CONSENSUS RECOMMENDATIONS ON THE RECOGNITION, ASSESSMENT, AND MANAGEMENT OF TARDIVE DYSKINESIA IN COUNTRIES FROM SOUTHEAST ASIA
Authors: Chee *Kok Yoon , Bhidayasiri Roongroj , Ang Jin Kiat , Ho Roger , Mawardi Ahmad Shahir Bin , Nurhidayat Adhi Wibowo , Paholpak Pongsatorn , Pariwatcharakul Pornjira , Sanguanvichaikul Thitima , Ung Eng Khean , Wardani Natalia Dewi , Yeo Brian , Correll Christoph U 
Published: February 2025

Abstract

Background
Tardive dyskinesia (TD) is a potentially irreversible, involuntary movement disorder induced by dopamine receptor blocking agents. TD may interfere with antipsychotic adherence and result in significant impairment of functioning and quality of life. In Southeast Asia (SEA), TD is not well recognized by clinicians and patients. As such, guidance on screening, diagnosis, and management of TD is needed.

Aims and Objectives
This study aimed to consolidate recommendations from experts on practical ways to recognize, assess, and manage TD for patients in countries in Southeast Asia.

Method
A formal consensus development process was conducted using the Modified RAND-UCLA Appropriateness Method. Thirteen experts from the neurology, psychiatry, and neuropsychiatry were invited to participate in the consensus development. The consensus development process involved a thematic literature search, creation of clinical scenarios, round 1 rating of clinical scenarios according to appropriateness of assessments and interventions (online), face-to-face discussion, round 2 ratings of clinical scenarios according to appropriateness of assessments and interventions (face-to-face), and conversion of clinical scenarios to consensus recommendations.

Results
The thematic literature search from medical databases generated 66 articles, which were used to support the development of clinical scenarios. These clinical scenarios were groups into 4 parts: recognition and screening of TD, diagnosis of TD, impact of TD to patients, and management of TD. In some countries in SEA, TD is underrecognized due to multiple factors, mainly lack of time for assessment (82%). The expert panel recommended that all patients taking antipsychotics should be screened for TD every 6 months (Median [Mdn]: 9; Interquartile Range [IQR]: 9,9). In a busy clinical practice, screening of TD should focus on the impact on functioning and quality of life and visual observation of movement abnormalities during mental status examination should be prioritized. Regarding diagnosis, most clinicians in SEA resort to visual examination as part of routine examination (90.9%) and patient or caregiver report on abnormal movements affecting functioning (72.7%). The expert panel recommended the following should be considered when diagnosing patients with TD: assessment of involuntary abnormal movements, which occurs during treatment with antipsychotics or within 4-8 weeks of withdrawal from antipsychotics; differential diagnosis from other conditions with involuntary movements; duration of exposure to antipsychotic medication; duration of abnormal movements; severity of abnormal movements in affected areas; number of areas with involuntary movements; and patient or caregiver report on abnormal movements affecting functioning or quality of life. Regarding management of TD, the expert panel agreed that a vesicular monoamine transporter-2 inhibitors is recommended as first-line treatment if available (Mdn: 9; IQR: 8,9). Other management that is feasible to the countries in the region were also recommended, such as dose adjustment or switch to other second-generation antipsychotics or clozapine, with consensus against anticholinergics.

Discussion & Conclusion
These expert consensus recommendations summarized practical guidelines intended for busy clinicians to support their recognition, screening, diagnosis, and management of patients with TD.