TD Management

Treat tardive dyskinesia (TD) while preserving your patient’s antipsychotic regimen1

Screen Regularly for TD

2004 American Psychiatric Association (APA) Guidelines2

  • Screen for TD before starting or restarting patients on dopamine receptor blocking agent (DRBA) treatment
  • Monitor for signs of TD every 3 to 12 months, depending on patient’s risk
  • Consider a diagnostic evaluation

TD may affect more than one area of the body—not just the face1

Identify patients with these signs and symptoms of TD in your practice.

Upper limbs

Asymmetrical movements, swaying, "piano fingers," grabbing of clothing3–5

Lower limbs

Splayed or hyperextended toes, gripping, ankle twisting3,4

Torso

Hyperextension, shifting, rocking3,4

Tongue

"Bonbon" sign, protrusion, darting3,4

Eyes

Excessive blinking and squinting3,4

Lips

Smacking, puckering, pursing3,4

Jaw

Biting, clenching, lateral movements, chewing3,4

Not actual patients

VMAT2 inhibitors like INGREZZA® (valbenazine) capsules are considered a first-line therapy for TD6

Preserve stable antipsychotic regimens

2013 American Academy of Neurology (AAN) Guidelines7

  • There is a lack of clear evidence to support or refute withdrawing or switching antipsychotics to treat TD
  • Changing a patient’s antipsychotic regimen may destabilize the underlying psychiatric condition


This 2018 practical treatment algorithm can help you determine how to reduce your patients’ TD movements.6,a

  • a Adapted from Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn S. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018;389:67-75.
  • GPi DBS, globus pallidus interna deep brain stimulation; VMAT2, vesicular monoamine transporter 2.

Watch expert perspective videos on screening and managing TD

Featuring Bryce Reynolds, MD

Using motivational interviewing to talk about tardive dyskinesia (TD)

Changing mindsets and behaviors for better tardive dyskinesia (TD) assessments

Watch more expert perspectives on THE INGREZZA YOUTUBE CHANNEL

REFERENCES: 1. Hauser RA, Factor SA, Marder SR, et al. KINECT 3: a phase 3 randomized, double-blind, placebo-controlled trial of valbenazine for tardive dyskinesia. Am J Psychiatry. 2017;174(5):476-484. 2. Lehman AF, Lieberman JA, Dixon LB, et al. Practice guideline for the treatment of patients with schizophrenia, second edition. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf. Published 2004. Accessed August 22, 2018. 3. Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976. 4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 5. Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (NY). 2013;3. Published 2013 Jul 12. doi:10.7916/D88P5Z71. 6. Bhidayasiri R, Jitkritsadakul O, Friedman JH, Fahn S. Updating the recommendations for treatment of tardive syndromes: a systematic review of new evidence and practical treatment algorithm. J Neurol Sci. 2018;389:67-75. 7.  Summary of evidence-based guidelines for clinicians: treatment of tardive syndromes. American Academy of Neurology website. https://www.aan.com/Guidelines/Home/GetGuidelineContent/613. Published 2013. Accessed August 22, 2018.