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 second case.

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

"What are the treatment options for Ida? So she has risk factors that include bipolar disorder. Mood disorder patients may have an even higher risk than schizophrenia disordered patients, that may be a little bit due to also higher doses that were given in the past, but still mood disorders is a risk spectrum. She had also already an antipsychotic or postsynaptic dopamine blocking related side effect, an acute motor problem, akathisia and Parkinsonism, making her most likely more vulnerable for tardive dyskinesia.

And she has both past and ongoing anticholinergic use, and anticholinergic use, again, can prime the brain somewhat for tardive dyskinesia, and it should definitely not be continued. She also has hyperglycemia that may be because she has obesity, she's on olanzapine, and that high blood sugar also is associated with an increased risk of tardive dyskinesia. Since Ida has no current EPS and since anticholinergic agents increase the risk of TD, biperiden should likely be decreased and then stopped, and to see whether there's even any EPS underlaying that, because often the brain counter regulates and what might need some anticholinergic in the beginning is then not necessary anymore, or we should even not have started an anticholinergic all the wrong and just lowered the dose of the postsynaptic dopamine blocker.

Should EPS emerge, the dose of olanzapine could possibly be reduced, she is on 15, maybe 12 and a half or 10, or switch to a lower extrapyramidal symptom risk antipsychotic, either quetiapine or one that also may reduce body weight and cardiometabolic risk like aripiprazole (Abilify, Otsuka America Pharmaceutical), cariprazine (Vraylar Allergan), lurasidone (Latuda, Dainippon Sumitomo Pharma America, Inc.), brexpiprazole (Rexulti, Otsuka America Pharmaceutical) could be used. Since diabetes and hyperglycemia are risk factors for TD, Ida is obese and has cardiometabolic risk factors, healthy lifestyle instruction or even intervention is indicated to help her reduce her weight and/or also the insulin resistance. Should the diabetes not stabilize with non-pharmacologic interventions, maybe Metformin needs to be considered. Since Ida's TD symptoms are moderate in severity and clearly distressing to her and her boyfriend, and they're also functionally impairing, the addition of an FDA-approved VMAT-2 inhibitor deutetrabenazine (Austedo, Teva Neuroscience, Inc.) or valbenazine (Ingrezza, Teva Neuroscience, Inc.) is discussed since she also had multiple episodes, and stopping the anti-psychotic as part of the dual mood stabilizer treatment for a bipolar disorder would most likely be destabilizing.