Antipsychotics (APs) are medications typically used to manage conditions such as schizophrenia, bipolar disorder and severe depression,¹ and can be further subdivided into first-generation antipsychotics (FGAs) and second generation antipsychotics (SGAs).¹ In recent decades, the number of people taking APs has dramatically increased from 2.2 million in 1997² to 6.3 million in 2017, with 6.7 million patients predicted to be receiving an AP by 2025.³ Tardive dyskinesia (TD), a hyperkinetic movement disorder, is associated with use of AP medication,⁴ with an estimated lower incidence rate with SGA use compared with FGA use.⁵ 

At the American Psychiatric Association virtual conference in 2021, Dr Craig Chepke presented an insightful presentation on the epidemiology and diagnosis of TD in clinical practice.

Dr Chepke highlights that the increased volume of AP prescriptions administered to patients is likely leading to an increase in the number of cases of TD, even if most are being treated with an SGA. He discusses the prevalence of TD in his own practice and emphasizes the importance of using consistent activation maneuvers to diagnose patients with TD. Dr Chepke also notes that even mild-to-moderate TD can have significant social and occupational consequences for patients, with one survey highlighting how negatively mild-to-moderate facial dyskinesia could be perceived by the public.⁶ Dr Chepke concludes by explaining that the ultimate legacy of SGAs may be more cases of TD rather than fewer, and recommends that TD should be continuously ruled out in any patient being treated with an AP.

Watch Dr Chepke’s presentation here.

References

1. National Institute of Mental Health. Mental Health Medications. 2016. Available at: https://www.nimh.nih.gov/health/topics/mental-health-medications (Accessed April 2022).
2. Stagnitti MD. Agency for Healthcare Research and Quality. Statistical Brief No. 275. 2010.
3. Dhir A, Schilling T, Abler V, et al. Estimation of epidemiology of tardive dyskinesia incidence and prevalence in the United States. Presented at the American Academy of Neurology 2017 Annual Meeting. April 22–28, 2017, Boston, Massachusetts, USA. Poster 2.018.
4. Patterson-Lomba O, Ayyagari R and Carroll B. Risk assessment and prediction of TD incidence in psychiatric patients taking concomitant antipsychotics: a retrospective data analysis. BMC Neurology 2019;19:174.
5. Carbon M, Kane JM, Leucht S, et al. Tardive dyskinesia risk with first- and second-generation antipsychotics in comparative randomized controlled trials: a meta-analysis. World Psychiatry 2018;17:330–340.
6. Ayyagari R, Goldschmidt D, Mu F, et al. An experimental study to assess the professional and social consequences of tardive dyskinesia. Clin Psychopharmacol Neurosci 2022;20:154–166.

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