Tardive Dyskinesia Across the Complexity Spectrum: From Quality of Life Improvement to Novel Treatments

Tardive dyskinesia, or TD, is a side effect of treatment with antipsychotic medications, resulting in repetitive and uncontrollable movements of the body and face. Affecting approximately 573,000 people in the United States, this disorder continues to significantly impact patient quality of life, affecting their social and work lives and contributing to high rates of antipsychotic nonadherence, with all its attendant consequences. Recent guideline and updates to expert consensus documents have highlighted the importance of early TD identification for rapid treatment initiation, thus avoiding its potentially irreversible effects and improving patient outcomes. With these updates, clinicians who may encounter patients with TD are called on to possess a broader knowledge of TD symptoms across multiple levels of symptom severity. However, clinicians are often unaware of best practices for TD screening and diagnosis, and its identification can be challenging. Early identification is especially important considering the recent availability of practice-changing vesicular monoamine transporter 2, or VMAT2, inhibitors for the treatment of TD. With the arrival of these agents onto the treatment landscape and given the continuing expansion of indications for current antipsychotic agents, clinicians must be prepared to integrate key clinical trial data and pertinent guideline updates into appropriate treatment plans for patients with mild, moderate, and severe TD. The TD360 2021 curriculum offered comprehensive education for a wide range of clinicians who require a better and more robust understanding of best-practices in TD detection and management. Upon completion of the educational activities, clinician learners were expected to be able to: • Outline the impact that TD has on patient outcomes, the prevalence of TD in patients currently taking antipsychotic medication, and current barriers to care; • Describe key clinical trial data and updated guideline recommendations for treatment with VMAT2 inhibitors into practice; and • Integrate updated knowledge of TD diagnosis and treatment with VMAT2 inhibitors into clinical treatment plans. Throughout the curriculum, significant increases were demonstrated across survey questions designed to assess knowledge and competence in clinician behavior and practice. Analysis indicated that clinician learners increased their confidence in their ability to manage patients with TD without a specialist referral. Clinicians also increased their confidence in their understanding of the mechanisms associated with newer VMAT2 inhibitors for the treatment of TD. Clinician learners also provided insight into what their intended changes to practice would be following the education, including considering use of VMAT2 inhibitors for the treatment of patients with mild TD; utilizing guideline-preferred VMAT2 inhibitors for the treatment of patients with moderate or severe TD; and tailoring treatment for individual patients with TD based on individualized appraisal of symptom severity and patient characteristics. TD continues to have a major impact on patient quality of life, antipsychotic adherence, and healthcare utilization costs. VMAT2 inhibitors have recently emerged as a paradigm-changing treatment option for this patient population, but a number of barriers impede their implementation into clinical practice. The recognition and diagnosis of TD can be challenging, and clinicians are often unprepared to recognize TD symptoms across varying stages of severity and integrate important screening procedures into practice. Clinicians also demonstrate an ongoing need for knowledge regarding key clinical trial data and guideline updates that can inform clinical practice and have indicated a desire for more information on these topics. Following education, however, learners are less likely to indicate a lack of knowledge, feeling more confident in their ability to properly use VMAT2 inhibitors in their clinics. Therefore, continuing education preparing clinicians to integrate key clinical trial data and pertinent guideline updates into appropriate treatment plans for patients with mild, moderate, and severe TD continues to be warranted.