Recognizing Tardive Dyskinesia: A 3-Question Quiz

Question 1:

Answer and Question #2 on Next Page »

The correct answer is E. All of the above

Discussion

Spontaneous dyskinesias (SDs) are abnormal involuntary movements in persons who have not been exposed to antipsychotics that are indistinguishable from TD. Withdrawal-emergent dyskinesias are TD-like movements that may appear after changes in dose or discontinuation of antipsychotics, and are time-limited.

 Dyskinesias persisting for longer than 4 to 8 weeks after antipsychotic changes/discontinuation suggest probable TD.¹ Both TD and SDs are also found in the general population, but are less prevalent than in patients with psychosis.² Epilepsy and Tourette syndrome are also included in a broad differential diagnosis of TD.

References for Question 1

1. Rakesh G, Muzyk A, Szabo ST, et al. Tardive dyskinesia: 21st century may bring new treatments to a forgotten disorder. Ann Clin Psychiatry. 2017;29:108-119.

2. Merrill RM, Lyon JL, Matiaco PM. Tardive and spontaneous dyskinesia incidence in the general population. BMC Psychiatry. 2013;13:152

Question 2:

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The correct answer is A. At least 6 months of cumulative antipsychotic treatment

Discussion

TD is often defined for research purposes by the Schooler-Kane criteria.¹ These include: at least 3 months of cumulative antipsychotic treatment; mild dyskinesias in 2 or more body areas or moderate dyskinesias in 1 body area; persistence of movements for at least 3 months; and the absence of other conditions causing involuntary dyskinesias. 

One of the most commonly used instruments to assess TD is the Abnormal Involuntary Movement Scale (AIMS)², an observer-rated scale that takes approximately 5 to 10 minutes to administer. Each item is scored 0-4, where 0=none, 1=minimal, 2=mild, 3=moderate, and 4=severe.

References for Question 2

1. Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982;39:486-467.

2. Guy W. ECDEU assessment manual for psychopharmacology: revised. DHEW Publication No. ADM 76-338. Rockville, MD: US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976: 534-537.

Question 3:

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The correct answer isB. Every 6 months in patients taking FGAs, and every 12 months in patients taking SGAs

The American Psychiatric Association practice guidelines for the treatment of schizophrenia recommend the clinical assessment of abnormal involuntary movements at baseline and every 6 months in patients taking FGAs, and every 12 months in patients taking SGAs.^{1[see PDF]} For patients at increased risk of TD, assessments should be done more frequently: every 3 months for FGAs or 6 months for SGAs.

Reference for Question 3

1. Lehman AF, Lieberman JA, Dixon LB, et al. Practice Guidelines for the Treatment of Patients With Schizophrenia. 2010.