Prevalence of Tardive Dyskinesia in an Electronic Medical Record Study at a Large Community Mental Health Treatment Center

Carol S. North, MD, MPE, DLFAPA^a,b; Katy McDonald, LPC^a,b; Judith Hunter, MD^a; John Burruss, MD^a,b

Prim Care Companion CNS Disord 2022;24(4):21m03069

ABSTRACT

Objective: To determine the prevalence of tardive dyskinesia (TD) identified by clinicians in naturalistic data in a real-world treatment setting.

Methods: Electronic medical record data were analyzed from a single large community mental health treatment center for all psychiatric provider encounters of 120,431 unique adult and child patients during a 5-year period from January 2013 through December 2017, focusing on clinician-identified TD in patients prescribed antipsychotic medication.

Results: Only half of the antipsychotic-prescribed patients had Abnormal Involuntary Movement Scale (AIMS) information recorded in their medical records, and only 1% of those with AIMS data had a positive AIMS identifying TD. AIMS testing represented the largest source of all identified TD in these patients, but only one-third of the patients with a positive AIMS in the record had a clinical diagnosis of TD recorded in the prescriber’s diagnostic impression list from billing code data. The clinical identification of only 1% of antipsychotic-prescribed patients with TD in this study is far below generally established TD prevalence estimates of previous research. An important methodological contributor to this discrepancy is generation of the data by treating clinicians in this study who greatly under identified TD relative to systematic research methodology.

Conclusions: Given the recent availability of US Food and Drug Administration–approved pharmaceutical agents for treatment of TD, it is now more important than ever to identify and intervene in TD. Agency-wide policies and procedures can be established to ensure that TD assessments are systematically conducted with regularity and accuracy among all antipsychotic-prescribed patients.

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References (17)

Correll CU, Kane JM, Citrome LL. Epidemiology, prevention, and assessment of tardive dyskinesia and advances in treatment. J Clin Psychiatry. 2017;78(8):1136–1147. PubMed CrossRef
Citrome L, Dufresne R, Dyrud JM. Tardive dyskinesia: minimizing risk and improving outcomes in schizophrenia and other disorders. Am J Manag Care. 2007;13:1–12.
D’Abreu A, Akbar U, Friedman JH. Tardive dyskinesia: epidemiology. J Neurol Sci. 2018;389:17–20. PubMed CrossRef
Kane JM, Correll CU, Nierenberg AA, et al; Tardive Dyskinesia Assessment Working Group. Revisiting the Abnormal Involuntary Movement Scale: proceedings from the Tardive Dyskinesia Assessment Workshop. J Clin Psychiatry. 2018;79(3):17cs11959. PubMed CrossRef
Lerner PP, Miodownik C, Lerner V. Tardive dyskinesia (syndrome): current concept and modern approaches to its management. Psychiatry Clin Neurosci. 2015;69(6):321–334. PubMed CrossRef
Carbon M, Hsieh CH, Kane JM, et al. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264–e278. PubMed CrossRef
Caroff SN, Yeomans K, Lenderking WR, et al. RE-KINECT: a prospective study of the presence and healthcare burden of tardive dyskinesia in clinical practice settings. J Clin Psychopharmacol. 2020;40(3):259–268. PubMed CrossRef
Widschwendter CG, Hofer A. Antipsychotic-induced tardive dyskinesia: update on epidemiology and management. Curr Opin Psychiatry. 2019;32(3):179–184. PubMed CrossRef
Cornett EM, Novitch M, Kaye AD, et al. Medication-induced tardive dyskinesia: a review and update. Ochsner J. 2017;17(2):162–174. PubMed
Brar JS, Parepally H, Chalasani L, et al. The impact of olanzapine on tardive dyskinetic symptoms in a state hospital population. Ann Clin Psychiatry. 2008;20(3):139–144. PubMed CrossRef
Woerner MG, Kane JM, Lieberman JA, et al. The prevalence of tardive dyskinesia. J Clin Psychopharmacol. 1991;11(1):34–42. PubMed CrossRef
Schooler NR, Kane JM. Research diagnoses for tardive dyskinesia. Arch Gen Psychiatry. 1982;39(4):486–487. PubMed CrossRef
Loughlin AM, Lin N, Abler V, et al. Tardive dyskinesia among patients using antipsychotic medications in customary clinical care in the United States. PLoS One. 2019;14(6):e0216044. PubMed CrossRef
Alexander GC, Gallagher SA, Mascola A, et al. Increasing off-label use of antipsychotic medications in the United States, 1995–2008. Pharmacoepidemiol Drug Saf. 2011;20(2):177–184. PubMed CrossRef
Carton L, Cottencin O, Lapeyre-Mestre M, et al. Off-label prescribing of antipsychotics in adults, children and elderly individuals: a systematic review of recent prescription trends. Curr Pharm Des. 2015;21(23):3280–3297. PubMed CrossRef
Trémeau F, Citrome L. Antipsychotics for patients without psychosis? what clinical trials support. Curr Psychiatr. 2006;5:33–44.
Wonodi I, Reeves G, Carmichael D, et al. Tardive dyskinesia in children treated with atypical antipsychotic medications. Mov Disord. 2007;22(12):1777–1782. PubMed CrossRef