Recognition and Treatment of Tardive Dyskinesia in Individuals with Intellectual Disability

Robert O Morton, Lucas C Morton, Rissa Fedora, Robert O Morton, Lucas C Morton, Rissa Fedora

Abstract

Individuals with intellectual disability (ID) commonly suffer from comorbid psychiatric and behavioral disorders that are frequently treated by antipsychotic medications. All individuals exposed to first- and second/third- generation antipsychotics are at risk for developing tardive dyskinesia (TD), characterized by abnormal, involuntary movements of the mouth/tongue/jaw, trunk, and extremities. TD can be highly disruptive for affected individuals and their caregivers, causing embarrassment, isolation, behavioral disturbances, and reduced functioning and quality of life. Information on TD incidence in individuals with ID is limited, but 2 small US studies reported TD prevalence rates of 42-45% in inpatients with ID. The safety and efficacy of vesicular monoamine transporter type 2 (VMAT2) inhibitors approved for treatment of TD in adults have been demonstrated in multiple clinical trials, but they excluded individuals with ID. Clinical characteristics and treatment outcomes of 5 adults (aged 28-63 years) with mild-to-severe ID and TD are presented, illustrating TD symptoms before/after treatment. All individuals had multiple comorbid psychiatric, behavioral, and other medical conditions, history of antipsychotic exposure, and abnormal movements affecting the tongue/mouth/jaw (n = 5), upper extremities (n = 5), lower extremities (n = 3), and trunk (n = 2), resulting in diminished ability to speak (n = 2), ambulate (n = 3), and perform activities of daily living (n = 3). Treatment with valbenazine resulted in meaningful improvements in TD symptoms and improved daily functioning, demeanor, and social/caregiver interactions. Given the high likelihood of antipsychotic exposure in the ID population, it is appropriate to screen for TD at every clinical visit through careful monitoring for abnormal movements and questioning the individual/caregiver regarding abnormal movements or TD-related functional impairments (i.e., speaking, swallowing, eating, ambulating, and social functioning). In this study, 5 individuals with ID and TD received once-daily valbenazine and experienced marked improvement in TD symptoms and daily functioning, resulting in increased quality of life for affected individuals and caregivers.

Conflict of interest statement

Dr. Morton has received consulting fees from Neurocrine Biosciences, Inc. Lucas Morton and Rissa Fedora report no competing interests.

Copyright © 2020 Robert O. Morton et al.

References

    1. Schalock R. L., Borthwick-Duffy S. A., Bradley V. J., et al. Intellectual Disability: Definition, Classification, and Systems of Supports. 11th edition. Washington DC: American Association on Intellectual and Developmental Disabilities; 2010.
    1. Zablotsky B., Black L. I., Blumberg S. J. Estimated prevalence of children with diagnosed developmental disabilities in the United States 2014-2016. NCHS Data Brief. 2017;(291):1–8.
    1. Boat T. F., Wu J. T., National Academies of Sciences Engineering, and Medicine . In: Prevalence of Intellectual Disabilities. In: Mental Disorders and Disabilities Among Low-Income Children. Boat T. F., Wu J. T., editors. Washington DC: National Academies Press; 2015.
    1. Cooper S. A., Smiley E., Jackson A., et al. Adults with intellectual disabilities: prevalence, incidence and remission of aggressive behaviour and related factors. Journal of Intellectual Disability Research. 2009;53(3):217–232. doi: 10.1111/j.1365-2788.2008.01127.x.
    1. Cooper S. A., Smiley E., Morrison J., Williamson A., Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. The British Journal of Psychiatry. 2007;190(1):27–35. doi: 10.1192/bjp.bp.106.022483.
    1. Axmon A., Bjorne P., Nylander L., Ahlstrom G. Psychiatric diagnoses in older people with intellectual disability in comparison with the general population: a register study. Epidemiology and Psychiatric Sciences. 2018;27(5):479–491. doi: 10.1017/S2045796017000051.
    1. Lunsky Y., Khuu W., Tadrous M., Vigod S., Cobigo V., Gomes T. Antipsychotic use with and without comorbid psychiatric diagnosis among adults with intellectual and developmental disabilities. Canadian Journal of Psychiatry. 2018;63(6):361–369. doi: 10.1177/0706743717727240.
    1. Sheehan R., Hassiotis A., Walters K., Osborn D., Strydom A., Horsfall L. Mental illness, challenging behaviour, and psychotropic drug prescribing in people with intellectual disability: UK population based cohort study. BMJ. 2015:p. h4326. doi: 10.1136/bmj.h4326.
    1. Savitt D., Jankovic J. Tardive syndromes. Journal of the Neurological Sciences. 2018;389:35–42. doi: 10.1016/j.jns.2018.02.005.
    1. Caroff S. N., Ungvari G. S., Cunningham Owens D. G. Historical perspectives on tardive dyskinesia. Journal of the Neurological Sciences. 2018;389:4–9. doi: 10.1016/j.jns.2018.02.015.
    1. American Psychiatrie Association. Diagnostic and Statistical Manual of Mental Disorders. 5th. Washington, D.C: American Psychiatric Association; 2013.
    1. Frei K., Truong D. D., Fahn S., Jankovic J., Hauser R. A. The nosology of tardive syndromes. Journal of the Neurological Sciences. 2018;389:10–16. doi: 10.1016/j.jns.2018.02.008.
    1. Ascher-Svanum H., Zhu B., Faries D., Peng X., Kinon B. J., Tohen M. Tardive dyskinesia and the 3-year course of schizophrenia: results from a large, prospective, naturalistic study. The Journal of Clinical Psychiatry. 2008;69(10):1580–1588. doi: 10.4088/JCP.v69n1008.
    1. Chong S. A., Tay J. A., Subramaniam M., Pek E., Machin D. Mortality rates among patients with schizophrenia and tardive dyskinesia. Journal of Clinical Psychopharmacology. 2009;29(1):5–8. doi: 10.1097/JCP.0b013e3181929f94.
    1. Zutshi D., Cloud L. J., Factor S. A. Tardive syndromes are rarely reversible after discontinuing dopamine receptor blocking agents: experience from a university-based movement disorder clinic. Tremor and Other Hyperkinetic Movements. 2020;4:p. 266. doi: 10.5334/tohm.199.
    1. Vinuela A., Kang U. J. Reversibility of tardive dyskinesia syndrome. Tremor and Other Hyperkinetic Movements. 2020;4:p. 282. doi: 10.5334/tohm.217.
    1. Carbon M., Hsieh C. H., Kane J. M., Correll C. U. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. The Journal of Clinical Psychiatry. 2017;78(3):e264–e278. doi: 10.4088/JCP.16r10832.
    1. Caroff S. N., Hurford I., Lybrand J., Campbell E. C. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurologic Clinics. 2011;29(1):127–148. doi: 10.1016/j.ncl.2010.10.002.
    1. Peluso M. J., Lewis S. W., Barnes T. R., Jones P. B. Extrapyramidal motor side-effects of first- and second-generation antipsychotic drugs. The British Journal of Psychiatry. 2012;200(5):387–392. doi: 10.1192/bjp.bp.111.101485.
    1. Woods S. W., Morgenstern H., Saksa J. R., et al. Incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: a prospective cohort study. The Journal of Clinical Psychiatry. 2010;71(4):463–474. doi: 10.4088/JCP.07m03890yel.
    1. Sheehan R., Horsfall L., Strydom A., Osborn D., Walters K., Hassiotis A. Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population-based cohort study. BMJ Open. 2017;7(8, article e017406) doi: 10.1136/bmjopen-2017-017406.
    1. Fodstad J. C., Bamburg J. W., Matson J. L., et al. Tardive dyskinesia and intellectual disability: an examination of demographics and topography in adults with dual diagnosis and atypical antipsychotic use. Research in Developmental Disabilities. 2010;31(3):750–759. doi: 10.1016/j.ridd.2010.01.017.
    1. Matson J. L., Fodstad J. C., Neal D., Dempsey T., Rivet T. T. Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use. Research in Developmental Disabilities. 2010;31(1):108–116. doi: 10.1016/j.ridd.2009.08.002.
    1. Bhidayasiri R., Jitkritsadakul O., Friedman J. H., Fahn S. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. Journal of the Neurological Sciences. 2018;389:67–75. doi: 10.1016/j.jns.2018.02.010.
    1. Bhidayasiri R., Fahn S., Weiner W. J., et al. Evidence-based guideline: treatment of tardive syndromes: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(5):463–469. doi: 10.1212/WNL.0b013e31829d86b6.
    1. Hauser R. A., Factor S. A., Marder S. R., et al. KINECT 3: a phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. The American Journal of Psychiatry. 2017;174(5):476–484. doi: 10.1176/appi.ajp.2017.16091037.
    1. O'Brien C. F., Jimenez R., Hauser R. A., et al. NBI-98854, a selective monoamine transport inhibitor for the treatment of tardive dyskinesia: a randomized, double-blind, placebo-controlled study. Movement Disorders. 2015;30(12):1681–1687. doi: 10.1002/mds.26330.
    1. Anderson K. E., Stamler D., Davis M. D., et al. Deutetrabenazine for treatment of involuntary movements in patients with tardive dyskinesia (AIM-TD): a double-blind, randomised, placebo-controlled, phase 3 trial. The Lancet Psychiatry. 2017;4(8):595–604. doi: 10.1016/S2215-0366(17)30236-5.
    1. Fernandez H. H., Factor S. A., Hauser R. A., et al. Randomized controlled trial of deutetrabenazine for tardive dyskinesia: the ARM-TD study. Neurology. 2017;88(21):2003–2010. doi: 10.1212/WNL.0000000000003960.
    1. Factor S. A., Remington G., Comella C. L., et al. The effects of valbenazine in participants with tardive Dyskinesia. The Journal of Clinical Psychiatry. 2017;78(9):1344–1350. doi: 10.4088/JCP.17m11777.
    1. Marder S. R., Singer C., Lindenmayer J.-P., et al. A phase 3, 1-year, open-label Trial of valbenazine in adults with tardive dyskinesia. Journal of Clinical Psychopharmacology. 2019;39(6):620–627. doi: 10.1097/JCP.0000000000001111.
    1. Hauser R. A., Truong D. Tardive dyskinesia: out of the shadows. Journal of the Neurological Sciences. 2018;389:1–3. doi: 10.1016/j.jns.2018.02.009.
    1. Meyer J. M. Future directions in tardive dyskinesia research. Journal of the Neurological Sciences. 2018;389:76–80. doi: 10.1016/j.jns.2018.02.004.
    1. Scorr L. M., Factor S. A. VMAT2 inhibitors for the treatment of tardive dyskinesia. Journal of the Neurological Sciences. 2018;389:43–47. doi: 10.1016/j.jns.2018.02.006.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren