eCase: TD Progression

CE / CME

eCase: Managing Tardive Dyskinesia From Onset to Progression

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour, including 1.00 hour of pharmacotherapy credit 

Social Workers: 1.00 ASWB ACE CE Credit

Pharmacists: 1.00 contact hour (0.1 CEUs)

Psychologists: 1.00 APA CE Credit

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit

Released: November 29, 2022

Expiration: November 28, 2023

Sneha Mantri
Sneha Mantri, MD, MS

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Case Study Introduction

A 57-year-old man presents to his psychiatrist’s office for a routine follow-up of bipolar disorder, which was diagnosed at the age of 23 years and has been well controlled with medications for 30 years. His psychiatric history includes a hospitalization at 24 years of age for a manic episode, at which point he was started on lithium. At 27 years of age, he developed diabetes insipidus and was transitioned to quetiapine. He had 1 subsequent psychiatric hospitalization at 35 years of age during an attempted taper of quetiapine. Symptoms improved with reinitiation of quetiapine 800 mg QD, and he has been adherent to this therapy ever since.

During the visit, he reports occasional involuntary rotation of the right ankle and wrist, typically when seated but it sometimes also occurs when standing for a prolonged time (eg, when in line at a grocery store). The patient is not aware of any other unusual or involuntary movements.

Appearance: neatly dressed, well groomed
Behavior: intermittent rotatory movements of the right ankle and wrist
Mood/affect: calm
Speech: normal prosody and articulation, nonpressured
Thought process: thought directed
Thought content: no delusions or preoccupations noted
Cognition: alert, fully oriented, provides a complete and cogent history
Insight: appropriate
Judgment: normal

Laboratory: creatinine 1.5 mg/dL, estimated glomerular filtration rate 54 mL/min/1.73 m2

Remainder of a comprehensive metabolic panel: within normal limits

AIMS score: 3 points

Family history: noncontributory

Medications: quetiapine 800 mg QD

What is the most appropriate next step in treatment?