1. Answers to Your Questions About Tardive Dyskinesia
An Educational Webinar Series for Patients and Families/Caregivers
Part 2: Can Tardive Dyskinesia Be Prevented?

2. Faculty Presented by: Leslie Citrome, MD, MPH
Clinical Professor of Psychiatry and Behavioral Sciences
New York Medical College, Valhalla, NY
Supported by an educational grant from Teva Pharmaceuticals
Prepared by Delaware Media Group for TDAnswers.com

3. Brief Review of TD
Definition: Tardive dyskinesia (TD) refers to uncontrollable abnormal movements (often in the areas of the face and hands) that result from taking certain medications
Symptoms: TD usually begins with spontaneous, involuntary movements of the face, mouth, lips and tongue
Causes: TD is usually caused by long-term exposure to certain types of drugs, such as antipsychotics, which are used to treat mental disorders

4. Brief Review of TD When do symptoms appear?
In most cases, 1 or more years after starting TD-inducing drugs
After discontinuing the medication (withdrawal dyskinesia) 
Changing or reducing the dose of the medication (withdrawal dyskinesia) 
Symptoms may occur sooner in some people 

5. TD Symptoms - Review Facial Symptoms
Involuntary movements: mouth, lips, and tongue
Grimacing, lip smacking, tongue movement
Eye Symptoms
Rapid blinking
Squinting
Movements in limbs and trunk
Involuntary hand movements
Writhing movements

6. Drug-Associated Risks for TD
TD develops in up to one-third of people taking antipsychotic drugs
The risks for each person vary. Increased risk is seen with:
Use of first-generation antipsychotics
Higher medication doses
Longer duration of treatment
People who have abnormal movements such as tremor

7. Gender Age Ethnicity Personal Risk Factors
Advanced age increases the risk for TD
Age
TD occurs more often in women
Gender
African-American patients have a higher risk for TD
Ethnicity
Personal Risk Factors
Other risk factors may include:
Diabetes
Substance abuse, alcoholism

8. Examples of First- and Second-Generation Antipsychotic Agents
First-Generation
Second-Generation
Chlorpromazine (Thorazine®)
Fluphenazine (Prolixin®)
Haloperidol (Haldol®)
Loxapine (Loxitane®)
Perphenazine (Trilafon®)
Thiothixene (Navane®)
Trifluoperazine (Stelazine®)
Asenapine (Saphris®)
Aripiprazole (Abilify®)
Brexpiprazole (Rexulti®)
Cariprazine (Vraylar®)
Clozapine (Clozaril®)
Iloperidone (Fanapt®)
Lurasidone (Latuda®)
Olanzapine (Zyprexa®)
Paliperidone (Invega®)
Quetiapine (Seroquel®)
Risperidone (Risperdal®)
Ziprasidone (Geodon®)
*Examples of common brand names are shown. Other brand names may be available.

9. Can TD Be Prevented?
The only sure prevention is to avoid treatment with antipsychotic drugs, but this is not always possible
People who require antipsychotics should use a second-generation antipsychotic, at the lowest effective dose, for the shortest amount of time
However, some disorders such as schizophrenia may require prolonged use of antipsychotic medication in order to control the disease and decrease the risk of relapse

10. Can We Keep TD From Getting Worse?
Early detection
Allows doctor to discontinue or reduce dose of antipsychotic when possible
Monitoring
TD symptoms can be irregular (may come and go)
People using antipsychotics should be examined regularly for signs of TD
Person’s need for antipsychotic or other drug should be evaluated regularly
Antipsychotic medication is usually necessary for people with schizophrenia, but alternative medications may be available to treat other diseases

11. How is TD Measured?
This simplified version of the AIMS shows what the evaluator will look for:
The Abnormal Involuntary Movement Scale (AIMS) is used to examine for TD and measure its severity.
Rating for each item is from 0 to 4, with 0 being no symptoms and 4 being severe symptoms.
Seven body regions are examined (4 on the face and 3 on the extremities and trunk)
1) Facial and oral movements
Muscles of facial expression
Lips
Jaw
Tongue
2) Extremity movements
Upper body (arms, wrists, hands, fingers)
Lower body (legs, knees, ankles, toes)
3) Trunk movements
Neck, shoulders, hips
4) Global judgment
Overall severity of movements
Are movements incapacitating?
Patient’s awareness of movements
5) Dental status
Current problems with teeth or dentures
Are dentures worn?
Missing teeth?
Do movements stop during sleep? 

12. Summary
It is best to prevent TD whenever possible, but not every person who is taking an antipsychotic agent is able to discontinue the drug or use a lower dose
Many people rely on these medications for control of serious psychiatric conditions
A hopeful sign is that new treatments for TD are available and more may be under development.
Treatments may reduce the frequency or severity of TD symptoms for many patients

13. Conclusion
You have just completed Part 2 in a series on tardive dyskinesia (TD), focusing on the risks and preventive steps.
To learn more about TD, see Webinars 1 and 3 in this series:
Part 1. What is TD? [LINK]
Part 3. If I Already Have TD, What Now? [LINK]

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