Chirag Shah, PharmD, RPh
Head Medical Affairs & Medical Education
Neurocrine Biosciences

Jonathan Meyer, MD
Clinical Professor of Psychiatry
University of California San Diego

American Psychiatric Association’s new recommendations on the treatment of schizophrenia, released in May 2021, take into account more recent data on antipsychotics, treatment-resistant schizophrenia, and patient preference.  The decision for the new changes was largely sparked by a systematic review led by McDonagh et al, that had been commissioned by the Agency for Healthcare Research and Quality (AHRQ).3  McDonagh’s team reported on new antipsychotics released into the market, including the role of VMAT2 inhibitors in managing tardive dyskinesia (TD) symptoms, and provided a more in-depth summary of antipsychotics with regard to optimizing and individualizing medication choices.

In its 2020 treatment guidelines for schizophrenia, the American Psychiatric Association  recommended that a structured instrument such as the AIMS be administered at least every 12 months, and more frequently (at least every 6 months) in patients with higher TD risk.13,14 Using a modified Delphi process, a panel of psychiatrists and neurologists agreed that a less formal assessment could also be used for screening in clinical practice settings.15

As presented in the real-world RE-KINECT study, these informal assessments could be based on a quick visual observation of the four major body regions (head/face, neck/trunk, upper extremities, lower extremities) and simple descriptors of severity (‘none’, ‘some’, or ‘a lot’),16″ says Jonathan Meyer, MD, Clinical Professor of Psychiatry, University of California San Diego.


“Ideally, patients should be assessed prior to initiating or modifying an antipsychotic treatment to establish baseline “normal” movements and then screened regularly during treatment for any changes. TD assessments can be incorporated into routine protocols that are already in place in many clinical practices, which are used to monitor other antipsychotic-associated adverse events.” Examples include orthostatic hypotension, hyperprolactinemia, weight gain, notes Dr. Meyer.


A critical element of the guidelines was for focus to also include psychological, social, and functional aspects of tardive dyskinesia. “As a movement disorder, TD can affect a patient’s ability to perform daily activities—and even impair basic functions such as walking, eating, and breathing,” says Chirag Shah, Head of Medical Affairs & Medical Education at Neurocrine Biosciences.31,32 Equally important, however, are the social and emotional impacts of TD.5,16,33″

“The use of SGAs is expanding in patients who would probably be aware of their abnormal movements, such as those with a mood disorder who are able to work, attend school, and/or manage a household (with appropriate antidepressant and antipsychotic treatment). For these patients, even “mild” TD symptoms can be highly distressing. Feelings of embarrassment or self-consciousness can cause these patients to withdraw from friends and family, which might not be good for their mental health. We are pleased that the APA has recognized the importance of considering functional ability and quality of life as important factors in treating TD. We strongly encourage all clinicians to do the same,” says Shah.



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