Case 3: Discussion
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 case.
Editor’s note: The following is an automatically generated transcript of the above video.
"Let's discuss Mary's case, then. Her risk factors for TD included female sex, older age, depression diagnosis, and antipsychotic exposure. Since Mary's depression had resolved by the time TD emerged, based on the augmentation for depression with an antipsychotic, stopping the likely causal antipsychotic was the most prudent action when the antipsychotic is only given for a disease that is not necessarily chronic and does not necessarily require chronic antipsychotic treatment for relapse prevention, because depression is often episodic and she always needed a severe trigger for the depression, always the loss, the death of a loved one. Mary opted to continue on fluoxetine for now for relapse prevention of her depression that had only recently resolved fully, which makes total sense.
She needs a seatbelt. Vitamin E was added as off-label treatment due to a meta-analytic evidence of its potential utility for TD at negligible risks because it's just a vitamin. Vitamin E could be stopped at three months after cessation of the TD symptoms that had only recently emerged, that were mild at baseline, and also in a situation where the offending agent could be stopped too. Mary and her daughter are relieved that both the depression and tardive dyskinesia symptoms resolved completely by month three, and upon renewed need for antidepressant augmentation in the future, Mary should likely not be given an antipsychotic, because she's sensitive to that post-synaptic dopamine blockade, but should rather be treated with other options to avoid recurrence of tardive dyskinesia."