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PSYCHOPHARMACOLOGY
Screening for Tardive Dyskinesia
June 29, 2022   

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An estimated 600,000 people in the United States have tardive dyskinesia (TD), and that number is expected to increase with the expanding use of dopamine receptor blocking agents (DRBAs) for various conditions. Experts agree that all patients who have been prescribed DRBAs should be screened for TD at every clinical encounter, regardless of the degree of risk of TD. The MIND-TD Questionnaire was developed to help healthcare professionals (HCPs) screen for TD and facilitate a dialogue between HCPs and patients about the risks, symptoms, and impact of TD. The MIND-TD Questionnaire consists of two parts. The MIND questions (Part 1) can stand alone and be administered during in-person visits or telehealth visits (video or audio-only). The TD section (Part 2) can be used to gather more information about a patient’s abnormal movements.

Part 1 of the questionnaire (MIND) uses yes-or-no terms to inquire about “extra or unwanted movements” (movement), feeling “embarrassed or self-conscious” about said movements (impact), whether anyone else has seen extra movements (notice), and if movements interfere with daily routines (daily activity). This first section can be administered by any trained medical staff either in person or via telehealth options.

Depending on the responses to Part 1, Part 2 (TD) should be conducted by the treating HCP and can also be done either in person or via telehealth. In Part 2, the “Thorough Interview” asks patients about 9 different subjects relating to physical/functional difficulties, including difficulty swallowing, challenges speaking, balance, and fidgeting. It also involves 3 simple speech exercises to check for articulation problems. The second portion of Part 2 (Differentiate) includes checklists of characteristic movements for TD and drug-induced parkinsonism, along with an item related to akathisia and suggestions for observing abnormal or involuntary movements.

>>  View the MIND-TD Questionnaire

Free CME/CE Activities on Tardive Dyskinesia
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Encore Presentation
The First Movement: Early Recognition and Diagnosis of Tardive Dyskinesia
CME/CE Credit: 1.0  |  Expires: February 26, 2025

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Expert Clinical Case
62-Year-Old Mother With Schizophrenia Who Feels Embarrassed By Her “Shakiness”
CME/CE Credit: 0.5  |  Expires: July 31, 2025

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Encore Presentation
Sitting Still: Strategies for Effective Symptom Management in Tardive Dyskinesia
CME/CE Credit: 0.75  |  Expires: February 26, 2025

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NEI Podcast
Episode 140 - Catch Me If You Can: Early Screening and Detection for Tardive Dyskinesia
CME/CE Credit: 1.0  |  Expires: March 23, 2025

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Encore Presentation
Move It on Over: Diagnosing and Treating Tardive Dyskinesia
CME/CE Credit: 1.0  |  Expires: April 24, 2025

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Figure. Dopamine regulates motor movements through both the direct (go) and indirect (stop) pathways. In the direct pathway (shown on the left), dopamine released into the striatum binds to dopamine 1 receptors on GABA neurons. This stimulates GABA release, which ultimately leads to glutamate release in the cortex and thus enhances motor output. In the indirect pathway (shown on the right), dopamine released into the striatum binds to dopamine 2 receptors on GABA neurons. This inhibits GABA release, thus inhibiting the "stop" pathway and therefore also enhancing motor output. VMAT2 inhibition can reduce activation of excitatory dopamine 1 receptors in the direct (go) pathway. This inhibits the direct (go) pathway and therefore can reduce the hyperkinetic movements of tardive dyskinesia. VMAT2 inhibition can also reduce the overstimulation of inhibitory dopamine 2 receptors in the indirect (stop) pathway. This disinhibits the indirect (stop) pathway and therefore can reduce the hyperkinetic movements of tardive dyskinesia.

References:

Lundt L et al. CNS Spectr. 2022;27(2):233-234. Abstract

Stahl SM. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 5th edition. Cambridge University Press; 2021.