Tardive Dyskinesia Care in Special Populations : Pre-test

1.

Of the following risk factors for developing TD, which is of particular relevance in older patients?

A. Alcohol/substance abuse
B. Cumulative antipsychotic dose
C. Intellectual disability
D. Negative symptoms of schizophrenia
E. Smoking

2.

When assessing a patient’s movement, which symptom would indicate a diagnosis OTHER THAN TD?

A. Blinking
B. Pursing and smacking lips
C. Rhythmic resting tremor
D. Writhing fingers

3.

Which statement is true as supported by published data on VMAT2 inhibitors specific to older adults with TD?

A. Treatment response is significantly improved compared with placebo
B. Treatment response assessed by AIMS appears approximately similar to that in younger adults
C. Response is attenuated after VMAT2 washout
D. All of the above

4.

Patient Case

Marlene is a 72-yr-old woman treated for several decades with a combination of second-generation antipsychotic medication (quetiapine 200 mg/day) and lithium (600 mg/day) for type 1 bipolar disorder

Comorbidity: type 2 diabetes and hypertension. Problem alcohol use in the remote past but has maintained sobriety for nearly 2 decades

For the past 3 yr, Marlene has been functioning well and is able to run her own private landscaping business

Approximately 2 yr ago, Marlene developed some involuntary perioral movements and movements of her hands that her HCP diagnosed as TD. Her HCP attempted to taper and stop her quetiapine, but Marlene became hypomanic (insomnia, mildly pressured speech, irritability) when the quetiapine dosage was reduced below 150 mg/day. The HCP has subsequently maintained her on a combination of lithium (serum level
0.8 mEq/L) and quetiapine 150 mg/day

Two wk ago, Marlene had a fall while working with landscaping equipment. Fortunately, she was not injured. Marlene tells her HCP that her hands are “twitching and shaking” and she feels these involuntary hand movements are interfering in her ability to manage her job

The next best course of action for Marlene’s HCP is:

A. Reduce dosage of quetiapine
B. Increase dosage of lithium
C. Evaluate possible causes of medical comorbidity that could be contributing to fall risk
D. Consider starting a VMAT2 inhibitor for management of TD
E. C and D are both correct

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Management of Tardive Dyskinesia With Considerations for Special Populations: Helping Our Patients Age Well

Credits Available

Pretest

Please answer the questions below.

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