Understanding the Impact of TD

Small movements can have a major impact on patients, their loved ones, and those around them, even when patients are unaware of their symptoms.

REAL PATIENTS DESCRIBE THE IMPACT OF TD

Click on each domain to see a video on how TD can impact each domain of a patient’s life.

Gray circle with gray half brain connected to purple half gear with cogs. Purple circle with purple half brain connected to purple half gear with cogs.

Psychological/Psychiatric

Gray circle around two gray speech bubbles, one with 3 gray dots inside. Purple circle around two purple speech bubbles, one with 3 purple dots inside.

Social

Gray outline of person hunched forward inside a gray circle. Purple outline of person hunched forward inside a purple circle.

Physical (and activities of daily living [ADLs])

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Vocational/Educational/Recreational

Patient images used with permission.

Patient images used with permission.

Patient images used with permission.

Patient images used with permission.

Patient images used with permission.

No clinical studies have been conducted to evaluate the effects of treating TD on the outcomes described on this website.

3 of 4 patients reported severe impact of TD*,†

Two online surveys, from 269 patients with TD and 162 caregivers, found that 3 out of 4 patients reported severe impact across all social, psychological, and physical domains.*

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*From 2 online surveys 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 96.5% of patients with very severe TD symptoms.

TD That Has an Impact on Patients Should Be Treated

  • APA Guidelines recommend treatment if TD has an impact on the patient, irrespective of the severity of that impact
  • Thus, assessment of impact is critical and should be performed at every patient visit

Assessment of impact should be performed at every patient visit

Impact-TD Scale

The Impact-TD Scale is a tool that can be used in clinical practice for the routine assessment of the impact of TD.

Recommendations:

  • A shared decision to treat TD must consider impact

Goal of Impact-TD Scale

Provide clinicians a short, easy-to-administer checklist to facilitate the assessment of TD impact on patients and guide treatment decisions

Orange rectangles with rounded corners and orange notebook lines. Click to open Impact-TD Scale

Impact-TD: A New Scale to Measure Impact in Clinical Practice

Consider the consequences of TD across the 4 domains as a guide for your dialogue about impact with your patients. Explore the different domains by clicking below.

Purple circle with purple half brain connected to purple half gear with cogs.

Psychological/Psychiatric

  • Sadness, depression
  • Anxiety, worry, concern
  • Low self-esteem
  • Hopelessness, loss of sense of purpose
  • Poor concentration, attention, memory
  • Worsening or recurrence of previous symptoms/disorder (eg, depressed mood, anxiety, psychosis, aggression)
  • Difficulty with appropriate treatment of mental disorder (eg, reduced adherence with medication regimens, discontinuation of treatment)
  • Unhealthy coping strategies (eg, substance use/abuse)
Purple circle around two purple speech bubbles, one with 3 purple dots inside.

Social

  • Difficulty participating in events with family and others (eg, holiday gatherings, religious institution attendance)
  • Self-consciousness/embarrassment about movements or being seen/asked about by others (ie, stigma, rejection)
  • Avoidance of interaction with others (eg, declines invitations, avoids leaving home, isolation)
  • Reduced quality of interpersonal communication (eg, distraction from conversation, problems interpreting body language)
Purple outline of person hunched forward inside a purple circle.

Physical (and ADLs)

  • Difficulty using utensils, writing, typing, dressing
  • Difficulty speaking, chewing, or swallowing
  • Difficulty walking or maintaining balance (eg, stumbling, need for assistive device)
  • Problems breathing (eg, shortness of breath, gasping for air)
  • Pain due to TD (eg, biting inside of mouth, teeth clenching)
  • Difficulty sitting still/falling asleep
Purple briefcase inside a purple circle.

Vocational/Educational/Recreational

  • Problems gaining or maintaining employment
  • Problems with recreational or vocational/educational performance (eg, poor concentration, trouble communicating, physical limitations)
  • Challenges getting to work/school or other activities
  • Difficulty with colleague/classmate/customer interactions
  • Difficulty performing tasks independently

How to Use the Scale:

  • Go through each domain and its associated components (listed above in each tab)
  • Assign a degree of severity for each of the domains, on a scale of 0 to 3 (0=no impact, 1=mild, 2=moderate, and 3=severe)
  • When assigning a score, consider the degree of interference, distress, and/or frequency for each domain
  • Once you have assigned a score for each domain, look at the highest number across all 4
  • The highest number is considered the Global Impact-TD score, and its associated impact should be considered the overall impact TD is having on a patient’s life
Click to open Impact-TD Scale
Orange globe icon inside an orange circle.

PerfecTD:

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

Question 1 of  

After watching this video, please select the domains in which the patient experiences TD impact.

 
 
 
 
 
 
 

Answer: Psychological/Psychiatric and Social

This patient describes difficulty participating in events with others and feeling embarrassed about movements, which are problems in the social domain. The patient also speaks of having to cancel doctor appointments because of the movements, which signifies impact in the psychological/psychiatric domain, especially because missed appointments can interfere with appropriate treatment of the mental health disorder.

Select the domain to which this question applies:

Are you experiencing poor or reduced concentration, attention, or memory?

 
 
 
 
 

Answer: Psychological/Psychiatric

Problems in the psychological domain include poor concentration, attention, and memory.

Select the domain to which this question applies:

Do you feel self-conscious when you go out to eat with friends?

 
 
 
 
 
 

Answer: Social

Problems in the social domain include self-consciousness or embarrassment about movements, or being seen/asked about by others (ie, stigma, rejection).

Thank you for completing

Screening and Assessment: Chapter 3

Assessing the Impact
of Tardive Dyskinesia (TD)

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

Summary:

Impact is the key driver in the decision to treat TD.

Explore the Next Chapter
Virtual Visit

Chapter 3 References:

American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. 3rd ed. Washington, DC: American Psychiatric Association; 2021.

American Psychological Association. https://www.apa.org/practice/guidelines/telepsychology.

Jackson R et al. J Clin Psychiatry. 2022;84(1):22cs14563.

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

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

Jain R et al. Presented at: Psych Congress 2021; October 29-November 1, 2021; San Antonio, TX.

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

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.