Exploring the functional, social, professional and psychological impact of tardive dyskinesia movements on patients’ lives

Tardive dyskinesia (TD) is a historically under-recognised movement disorder that predominately affects individuals with psychiatric conditions who have been treated with dopamine receptor antagonists for more than a few months.^1,2 The highest prevalence of TD is observed in those treated with antipsychotic medications, with around a quarter developing TD in their lifetime.² TD is associated with neurocognitive and functional impairment and often has a wider impact on an individual’s social and psychological well-being.^3–8 It is vital that patients treated with antipsychotic drugs are regularly assessed for signs or symptoms of TD to avoid under-recognition or misdiagnosis.^9–11

TD is an under-recognised drug-induced movement disorder^1,2 

TD is an often irreversible extrapyramidal side effect (EPS) caused by exposure to dopamine receptor antagonists.^1,2,12 TD typically emerges in individuals who have received long-term treatment with antipsychotic medications.¹ In Europe, 2017, TD was reported in 22.3% of individuals in this population.² The involuntary arrhythmic movements of TD often affect the face;¹³ however, in some cases these extend to the trunk and limbs.^1,12 TD symptoms are chronic but may wax and wane in severity over time and may have substantial impact on patients, even when considered mild.^a,1,3 

TD affects daily functioning and well-being^4–6

The impact of TD movements on usual day-to-day activities, including eating and self-care, can vary from ‘a lot’ to ‘little’ or ‘some’ impact, but they frequently reduce quality of life.^4,5 Many patients with TD experience lower productivity and fewer are in full-time employment than those without TD.^4,5 They often feel uncomfortable in their own skin, with many feeling their ability to socialise is affected.⁴ Feelings of unacceptance and stigma may also develop as a result of discrimination by others.^5,6 For instance, when shown videos of actors simulating orofacial TD movements, approximately 50% of responders would not be "interested to meet in person for a coffee or a drink" or disagree that "the candidate would be suitable for client facing jobs".⁶ Patients with TD can also experience negative impacts on their psychological well-being and underlying psychiatric conditions.^3,4 Studies have found higher rates of EPS, drug or alcohol dependency, hospitalisations due to psychiatric conditions and reduced symptom remission in patients treated with antipsychotics with TD when compared with those without TD.^8,14 

TD may be associated with reduced neurocognitive function^7,8

In some cases, TD may be associated with cognitive impairment.⁸ When comparing patients with schizophrenia with and without TD, those with TD tend to score lower on neurocognitive tests that reflect functional ability in simple and complex tasks, attention and decision-making, processing speed, reasoning and memory.^b,7,8

Early recognition is essential for the management of TD^1,13

TD presents in a similar way to other movement disorders and some patients may be misdiagnosed.^1,13 To prevent this happening and identify neurologic causes of abnormal movements, the American Psychiatric Association recommends that all patients treated with antipsychotic drugs are regularly assessed for movements associated with TD using a structured tool, such as the Abnormal Involuntary Movement Scale.¹⁵ While available, European guidelines, such as those published by the National Institute for Health and Care Excellence, British Association of Psychopharmacology and German Association for Psychiatry, Psychotherapy and Psychosomatics, are less explicit than those available in the United States and do not provide specific recommendations for tools to monitor emergence of movement disorders or the frequency of assessments.^9–11

^a_{Based on mental and physical health status evaluated using SF12v2 and SF-36v2 Health Survey scores. Scores range from 0–100, with higher scores indicating better health status.} ^b_{A neurocognitive composite score was calculated by creating a Z-score of the average of 5 standardised neurocognitive domain scores (verbal memory, working memory, processing speed, vigilance, and reasoning). Adjusted for baseline covariates.}

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