Consider Patient and Caregiver Assessments in Tardive Dyskinesia Screenings

Eiry W. Roberts, MD

Physicians, caregivers, and patients may all perceive a patient’s tardive dyskinesia impairment and ability differently, according to recent research.

Investigators from Neurocrine Biosciences evaluated 204 psychiatric outpatients with visible movements and possible tardive dyskinesia in order to describe their diagnosis assessed by not only clinicians, but also patients and caregivers.

The patients were recruited from 37 outpatient psychiatry practices across the US and were all ≥18 years of age. The patients, additionally, had at least 3 months’ lifetime exposure to antipsychotic medications and at least one clinician-confirmed psychiatric disorder, such as major depressive disorder, bipolar disorder, schizophrenia, or schizoaffective disorder. Given the long-term nature of antipsychotic use for indications other than psychotic disorders, the study authors said, more information is needed about tardive dyskinesia in patients prescribed these medications.

Caregivers for patients were asked to complete a baseline questionnaire, because the study authors felt that there is low awareness of tardive dyskinesia symptoms reported in some patients. At the same time, the investigators collected demographic data, overall health assessments for the patients, and the presence, location, and severity of the involuntary movements according to the clinician, patient, and caregivers, individually.

A majority of the caregivers (80%) were either a family member or a friend of the patient. Authors noted that managing tardive dyskinesia can require a considerable time investment from both the patient and their caregiver, and can be socially isolating. In general, patients’ health was rated worse by caregivers than by the patients, the investigators reported.

“We found that although patients, caregivers, and clinicians generally agreed on the severity of involuntary movements, caregivers tended to report the movements as more severe, indicating caregivers may experience a higher burden associated with the impact of involuntary, abnormal movements,” Neurocrine Biosciences Chief Medical Officer Eiry W. Roberts, MD, told MD Magazine®. “It is important to better understand how physicians, patients, and caregivers perceive a patient’s uncontrollable movements and the effect that these movements can have on the everyday lives of patients and their caregivers.”

Half of the patients spent the most time managing their mental health conditions, according to the perception of the caregivers and the patients. But patients and caregivers agreed on the severity of involuntary movements and locations, the researchers said. The caregivers’ assessments of involuntary movements were more severe than clinicians’, though. Patients, clinicians, and caregivers were asked to report severity of involuntary movements in the head/face, neck/trunk, upper extremities, and lower extremities with ratings of “none,” “some,” or “a lot.” For almost every location, caregivers were more likely to select the “a lot” category.

“These data reinforce the need for healthcare providers to consider assessments from both patients and caregivers when screening for tardive dyskinesia,” Roberts said. “We hope that the data help healthcare providers deepen their understanding of the full impact that the involuntary, abnormal movements associated with tardive dyskinesia can have on patients and their caregivers, including the effects of the condition on their daily lives.”

The poster, “Tardive Dyskinesia Symptom Screening in Real-World Outpatient Settings: Correlations between Patient-, Caregiver-, and Clinician-Reported Assessments in the RE-KINECT Study,” was presented at the Annual US Psychiatric and Mental Health Congress in Orlando, FL.