Tardive Dyskinesia Clinical Case Review

Christoph U. Correll, MD, professor of psychiatry at The Zucker School of Medicine at Hofstra/Northwell and professor and chair of the department of child and adolescent psychiatry at Charité University Medicine in Berlin, Germanye, discusses the treatment options for the first case.

Editor’s note: The following is an automatically generated transcript of the above video.

"Let's review this in terms of understanding the path into tardive dyskinesia. Paul's risk factors for tardive dyskinesia includes that he's middle aged, higher age is always a risk factor, alcohol abuse, which is in current remission. He also had some high dose antipsychotic treatment, first-generation antipsychotic use, but he's currently only on second generation or atypical antipsychotics, so that risk factor is also taken care of. Intermittent antipsychotic use, which has been associated also with tardive dyskinesia, but he's currently on a depot injectable.

Since all the risk factors are either unmodifiable, his age, that he had high dose treatment in the past are already addressed, and since the patient requires longstanding antipsychotic treatment and is currently stable on once monthly paliperidone palmitate, a switch of the underlying antipsychotic treatment is not an option. Since no extra pyramidal symptoms were noted on examination, in addition to the aims, a dose reduction of the once monthly paliperidone palmitate doesn't seem to be indicated either.

Since the tardive dyskinesia is moderately severe, the overall rating always goes with the highest rating on an individual item, and he has two threes, two moderates. And since the TD is also impairing, treatment is clearly indicated. And in this case, since we want to keep the treatment where it is to keep him stable, since we can't modify any of the risk factors, the addition of the only currently approved treatment for tardive dyskinesia, which is a VMAT-2 inhibitor, a vesicular monoamine transporter-2 inhibitor, either valbenazine (Ingrezza, Neurocrine Biosciences) or deutetrabenazine (Austedo, Teva Neuroscience, Inc.) is discussed."