Tardive Dyskinesia Symptom Screening in Real-World Outpatient Settings: Correlations Between Patient-, Caregiver-, and Clinician-Reported Assessments in the RE-KINECT Study

Objective: To document possible tardive dyskinesia (TD) in psychiatric outpatients, as assessed by patients, caregivers, and clinicians.
Methods: RE-KINECT (NCT03062033) included adults with ≥3 months of lifetime antipsychotic exposure and ≥1 psychiatric diagnosis. Possible TD was determined by clinician’s assessment of involuntary movements in 4 body regions (head/face, neck/trunk, upper extremities, lower extremities). Patients with possible TD and qualified (unpaid/informal) caregivers also assessed the presence, location, and severity of involuntary movements. Associations between clinician/patient-reported or clinician/caregiver-reported assessments were analyzed using Spearman’s correlation (ρ).
Results: Patient/clinician correlations were significant for rating of severity of involuntary movements by body region (head/face, ρ=0.76; neck/trunk, ρ=0.61; upper extremities, ρ=0.75; lower extremities, ρ=0.75; all P<0.0001) and for maximum severity score across all 4 regions (ρ=0.50; P<0.0001). Caregivers’ assessments were more severe than clinicians’ assessments, resulting in weaker but still significant caregiver/clinician correlations for severity by region (head/face, ρ=0.65; neck/trunk, ρ=0.43; upper extremities, ρ=0.57; lower extremities, ρ=0.49; all P<0.05) but no observed significance for maximum severity (ρ=0.24; P=0.1454). However, the correlation for total number of body regions impacted by involuntary movements was higher for caregiver/clinician (ρ=0.46; P=0.0027) than patient/clinician (ρ=0.24; P=0.0005), due to the fewer number of affected regions reported by patients.  
Conclusions: Patients, caregivers, and clinicians generally agreed on the severity of involuntary movements in each of the 4 main body regions, although caregivers tended to give more severe ratings and patients tended to report fewer affected regions. Along with clinician assessment, patient and caregiver reports of involuntary movements are important in TD screening procedures.