive dyskinesia is really focusing on the impact and impairment that TD can cause patients. We have numerous evidence now that shows that TD goes beyond what those movements look like and really does cause impact in emotional, psychological, as well as functional impairment. And we also can't forget about the caregivers. In a survey of caregivers caring for patients with TD, these caregivers actually reported being away from work and being absent, feeling overwhelmed, overburdened with daily activities. So really TD affects the patient, it can affect the family, and it also is costly to have tardive dyskinesia. We see studies out there that TD is expensive, there's more ER visits, more inpatient visits, as well as overall higher healthcare costs.

In order to have optimum care for these patients living with TD, we need to really utilize as providers effective and FDA approved treatment options for tardive dyskinesia. And that includes VMAT2 inhibitors. We have deutetrabenazine as well as valbenazine. 

I think it's really important for providers to understand how to use both because different payers may prefer one over the other. One patient may fail one VMAT2 inhibitor and there's no reason not to try a second agent. So really knowing how to use both of those agents that are FDA approved, they're efficacious and generally well-tolerated.

With that said, because there's only two FDA approved treatment options for TD right now, providers, we need to certainly anticipate and know how to mitigate side effects and manage that if that comes up. Generally speaking, sedation is generally mild to moderate with these agents, but in some cases we may be doing awful evil dosing because usually the sedation tends to be short-lived and we can rechallenge these VMAT2 inhibitors at appropriate dosing later on in treatment to really balance certainly the side effects with the efficacy of these agents.

Desiree Matthews, PMHNP-BC, is a board certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include treatment of schizophrenia, bipolar disorder, treatment resistant unipolar depression and drug induced movement disorders including tardive dyskinesia. She has provided faculty expertise and insight in the development of a clinical screener for TD called MIND-TD.