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, Germany, discusses the selected treatment for the second case.

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

"So Biperiden was titrated down, and then after a week the titration down, she was then stopped by two weeks without any resurgence of EPS. She also started a walking schedule with her boyfriend losing actually four pounds per month, bringing the blood sugar below 110 by week eight. So she was really motivated and her boyfriend helped her with that. The TD symptoms remained unchanged even though the anticholinergic was stopped and also she started to go below the diabetes threshold in the blood sugar. So since there seems to be more of a brain dysfunction that is internal and not just, cannot just be changed by these risk factor modifications, the decision is made to try Deutetrabenazine extended release, allowing for dosing independent of food, and once daily titration.

Compared to the prior Deutetrabenazine that was not extended release. And since the titration in smaller steps can be given, that is seen as an advantage here, because she's had multiple side effects with psychotropic medications in the past, considering herself sensitive to adverse effects of medications. So deutetrabenazine XR is started at 12 milligrams per day as indicated, and then titrated by six milligrams every other week up to 36 milligrams per day. You can go up to 48 milligrams per day without any perceived side effects and good clinical response of the tardive dyskinesia movements and also continued stability. Offer bipolar disorder since we didn't touch the Olanzapine and Lithium as her stabilizing treatments for bipolar disorder."