Interactive Case Challenge - eCase: TD Progression

CE / CME

eCase: Managing Tardive Dyskinesia From Onset to Progression

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Social Workers: 1.00 ASWB ACE CE Credit

Pharmacists: 1.00 contact hour (0.1 CEUs)

Psychologists: 1.00 APA CE Credit

Nurses: 1.00 Nursing contact hour, including 1.00 hour of pharmacotherapy credit

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: November 29, 2022

Expiration: November 28, 2023

Sneha Mantri, MD, MS

CME/CE Information

Activity

Progress

Course Completed

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Pre-Activity Introduction Case Presentation References

Introduction

Tardive syndrome is a late-onset, typically persistent movement disorder attributed to the chronic use of dopamine receptor–blocking agents (DRBA).¹ The most common manifestation of tardive syndrome is TD, with stereotypical, involuntary movements of the face, tongue, trunk, and/or extremities. A 2017 meta-analysis revealed that global mean prevalence of TD among patients receiving typical antipsychotics is approximately 30.0%, dropping to 20.7% among patients receiving atypical antipsychotics, and 7.7% among people never exposed to antipsychotics.² Risk factors for TD include older age, female sex, and longer duration of exposure to typical or atypical antipsychotics. TD has also been reported with use of nonantipsychotic medications that block or modulate dopamine transmission, such as antiemetics³ (eg, metoclopramide, prochlorperazine) and some antidepressants⁴ (eg, fluoxetine, phenelzine, amitriptyline).

TD is thought to arise from DRBA-induced upregulation of dopamine receptors and postsynaptic receptor hypersensitivity.⁵ Symptoms often improve after discontinuation of the offending DRBA, but in some individuals, symptoms can persist for years. Withdrawal-emergent TD, in which TD develops or worsens after discontinuing a DRBA, may also occur, suggesting a complex pathophysiology.

TD has a major impact on the quality of life for patients with psychiatric disorders⁶ and is associated with professional and personal stigma.⁷ Individuals with schizophrenia appear to be more sensitive to the impact of TD than individuals receiving a DRBA for mood disorders,⁶ but TD can negatively affect health-related quality of life in all patients. One social media analysis of unsolicited patient/caregiver posts found that individuals with TD often feel anger and insecurity regarding their symptoms.⁸ Thus, early recognition of incipient TD by healthcare professionals is essential to improving patient experience. Treatment often starts with decreasing or withdrawing the offending agent, if possible. However, this does not always resolve the movement disorder, and in some cases, movements will paradoxically worsen with withdrawal-emergent TD.⁹

TD can be identified and tracked (ie, disease progression, response to therapy) using the Abnormal Involuntary Movements Scale (AIMS), a 14-item scale that assesses location, severity, and incapacitation/impact of involuntary movements.¹⁰

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