Tardive Dyskinesia in Older Patients With Mood Disorders : Pre-test

1.

Among 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.

Charlene is a 63-yr-old woman treated for several decades with a second-generation antipsychotic (quetiapine 200 mg/day) and lithium 600 mg/day for schizoaffective disorder. She has overall good functioning and works as a hairdresser.

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

2 yr ago, Charlene developed some involuntary peri-oral and hand movements. Her HCP diagnosed TD and attempted to taper and stop her quetiapine, but she became hypomanic when reduced below 150 mg/day. She has subsequently been maintained on lithium (serum level 0.8 mEq/L) and quetiapine 150 mg/day

2 wk ago, Charlene had a fall while working in her salon. Fortunately, she was not injured. She tells her HCP she has involuntary “twitching and shaking” in her hands, which is interfering in her ability to work.

The next best course of action for Charlene’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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Tackling Tardive Dyskinesia in Older Patients With Mood Disorders

Robert O. Cotes, MD, DFAPA

Pretest

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