Tasha, 27 Years
 
Charlene, 63 Years
 
Ron, 58 Years

Any presentation of TD may impact patients’ lives and can complicate management of their mental health disorder

TD Undermines Your Ability to Manage Patients’ Mental Health

Homes require ongoing maintenance to avoid deterioration. Not dissimilarly, patients with schizophrenia and mood disorders are better able to maintain their mental health through treatment with APDs and regular contact with a psychiatry provider.

As TD arises from the use of APDs, it may create doubts about medication and distrust of providers. Just as cracks in the foundation may threaten the stability of the home, TD can create cracks in the foundation of psychiatric stability.

In a recent study on the impact of TD on patients taking antipsychotic medications (APDs),*

A dilapidated house with cracks in the roof, the walls, and the foundation. 4 boxes surround the house with lines pointing to various broken parts of the house

48%

Skipped doses or took less
than the doctor instructed

 

36%

Stopped going to the doctor
treating their underlying condition

 

39%

Stopped taking the
APD altogether

 

21%

Advised someone else
not to take an APD

 

*From an online survey with one-time data collection from 269 patients with TD.

Severe Impact of TD Is Reported in 3 Out of 4 Patients*

Patients with TD often experience disability through its impact on the psychological, social, physical, and vocational domains.

Patient suffering with TD is extensive, and not often perceived at the same level by HCPs.†

  • In one study, the proportion of patients reporting the physical domain as most impacted was nearly double that of HCPs

  • Compared with HCPs, patients reported that TD had a significantly greater level of impact across all domains

3 out of 4

patients reported

severe impact of TD

*From an online survey with one-time data collection from 269 patients with TD. 75.1% of patients reported severe impact (impact score of ≥4 on ≥1 item with
each domain [physical, psychological, and social]), increasing from 61.5% for patients with no, mild, or moderate TD symptoms to 95.4% for patients with severe
or very severe TD symptoms.

†From an online survey completed by adults with TD and a diagnosis of schizophrenia, bipolar disorder (BD), or major depressive disorder (MDD) and
unconnected HCPs (ie, HCPs not treating one of the participating patients); HCPs reported on specific, recently seen patients.

TD Can Also Have a Severe Impact on Caregivers*,†

Nearly 1 in 4 caregivers reported a “severe impact” of the patient’s TD on their own function and well-being.

Work Impairment

  • 46% of caregivers reported impact on regular activities
  • Nearly 50% reported impact on work due to absenteeism and presenteeism

Psychological Impact

  • Over 70% reported feeling anxious or worried

Reduced Social Engagement

  • More than 50% reported an impact of patients’ TD on their overall ability to enjoy activities and socialize with friends at least sometimes

*From an online survey with one-time data collection from 162 caregivers of patients with TD.

†Caregiver impact examined the burden of tasks performed, psychosocial well-being, daily activities, and professional life.

Clinicians May Fail to Appreciate Subtle Presentations of Symptoms

Psychiatrists and other mental health professionals are trained to listen to patients and not necessarily to visually scrutinize their movements. Listening to the patient in this clip, without visual clues, one might assume that her movements are severe.

Click to listen to a patient with TD

Patient images used with permission.

 

However, in the same clip with both audio and video, the subtlety of her symptoms becomes more evident. A clinician trained to listen to the patient and not necessarily observe them visually might miss these symptoms.

Click to see and hear the patient

Patient images used with permission.

 

In this version of the clip, without sound, clinicians observing the patient without simultaneously listening to them may find it easier to notice subtle TD movements they might otherwise miss.

Small movements can have a major impact on patients, their loved ones, and those around them.


Click to observe the patient

Patient images used with permission.

 

Study Designs

This study was conducted to assess differences in perceptions of the key impacts of TD between patients and healthcare professionals (HCPs) in the United States. Surveys used a 10-point Likert scale to measure impact in 4 domains: physical, social, psychological/emotional, and work. Surveys were collected from 154 patients with TD and 150 HCPs unconnected with those patients. Professionals included psychiatrists, neurologists, and psychiatric nurse providers. Professionals reported on specific, recently seen patients.

Finkbeiner S, Leo S, Goldschmidt D, et al. Differences in patient and healthcare professional perspectives on the key impacts of tardive dyskinesia. Poster presented at: XXVIII World Congress on Parkinson’s Disease and Related Disorders; May 13-16, 2023; Chicago, IL.

This study was conducted to assess the impact of TD in 4 domains: physical, psychological, social, and professional. 269 patients across the US with schizophrenia, bipolar disorder, or major depressive disorder as well as current diagnoses of TD were recruited for a survey conducted April 2020 to June 2021. Respondents used a Likert scale scored from 1 (least impact) to 5 (most impact) to answer survey questions rating the impact of TD in the 4 domains in the previous 7 days.

Jain R, Ayyagari R, Goldschmidt D, Zhou M, Finkbeiner S, Leo S. Impact of tardive dyskinesia on physical, psychological, social, and professional domains
of patient lives: a survey of patients in the United States. J Clin Psychiatry. 2023;84(3):22m14694.

 
Orange globe icon inside an orange circle.

PerfecTD:

Pencil and open spiral notebook with √TD written in it.

Question 1 of  

True or False: Movements must be severe in order for a diagnosis of TD to be made.

 
 
 

Answer: False

Movements do not have to be severe in order for a diagnosis of TD to be made.

True or False: In a survey of patients with TD, more than 1 in 3 reported that they stopped taking antipsychotic
medication altogether.

 
 
 

Answer: True

In a survey of patients with TD, more than 1 in 3 reported that they stopped taking antipsychotic medication altogether.

True or False: TD can have an impact on caretakers as well as the patients themselves.

 
 
 

Answer: True

TD can have an impact on caretakers as well as the patients themselves.

Thank you for completing

The Impact of TD—Real Patients,
Real Stories: Chapter 1

An Overview of
the Impact of
Tardive Dyskinesia

Orange clipboard with checkmarks next to 3 lines, surrounded by an orange circle.

Summary:

TD is a movement disorder resulting from treatment with APDs that can impact the everyday life of the patient and hinder their progress toward stable mental health. It may also have an impact on caregivers. Clinicians may not always be attuned to the subtle presentation of symptoms in patients with TD.

Explore the Next Chapter
The Domains

Chapter 1 References:

Caroff SN. Neuropsychiatr Dis Treat. 2019;15:785-794.

Finkbeiner SR et al. Presented at: XXVIII World Congress on Parkinson’s Disease and Related Disorders; May 13-16, 2023; Chicago, IL.

Jackson R et al. Neuropsych Dis Treat. 2021;17:1589-1597.

Jain R et al. J Clin Psychiatry. 2023;84(3):22m14694.

Jain R et al. J Patient Rep Outcomes. 2023;7(1):122.

INDICATIONS AND USAGE

AUSTEDO XR® (deutetrabenazine) extended-release tablets and AUSTEDO® (deutetrabenazine) tablets are indicated in adults for the treatment of chorea associated with Huntington’s disease and for the treatment of tardive dyskinesia.

IMPORTANT SAFETY INFORMATION

Depression and Suicidality in Patients with Huntington’s Disease: AUSTEDO XR® and AUSTEDO® can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidality, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidality and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation. AUSTEDO XR and AUSTEDO are contraindicated in patients who are suicidal, and in patients with untreated or inadequately treated depression.

Contraindications: AUSTEDO XR and AUSTEDO are contraindicated in patients with Huntington’s disease who are suicidal, or have untreated or inadequately treated depression. AUSTEDO XR and AUSTEDO are also contraindicated in: patients with hepatic impairment; patients taking reserpine or within 20 days of discontinuing reserpine; patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of discontinuing MAOI therapy; and patients taking tetrabenazine or valbenazine.

Clinical Worsening and Adverse Events in Patients with Huntington’s Disease: AUSTEDO XR and AUSTEDO may cause a worsening in mood, cognition, rigidity, and functional capacity. Prescribers should periodically re-evaluate the need for AUSTEDO XR or AUSTEDO in their patients by assessing the effect on chorea and possible adverse effects.

QTc Prolongation: AUSTEDO XR and AUSTEDO may prolong the QT interval, but the degree of QT prolongation is not clinically significant when AUSTEDO XR or AUSTEDO is administered within the recommended dosage range. AUSTEDO XR and AUSTEDO should be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias.

Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex reported in association with drugs that reduce dopaminergic transmission, has been observed in patients receiving tetrabenazine. The risk may be increased by concomitant use of dopamine antagonists or antipsychotics. The management of NMS should include immediate discontinuation of AUSTEDO XR and AUSTEDO; intensive symptomatic treatment and medical monitoring; and treatment of any concomitant serious medical problems.

Akathisia, Agitation, and Restlessness: AUSTEDO XR and AUSTEDO may increase the risk of akathisia, agitation, and restlessness. The risk of akathisia may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops akathisia, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.

Parkinsonism: AUSTEDO XR and AUSTEDO may cause parkinsonism in patients with Huntington’s disease or tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. The risk of parkinsonism may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops parkinsonism, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.

Sedation and Somnolence: Sedation is a common dose-limiting adverse reaction of AUSTEDO XR and AUSTEDO. Patients should not perform activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, until they are on a maintenance dose of AUSTEDO XR or AUSTEDO and know how the drug affects them. Concomitant use of alcohol or other sedating drugs may have additive effects and worsen sedation and somnolence.

Hyperprolactinemia: Tetrabenazine elevates serum prolactin concentrations in humans. If there is a clinical suspicion of symptomatic hyperprolactinemia, appropriate laboratory testing should be done and consideration should be given to discontinuation of AUSTEDO XR and AUSTEDO.

Binding to Melanin-Containing Tissues: Deutetrabenazine or its metabolites bind to melanin-containing tissues and could accumulate in these tissues over time. Prescribers should be aware of the possibility of long-term ophthalmologic effects.

Common Adverse Reactions: The most common adverse reactions for AUSTEDO (>8% and greater than placebo) in a controlled clinical study in patients with Huntington’s disease were somnolence, diarrhea, dry mouth, and fatigue. The most common adverse reactions for AUSTEDO (4% and greater than placebo) in controlled clinical studies in patients with tardive dyskinesia were nasopharyngitis and insomnia. Adverse reactions with AUSTEDO XR extended-release tablets are expected to be similar to AUSTEDO tablets.

Please see accompanying full Prescribing Information, including Boxed Warning.