TD in 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.

Evelyn is a 70-yr-old woman with bipolar I disorder who has been stable for several yr on olanzapine 10 mg nightly and lithium 900 mg/day (serum level 0.8 mEq/L). She also has osteoarthritis of her knees and a history of hepatitis C–related cirrhosis. Her liver disease is currently Child-Pugh class B (moderate impairment), with stable labs and no history of encephalopathy.

Evelyn retired from her job as a high school English teacher but continues to work part-time at a local library leading a children’s reading program. She enjoys the work but says the involuntary lip-smacking and tongue movements have become increasingly noticeable, and some parents have asked if she is “okay.” She has also started avoiding social gatherings at church.

Her HCP diagnosed tardive dyskinesia 1 yr ago. A prior attempt to taper olanzapine led to recurrence of mania with reduced sleep and pressured speech. Evelyn is now psychiatrically stable, but the TD symptoms are distressing and interfere with her quality of life.

What is the next best course of action?

A. Start benztropine 1 mg BID to reduce abnormal movements
B. Start deutetrabenazine IR 6 mg BID with food, titrating upward
C. Start valbenazine 40 mg daily
D. Start tetrabenazine 12.5 mg TID
E. There is more than one appropriate treatment choice in the options given

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Managing Tardive Dyskinesia in Mood Disorders: Evidence-Based Approaches for Patients on Antipsychotic Therapy

Robert O. Cotes, MD, DFAPA

Joseph F. Goldberg, MD

Pretest

Please answer the questions below.

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