Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia

Joseph Mcevoy,Avery A Rizio,Mark Kosinski,Benjamin Carroll,Jakob Bue Bjorner,Stephen Maher,Sanjay K Gandhi

doi:10.1007/s11136-019-02269-8

Abstract

PurposeTardive dyskinesia (TD) is a common but serious hyperkinetic movement disorder and side effect of antipsychotic medications used to treat bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ). The purpose of this study was to evaluate health-related quality of life (HRQoL) in a population with diagnoses for BD, MDD, or SZ by comparing patients with TD (n = 197) with those without TD (n = 219). HRQoL in each group was also compared with HRQoL of the general population.MethodsThis study employed a cross-sectional web-based survey. HRQoL was assessed by four instruments: the SF-12 Health Survey, Version 2 (SF-12v2), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), the Social Withdrawal subscale of the Internalized Stigma of Mental Illness Scale (SW-ISMI); and two questions on movement disorders.ResultsPatients with TD had significantly worse HRQoL and social withdrawal than those without. The differences were more pronounced for physical HRQoL domains than for mental health domains. Patients with more-severe TD, assessed through either self-rating or clinician rating, experienced significantly worse HRQoL than did those with less-severe TD. The impact of TD was substantially greater in patients with SZ than in those with BD or MDD. Compared with the general population, patients with BD, MDD, or SZ experienced significantly worse HRQoL regardless of TD status, although this deficit in HRQoL was greater among those with TD.ConclusionsThe presence of TD is associated with worse HRQoL and social withdrawal. The most severe impact of TD is on physical aspects of patients’ HRQoL.

Highlights

Tardive dyskinesia (TD) is an often irreversible hyperkinetic movement disorder that is typically caused by exposure to antipsychotic medications used for the treatment of mental illnesses, including bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ) [1,2,3,4,5].PA 19355, USA 3 Optum, Johnston, RI, USASymptoms of TD are characterized by involuntary and repetitive movements that most commonly affect the face, mouth, and tongue, but can manifest in the extremities [6, 7]
Weights for mean scores for each benchmark sample were estimated based on these matched sample characteristic demographics, with mean scores and standard errors adjusted based on these weights
To evaluate the health status burden associated with TD, baseline social function (SF)-12v2 (MCS, PCS, and physical function (PF)) scores from the pooled group with BD, MDD, and SZ were compared with adjusted benchmark scores from the US general population (Fig. 3)

Summary

Introduction

Symptoms of TD are characterized by involuntary and repetitive movements that most commonly affect the face, mouth, and tongue, but can manifest in the extremities [6, 7]. These can range from mild to severe, with involuntary movements being localized or widespread [2, 5]. It is difficult to rate the impact of TD on a patient’s HRQoL by rating the severity of abnormal movements alone, because even subtle involuntary movements in the facial area can have substantial negative social and emotional impacts.

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