Impact-TD allows clinicians to measure the impact of tardive dyskinesia (TD) in the physical, social, psychological/psychiatric, and vocational/educational/recreational domains.
American Psychiatric Association (APA) guidelines recommend treatment if TD, irrespective of severity, has an impact on the patient.
Assessment of impact should be performed at every patient visit.
The Impact-TD Scale
Provide clinicians a short, easy-to-
administer checklist to facilitate the assessment of TD impact on patients and guide treatment decisions
Click to open Impact-TD Scale
When using the Impact-TD Scale with a patient,
The global Impact-TD score is based on the highest single score for any domain.
When watching the video, consider TD impact in the psychological/
psychiatric domain:
Patient images used with permission.
Severe
Significant and detrimental impact
*Impact-TD Scale ratings for these videos were decided by 2 experienced clinicians who are familiar with the Impact-TD Scale and have published multiple peer-reviewed journal articles on the diagnosis and treatment of TD.
When watching the video, consider TD impact in the social domain:
Patient images used with permission.
Moderate
Exceeds minimal impact but is not severe
*Impact-TD Scale ratings for these videos were decided by 2 experienced clinicians who are familiar with the Impact-TD Scale and have published multiple peer-reviewed journal articles on the diagnosis and treatment of TD.
When watching the video, consider TD impact in the physical domain:
Patient images used with permission.
Moderate
Exceeds minimal impact but is not severe
*Impact-TD Scale ratings for these videos were decided by 2 experienced clinicians who are familiar with the Impact-TD Scale and have published multiple peer-reviewed journal articles on the diagnosis and treatment of TD.
![Vocational-Educational-Recreational-Domain-Icon.]](/globalassets/austedohcp/connectd/impact-of-td/td-scale/vocational-educational-recreational-domain-icon.svg){kind=icon}
When watching the video, consider TD impact in the vocational/educational/recreational domain:
Patient images used with permission.
No Impact
No impact is present
*Impact-TD Scale ratings for these videos were decided by 2 experienced clinicians who are familiar with the Impact-TD Scale and have published multiple peer-reviewed journal articles on the diagnosis and treatment of TD.
American Psychiatric Association (APA) guidelines recommend treatment if TD, irrespective of severity, has an impact on the patient. Assessment of impact should be performed at every patient visit.
Vesicular monoamine transporter 2 (VMAT2) inhibitors, such as AUSTEDO XR®
Thank you for completing
The Impact of TD—Real Patients,
Real Stories: Chapter 3
The Value of
Patient
Assessment
With the
Impact-TD Scale
Summary:
The impact of TD can be measured in every domain of patients’ lives, and even seemingly small changes in movement can have significant impact. The Impact-TD Scale is an easy-to-use tool that allows clinicians to assess the impact of TD in 4 important domains, thus offering an expanded understanding of the impact of TD on the individual patient. Assessment of TD is essential because TD that has an impact on the patient should be treated.
Chapter 3 References:
American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. 3rd ed. American
Psychiatric Association; 2020.
AUSTEDO XR® (deutetrabenazine) extended-release tablets/AUSTEDO® current Prescribing Information. Parsippany, NJ: Teva Neuroscience, Inc.
Jackson R et al. J Clin Psychiatry. 2023;84(1):22cs14563.
AUSTEDO XR® (deutetrabenazine) extended-release tablets and AUSTEDO® (deutetrabenazine) tablets are indicated in adults for the treatment of chorea associated with Huntington’s disease and for the treatment of tardive dyskinesia.
Depression and Suicidality in Patients with Huntington’s Disease: AUSTEDO XR® and AUSTEDO® can increase the risk of depression and suicidal thoughts and behavior (suicidality) in patients with Huntington’s disease. Balance the risks of depression and suicidality with the clinical need for treatment of chorea. Closely monitor patients for the emergence or worsening of depression, suicidality, or unusual changes in behavior. Inform patients, their caregivers, and families of the risk of depression and suicidality and instruct them to report behaviors of concern promptly to the treating physician. Exercise caution when treating patients with a history of depression or prior suicide attempts or ideation. AUSTEDO XR and AUSTEDO are contraindicated in patients who are suicidal, and in patients with untreated or inadequately treated depression.
Contraindications: AUSTEDO XR and AUSTEDO are contraindicated in patients with Huntington’s disease who are suicidal, or have untreated or inadequately treated depression. AUSTEDO XR and AUSTEDO are also contraindicated in: patients with hepatic impairment; patients taking reserpine or within 20 days of discontinuing reserpine; patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of discontinuing MAOI therapy; and patients taking tetrabenazine or valbenazine.
Clinical Worsening and Adverse Events in Patients with Huntington’s Disease: AUSTEDO XR and AUSTEDO may cause a worsening in mood, cognition, rigidity, and functional capacity. Prescribers should periodically re-evaluate the need for AUSTEDO XR or AUSTEDO in their patients by assessing the effect on chorea and possible adverse effects.
QTc Prolongation: AUSTEDO XR and AUSTEDO may prolong the QT interval, but the degree of QT prolongation is not clinically significant when AUSTEDO XR or AUSTEDO is administered within the recommended dosage range. AUSTEDO XR and AUSTEDO should be avoided in patients with congenital long QT syndrome and in patients with a history of cardiac arrhythmias.
Neuroleptic Malignant Syndrome (NMS), a potentially fatal symptom complex reported in association with drugs that reduce dopaminergic transmission, has been observed in patients receiving tetrabenazine. The risk may be increased by concomitant use of dopamine antagonists or antipsychotics. The management of NMS should include immediate discontinuation of AUSTEDO XR and AUSTEDO; intensive symptomatic treatment and medical monitoring; and treatment of any concomitant serious medical problems.
Akathisia, Agitation, and Restlessness: AUSTEDO XR and AUSTEDO may increase the risk of akathisia, agitation, and restlessness. The risk of akathisia may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops akathisia, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.
Parkinsonism: AUSTEDO XR and AUSTEDO may cause parkinsonism in patients with Huntington’s disease or tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. The risk of parkinsonism may be increased by concomitant use of dopamine antagonists or antipsychotics. If a patient develops parkinsonism, the AUSTEDO XR or AUSTEDO dose should be reduced; some patients may require discontinuation of therapy.
Sedation and Somnolence: Sedation is a common dose-limiting adverse reaction of AUSTEDO XR and AUSTEDO. Patients should not perform activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, until they are on a maintenance dose of AUSTEDO XR or AUSTEDO and know how the drug affects them. Concomitant use of alcohol or other sedating drugs may have additive effects and worsen sedation and somnolence.
Hyperprolactinemia: Tetrabenazine elevates serum prolactin concentrations in humans. If there is a clinical suspicion of symptomatic hyperprolactinemia, appropriate laboratory testing should be done and consideration should be given to discontinuation of AUSTEDO XR and AUSTEDO.
Binding to Melanin-Containing Tissues: Deutetrabenazine or its metabolites bind to melanin-containing tissues and could accumulate in these tissues over time. Prescribers should be aware of the possibility of long-term ophthalmologic effects.
Common Adverse Reactions: The most common adverse reactions for AUSTEDO (>8% and greater than placebo) in a controlled clinical study in patients with Huntington’s disease were somnolence, diarrhea, dry mouth, and fatigue. The most common adverse reactions for AUSTEDO (4% and greater than placebo) in controlled clinical studies in patients with tardive dyskinesia were nasopharyngitis and insomnia. Adverse reactions with AUSTEDO XR extended-release tablets are expected to be similar to AUSTEDO tablets.
Please see accompanying full Prescribing Information, including Boxed Warning.