Newer Treatments for Tardive Dyskinesia, Best Approaches Among CME Needs

Notwithstanding a lack of clinical evidence supporting the practice, a notable percentage of psychiatrists said they would use an anticholinergic medication to manage symptoms of tardive dyskinesia in a patient.

Researchers presented their findings in a poster at the virtual 2021 American Psychiatric Association Annual Meeting.

“Despite recommendations from American Psychiatric Association guidelines and evidence suggesting that anticholinergic drugs may exacerbate dyskinesias, these continue to be used for tardive dyskinesia management,” wrote first author Shereta Wiley, MPH, of CE Outcomes LLC in Birmingham, Alabama, and colleagues.

The study looked at psychiatrist understanding of tardive dyskinesia and potential knowledge gaps that could inform continuing medication education (CME) on the subject. Researchers assessed current practice, knowledge, and attitudes of US-based psychiatrists in May 2018 and again in March 2020. Some 213 psychiatrists participated in 2018 and 125 psychiatrists in 2020. Participants in the 2020 survey averaged 31 years in practice and 15 patients with tardive dyskinesia per month.

In both survey years, many psychiatrists underestimated the reported prevalence of tardive dyskinesia in patients taking maintenance antipsychotics, researchers said. Additionally, both surveys indicated some psychiatrists do not routinely use standardized assessment scales that can assist with objective evaluation and tracking of symptoms during treatment. In 2018, 77% of psychiatrists reported using standardized rating scales in initial evaluations; in 2020, 80%.

Quiz: How Often Should Patients Be Evaluated for Tardive Dyskinesia?

Psychiatrists reported moderate familiarity with vesicular monoamine transporter 2 (VMAT2) inhibitor therapies for tardive dyskinesia management. Although self-reported familiarity with valbenazine, deutetrabenazine, and tetrabenazine increased little between the two surveys, the percentage of psychiatrists who said they would use a VMAT2 inhibitor increased from 44% in 2018 to 54% in 2020.

Meanwhile, 24% of psychiatrists in 2018 and 16% in 2020 said they would use an anticholinergic to manage tardive dyskinesia symptoms, according to the study.

“The findings support the need for continued CME on tardive dyskinesia focused to psychiatrists specifically including information on tardive dyskinesia prevalence, newer treatments for tardive dyskinesia, and best approaches to maintain control of underlying psychiatric disorders when managing patients with tardive dyskinesia,” researchers concluded.

—Jolynn Tumolo

Reference

Wiley S, Stacy S, Shah C, Lundt L. Understanding the evolving continuing medical education needs of psychiatrists managing patients with TD. Poster presented at the American Psychiatric Association Annual Meeting; May 1-3, 2021; Virtual.