Tardive dyskinesia assessment and diagnosis
Make screening a part of your routine for all patients on antipsychotics
2020 American Psychiatric Association guidelines recommend1:
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1
Screening for TD before starting or changing patients’ dopamine receptor blocking agent (DRBA) treatment
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2
Monitoring for signs of TD at each visit
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3
Conducting a structured TD assessment every 6 to 12 months, depending on patient’s risk, and if new or worsening movements are detected at any visit
The involuntary and uncontrollable movements from TD may
not only impact your patients physically, but also emotionally2
When assessing the signs of tardive dyskinesia, ask about how it is affecting their everyday lives.
ASK ABOUT TD IMPACT
Tardive dyskinesia (TD) doesn’t just present in the face and mouth—involuntary movements may impact upper and lower limbs, the neck, and trunk3,4
UPPER LIMBS

Asymmetrical movements, swaying, “piano fingers,” grabbing of clothing3,4
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
Actor portrayals

Take the TD Challenge: Assessment and diagnosis
Can you differentiate tardive dyskinesia from drug-induced parkinsonism and other acute extrapyramidal symptoms?
Put your knowledge to the test.

Take the TD Challenge:
Assessment and diagnosis
Question 1 of 5
TD Challenge
Take the TD Challenge:
Assessment and diagnosis
Question 1 of 5
TRUE OR FALSE:
The movements in this video show tardive dyskinesia (TD).
Actor portrayal
ASSESSMENT TIP
Ask patients to remove any gum or candy before assessing for TD movements.5
QUESTION
REFERENCES
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Gupta R, Bhatia MS. Drug induced parkinsonism presenting as isolated jaw tremors. Online J Health Allied Scs. 2005;4(3):1-3.
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.
- Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988;39(11):1172-1177.

Take the TD Challenge:
Assessment and diagnosis
Question 2 of 5
TD Challenge
Take the TD Challenge:
Assessment and diagnosis
Question 2 of 5
TRUE OR FALSE:
The movements in this video show tardive dyskinesia (TD).
Actor portrayal
THE CORRECT RESPONSE IS TRUE.
This is TD.
Lower-limb movements associated with TD may include splayed or hyperextended toes, gripping, and ankle twisting.1-3
These movements can be more challenging to recognize than TD movements of the face and mouth.1
ASSESSMENT TIP
To help identify lower-limb movements associated with TD, ask patients to remove their shoes and socks before you begin the assessment.4,5
QUESTION
REFERENCES
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.
- Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988;39(11):1172-1177.
- Saltz BL, Robinson DG, Woerner MG. Recognizing and managing antipsychotic drug treatment side effects in the elderly. Prim Care Companion J Clin Psychiatry. 2004;6(2):14-19.

Take the TD Challenge:
Assessment and diagnosis
Question 3 of 5
TD Challenge
Take the TD Challenge:
Assessment and diagnosis
Question 3 of 5
TRUE OR FALSE:
Tardive dyskinesia (TD) and acute extrapyramidal symptoms (EPS) (eg, drug-induced parkinsonism) never coexist.
THE CORRECT RESPONSE IS FALSE.
TD and acute EPS may coexist as different and distinct drug-induced movement disorders, each requiring specific identification and management.1-3
ASSESSMENT TIP
It is important to consider the time between the initiation of antipsychotic treatment and the onset of involuntary movements to differentiate TD from acute EPS.4
QUESTION
REFERENCES
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
- Caroff SN, Huford I, Lybrand J, et al. Movement disorders induced by antipsychotic drugs: implications of the CATIE schizophrenia trial. Neurol Clin. 2011;29(1):127-148.
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Take the TD Challenge:
Assessment and diagnosis
Question 4 of 5
TD Challenge
Take the TD Challenge:
Assessment and diagnosis
Question 4 of 5
TRUE OR FALSE:
The movements in this video show tardive dyskinesia (TD).
Actor portrayal
THE CORRECT RESPONSE IS FALSE.
These are parkinsonian hand tremors.
Parkinsonian hand tremors are characterized as rhythmic movements that can be of high amplitude and typically occur when the patient is at rest.1-4
TD hand movements may include grabbing of clothing and “piano fingers.”1,2,5
ASSESSMENT TIP
Activation techniques, such as asking patients to tap their thumb to another finger rapidly for 15 seconds, can help identify suppressed TD movements.6
QUESTION
REFERENCES
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Saltz BL, Robinson DG, Woerner MG. Recognizing and managing antipsychotic drug treatment side effects in the elderly. Prim Care Companion J Clin Psychiatry. 2004;6(2):14-19.
- Thenganatt MA, Louis ED. Distinguishing essential tremor from Parkinson’s disease: bedside tests and laboratory evaluations. Expert Rev Neurother. 2012;12(6):687-696.
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.
- Munetz MR, Benjamin S. How to examine patients using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry. 1988;39(11):1172-1177.

Take the TD Challenge:
Assessment and diagnosis
Question 5 of 5
TD Challenge
Take the TD Challenge:
Assessment and diagnosis
Question 5 of 5
TRUE OR FALSE:
The movements in this video show tardive dyskinesia (TD).
Actor portrayal
THE CORRECT RESPONSE IS TRUE.
This is TD.
Movements of the eyes and face associated with TD may include excessive blinking and squinting.1-3
ASSESSMENT TIP
Remember, TD may affect more than one area of the body—not just the face. A comprehensive full body assessment may help you identify abnormal involuntary movements.1-3
SCORE
REFERENCES
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976.
You’ve completed the TD Challenge: Assessment and diagnosis
HELP YOUR TD PATIENTS TAKE CONTROL6
Explore how INGREZZA reduced TD severity in both short- and long-term studies of adult patients with TD
REVIEW EFFICACYTREAT FIRST LINE WITH VMAT2 INHIBITORS
VMAT2 inhibitors, like INGREZZA, are recommended as first-line treatment for TD1,7,8
TD GUIDELINESSEE INGREZZA EFFICACY FOR YOURSELF
Register for INGREZZA Insider to see real patient case reviews from the INGREZZA KINECT 3 and KINECT 4 clinical trials
SIGN UPEXPERT PERSPECTIVES:
Tardive dyskinesia (TD) is clinically distinct
Dr. Laxman Bahroo, from Georgetown University’s Neurology Department, discusses the clinical distinctions between TD and acute extrapyramidal symptoms (EPS) and what to look for.

EXPERT PERSPECTIVES:
Tardive dyskinesia (TD) is clinically distinct
Dr. Laxman Bahroo, from Georgetown University’s Neurology Department, discusses the clinical distinctions between TD and acute extrapyramidal symptoms (EPS) and what to look for.
REFERENCES:
- Keepers GA, Fochtmann LJ, Anzia JM, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American Psychiatric Association Publishing, 2020
- McEvoy J, Gandhi SK, Rizio AA, et al. Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia. Qual Life Res. 2019;28(12):3303-3312
- Guy W. ECDEU Assessment Manual for Psychopharmacology. Revised 1976. Rockville, MD: National Institute of Mental Health; 1976
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013
- Task Force on Tardive Dyskinesia. Tardive Dyskinesia: A Task Force Report of the American Psychiatric Association. Washington, DC: American Psychiatric Association; 1992
- INGREZZA [package insert]. San Diego, CA: Neurocrine Biosciences, Inc
- 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
- Caroff SN, Citrome L, Meyer J, et al. A modified Delphi consensus study of the screening, diagnosis, and treatment of tardive dyskinesia. J Clin Psychiatry. 2020;81(2):19cs12983