Among their recommendations:

  • The terms “mild” and “probable” should be avoided when diagnosing TD,
    as any movement can cause social anxiety and problems with daily activities
  • The impact of TD should be assessed across the key domains of a patient’s life:
    • Physical
    • Psychological/Psychiatric
    • Social
    • Vocational/Educational/Recreational
  • The shared decision to treat TD must consider impact
Functional-disabilities-circle
Physical-icon-lg

The Impact of TD: The Physical Domain

The physical impacts of the involuntary movements of TD can include

  • Dental damage
  • Biting the lip and tongue
  • Spilling food/difficulty eating
  • Musculoskeletal pain
  • Labored breathing
  • Speech impairment
  • Gait issues and imbalance
  • Falling

Patients may routinely need help with activities they previously took for granted, such as buttoning clothes and tying shoes.

For Patients With TD, the Most Common Tasks Become Difficult

In an online survey of 269 patients with TD, 9 out of 10 patients said that TD impacted their physical functioning.

Of participants in the survey, in the previous 7 days…

Up to 

Reported
difficulty
speaking

Icon-Difficulty-Speaking
Up to 

Reported
difficulty eating

Icon-Difficulty-Eating
 

Reported difficulty
holding objects

Icon-Difficulty-Holding
 

Reported
difficulty doing
household chores

Icon-Difficulty-Doing

…because of their TD.

TD Can Affect the Entire Body

Dental-Issues-Icon

Dental Issues

Because orofacial movements are
common, patients with TD often
have dental problems.

Patient images used with permission.

 
Difficulty-Chewing-Icon

Difficulty Chewing

Involuntary movements of the mouth, tongue, and jaw may lead to difficulty chewing and swallowing.

Patient images used with permission.

 
Breathing-Complications-Icon

Breathing Complications

Grunting, snorting, and gasping may occur due to the impact of TD on
muscles that control breathing.

Patient images used with permission.

 
Breathing-Complications-Icon

Musculoskeletal pain and discomfort

TD can cause chronic muscle spasms, leading to musculoskeletal pain.

Patient images used with permission.

 
Imbalance-Icon

Imbalance

TD-linked gait and postural abnormalities
may increase risk of falls and mobility issues.

Patient images used with permission.

 
Psychological-Domain-Icon

The Impact of TD: The Psychological/Psychiatric Domain

The psychological and psychiatric impact of TD can include

  • Reduced adherence to APDs, resulting in
    • Risk of relapse
    • Poor response to treatment
  • Feelings of hopelessness
  • Loss of sense of purpose
  • Worsening anxiety and depression

These in turn may lead to unhealthy coping strategies, such as substance abuse.

TD Can Create Cracks in the Foundation of Psychiatric Stability Achieved by the Patient’s APD

How many patients with TD reported negative psychological and psychiatric consequences from the disorder?*

Up to 0%

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

Because of their TD,
3 out of 4 patients reported feeling…

  • Anxious or worried
  • Low self-esteem
  • Sad or unhappy
  • Embarrassed
  • Fear of rejection

…in the past 7 days*

In this brief video, Toni describes the psychological consequences of her TD.

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

 
Social-Domain-Icon

The Impact of TD: The Social Domain

TD can have a negative impact on patients’ social and family ties

Orofacial symptoms are among the most common and may lead to problems with speech. This can result in

  • Diminished friendships and romantic relationships
  • Social avoidance and withdrawal

TD patients often isolate themselves out of shame and embarrassment, and cut themselves off from much-needed support networks.

Stigma Around TD Has a Substantial Impact on Patients’ Social Lives

TD Affects the Social Activities of Over 9 Out of 10 Patients*

Social-Activities-Icon

78%

Were bothered when
a potential partner or date displayed negative reactions to their TD

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

TD Impacts How Others View the Patient: In One Study, Actors Simulating Mild to Moderate Orofacial TD Movements
Were Negatively Perceived

Participants watched a video in which trained actors, coached by an expert in TD, performed a script either with or without
mild to moderate orofacial TD movements. Participants were then asked about their impressions.

TD affects how patients are perceived socially*

Chart-TD-Movement-Survey-Results

*In this experimental, randomized, blinded, digital survey in a general population sample, participants were randomized 1:1 into a test or control group to view a video of a professional actor speaking from a short script while simulating TD movements or no TD movements. Authenticity of abnormal movements were evaluated by physician experts. Participants were asked to rate their level of agreement with specific statements regarding the actors’ suitability for employment, dating, and friendship.


Ayyagari R, Goldschmidt D, Mu F, Caroff SN, Carroll B. An experimental study to assess the professional and social consequences of tardive dyskinesia. Clin Psychopharmacol Neurosci. 2022;20(1):154-166.

Vocational-Educational-Recreational-Domain-Icon

The Impact of TD: The Vocational/Educational/
Recreational Domain

TD can have deleterious repercussions for patients in the workplace

Abnormal movements can change how patients are perceived by work colleagues; changes in speech may make communication difficult. These symptoms may result in

  • Impairment of work productivity
  • Missed job opportunities
  • Missed opportunities for promotion

TD can curtail education opportunities, as well, and may force patients to give up recreational aspects of their lives they had previously found fulfilling.

The Impact of TD Can Spread to Lost Opportunities in School and at Work, and Make It Difficult to Enjoy Hobbies*

TD prevented

1-out-of-3-people

~1/3

of patients reported that TD prevented them from applying for a job, seeking a promotion, and/or getting a job they applied for

2-out-of-3-people

>2/3

of patients found that TD impacted their ability to do schoolwork

3-out-of-4-people

>3/4

of patients reported that their TD interfered with their ability to enjoy the things they do for fun

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

Peggy, Sandra, and Robert

Watch Peggy, Sandra, and Robert describe how TD has created personal challenges in this domain.

Patient images used with permission.

 

In One Study, Actors Simulating Mild to Moderate Orofacial TD Movements Were Less Likely to Be Considered Candidates
for Employment

Participants watched a video in which trained actors, coached by an expert in TD, performed a script either with or without
orofacial TD movements. Participants were then asked about their impressions.

Chart-TD-Employment-Survey-Results

*In this experimental, randomized, blinded,
digital survey in a general population sample, participants were randomized 1:1 into a test or control group to view a video of a professional actor speaking from a short script while simulating TD movements or no TD movements. Authenticity of abnormal movements were evaluated by physician experts. Participants were asked to rate their level of agreement with specific statements regarding the actors’ suitability for employment, dating, and
friendship.


Ayyagari R, Goldschmidt D, Mu F, Caroff SN, Carroll B. An experimental study to assess the professional and social consequences of tardive dyskinesia. Clin Psychopharmacol Neurosci. 2022;20(1):154-166.

It Is Important to Understand the Impact of TD in Each of the 4 Domains

In this video, Candace, a patient with TD, describes how abnormal movements have affected her across all 4 domains.

 

Patient images used with permission.

Orange globe icon inside an orange circle.

PerfecTD:

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

Question 1 of  

In the video, Candace described dental issues associated with TD. This represents impact in which domain?

 
 
 
 
 

Answer: Physical

Candace’s dental issues are in the physical domain.

In the video, Candace said that, because of TD, “the depression worsened. It just worsened.” This represents
impact in which domain?

 
 
 
 
 

Answer: Psychological/Psychiatric

Candace’s experience of worsening depression represents impact in the Psychological/Psychiatric domain.

Thank you for completing

The Impact of TD—Real Patients,
Real Stories: Chapter 2

The Impact of TD
on 4 Domains of Daily Life

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

Summary:

The full impact of TD may be seen plainly by evaluating how the disorder affects the patient in 4 domains of daily life: the Psychological/Psychiatric domain, the Social domain, the Physical domain, and the Vocational/
Educational/Recreational domain.
When surveyed, high percentages of TD patients report impact in one or more of these domains. Any impact in any domain warrants treatment.

Explore the Next Chapter
The Impact-TD Scale

Chapter 2 References:

Aquino CCH, Lang A. Parkinsonism Relat Disord. 2014;20(suppl 1):S113-S117.

Ayyagari R et al. Clin Psychopharmacol Neurosci. 2022;20(1):154-166.

Caroff SN et al. J Clin Psychiatry. 2011;72(3):295-303.

Data on file. Teva Neuroscience.

Jackson R et al. J Clin Psychiatry. 2023;84(1):22cs14563.

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

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

Menzies V, Farrell SP. J Am Psychiatr Nurses Assoc. 2002;8(2):51-56.

Strassnig M et al. CNS Spectr. 2018;23(6):370-377.

Ward KM, Citrome L. Neurol Ther. 2018;7(2):233-248.

Wain O, Jankovic J. Tremor Other Hyperkinet Mov. 2013;12:3:tre-03-161-4138-1.

Yassa R. Acta Psychiatr Scand. 1989;80(1):64-67.

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.