Tardive dyskinesia negatively impacts physical, emotional, and social functioning, which can result in suboptimal treatment of underlying psychiatric disorders.
“Target dyskinesia (TD) is not only a common disorder; it is also highly impairing,” Rakesh Jain, MD, MPH, notes. “However, despite 50 years of research, we do not have a good handle on the impact of TD on QOL, and we truly don’t understand how it impacts different domains of a patient’s life, such as physical, emotional, and social domains.”
For a study published in The Journal of Clinical Psychiatry, the researchers aimed to understand “the extent of the impact of TD, as well as which specific elements of individual functioning are most impacted by TD,” Dr. Jain says.
The study utilized an online survey, conducted from April 2020 to June 2021, to evaluate the burden of TD on patients. Survey respondents included adults with TD and schizophrenia, bipolar disorder, or major depressive disorder. They rated the 7-day effect of TD on physical, psychological, and social functioning via Likert scales ranging from 1 (least impact) to 5 (most impact). Dr. Jain and colleagues determined impact scores and summarized them overall based on self-reported disease severity and underlying disease. Respondents also completed the Work Productivity and Activity Impairment Questionnaire and described the impact of TD on their underlying psychiatric condition.
Physical, Emotional, and Social Functioning
The study included 269 survey respondents (mean age, 40.6; 74.7% employed). Participants reported mean impact scores of 3.1 for the physical domain, 3.5 for the psychological domain, and 3.2 for the social domain. Scores rose as reported TD symptom severity increased, and patients with schizophrenia experienced the highest burden for all domains. Overall, patients reported an activity impairment of 66.2% because of TD.
Respondents who were employed (N=193) had absenteeism rates of 29.1% and presenteeism rates of 68.4%. These respondents also described an overall work-related impairment rate of 73.5%.
Nearly half of the survey respondents (48.4%) described skipping/decreasing antipsychotic medications because of TD. More than one-third stopped antipsychotic medications (39.3%) and stopped attending clinician visits (35.7%) for the underlying psychiatric condition because of TD.
“The primary findings are nothing short of astounding,” Dr. Jain says. “We were astonished by both the deep breadth and scope of the negative impact of TD on physical functioning, emotional functioning, and social functioning. We knew there would be a negative impact, but we were not fully prepared to see how significant of an impact TD has on every single domain of a patient’s life.”
Addressing the ‘Substantial Burden’ of TD
In their conclusion, the researchers noted the “substantial burden” of TD on physical, psychological, social, and professional aspects of patients’ lives. They also described its impact on the management of a patient’s underlying psychiatric condition.
“We certainly hope that this large, well-conducted study alerts the psychiatric community at large to the impact of TD,” Dr. Jain says. “TD is not just a movement disorder. It is a movement disorder that causes suffering and pain.”
He also hopes that the study serves as “a call to action” for healthcare professionals..
“We have documented the various elements of physical, emotional, and social functioning that are impacted in this patient population,” he continues. “We hope our paper is a call to action for all practitioners in the fields of medicine and mental health to start recognizing TD and its impact and offer evidence-based, FDA-approved treatment in order to diminish the negative impact of this disease.”
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