Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia

Abstract

Purpose: Tardive dyskinesia (TD) is a common but serious hyperkinetic movement disorder and side effect of antipsychotic medications used to treat bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ). The purpose of this study was to evaluate health-related quality of life (HRQoL) in a population with diagnoses for BD, MDD, or SZ by comparing patients with TD (n = 197) with those without TD (n = 219). HRQoL in each group was also compared with HRQoL of the general population.

Methods: This study employed a cross-sectional web-based survey. HRQoL was assessed by four instruments: the SF-12 Health Survey, Version 2 (SF-12v2), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), the Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale (SW-ISMI); and two questions on movement disorders.

Results: Patients with TD had significantly worse HRQoL and social withdrawal than those without. The differences were more pronounced for physical HRQoL domains than for mental health domains. Patients with more-severe TD, assessed through either self-rating or clinician rating, experienced significantly worse HRQoL than did those with less-severe TD. The impact of TD was substantially greater in patients with SZ than in those with BD or MDD. Compared with the general population, patients with BD, MDD, or SZ experienced significantly worse HRQoL regardless of TD status, although this deficit in HRQoL was greater among those with TD.

Conclusions: The presence of TD is associated with worse HRQoL and social withdrawal. The most severe impact of TD is on physical aspects of patients' HRQoL.

Keywords: Bipolar disorder; Health-related quality of life; Major depressive disorder; Patient-reported outcome; Schizophrenia; Tardive dyskinesia.

Conflict of interest statement

Joseph McEvoy: Advisory Board: Auspex/Teva, Neurocrine. Research Grants: Auspex/Teva, Alkermes, Avanir, Boehringer Ingelheim, Otsuka. Benjamin Carroll and Sanjay K. Gandhi are employees of Teva Pharmaceuticals. Avery Rizio, Stephen Maher, Mark Kosinski, and Jakob Bue Bjorner are employees of Optum.

Figures

Fig. 1

Health-related quality of life in patients with and without TD. a SW-ISMI score for patients without TD vs those with TD. For the SW-ISMI scale, higher values indicate worse social withdrawal. b SF-12v2 score and c Q-LES-SF score for patients without TD vs those with TD. For the SF-12v and Q-LES-Q SF scales, higher scores indicate better quality of life status [21]. *Not significant when model includes severity of BD, MDD, or SZ as measured by CGI on a seven-point scale. BD bipolar disorder, CGI clinical global impression, SW-ISMI Social Withdrawal subscale of the Internalized Stigma of Mental Illness scale, MCS mental component summary of the SF-12, MDD major depressive disorder, PCS physical component summary of the SF-12, PF physical functioning of the SF-36v2, Q-LES-Q SF Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, SF-12 SF-12v2 Health Survey, SZ schizophrenia, TD tardive dyskinesia. The data show group mean ± standard error, represented by the error bars

Fig. 2

Health-related quality of life in TD patients stratified by clinician-reported symptom severity. a SW-ISMI score stratified by clinicians for patients with mild vs moderate/severe TD. For the SW-ISMI scale, higher values indicate worse social withdrawal. b SF-12v2 score and c Q-LES-SF score stratified by clinicians for patients with mild vs moderate/severe TD. For the SF-12v and Q-LES-Q SF scales, higher scores indicate better quality of life status [21]. MCS mental component summary of the SF-12, PCS physical component summary of the SF-12, NS not significant, Q-LES-Q SF Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, PF physical functioning of the SF-36v2, SF-12 SF-12v2 Health Survey, SW-ISMI Social Withdrawal subscale of the Internalized Stigma of Mental Illness scale, TD tardive dyskinesia. The data show group mean ± standard error, represented by the error bars

Fig. 3

MCS, PCS and PF Scores: difference from the general population in patients with and without TD. For MCS, PCS, and PF, higher scores indicate better health status [21]. The difference from the general population was weighted to the gender and age of the patient samples. *P = 0.015 (comparing the mean value with the general population mean); **P < 0.001 (comparing the mean value with the general population mean). MCS mental component summary of the SF-12v2, PCS physical component summary of the SF-12v2, PF physical functioning of the SF-36v2, TD tardive dyskinesia