Abstract
Individuals with intellectual disability (ID) commonly suffer from comorbid psychiatric and behavioral disorders that are frequently treated by antipsychotic medications. All individuals exposed to first- and second/third- generation antipsychotics are at risk for developing tardive dyskinesia (TD), characterized by abnormal, involuntary movements of the mouth/tongue/jaw, trunk, and extremities. TD can be highly disruptive for affected individuals and their caregivers, causing embarrassment, isolation, behavioral disturbances, and reduced functioning and quality of life. Information on TD incidence in individuals with ID is limited, but 2 small US studies reported TD prevalence rates of 42-45% in inpatients with ID. The safety and efficacy of vesicular monoamine transporter type 2 (VMAT2) inhibitors approved for treatment of TD in adults have been demonstrated in multiple clinical trials, but they excluded individuals with ID. Clinical characteristics and treatment outcomes of 5 adults (aged 28–63 years) with mild-to-severe ID and TD are presented, illustrating TD symptoms before/after treatment. All individuals had multiple comorbid psychiatric, behavioral, and other medical conditions, history of antipsychotic exposure, and abnormal movements affecting the tongue/mouth/jaw (n = 5), upper extremities (n = 5), lower extremities (n = 3), and trunk (n = 2), resulting in diminished ability to speak (n = 2), ambulate (n = 3), and perform activities of daily living (n = 3). Treatment with valbenazine resulted in meaningful improvements in TD symptoms and improved daily functioning, demeanor, and social/caregiver interactions. Given the high likelihood of antipsychotic exposure in the ID population, it is appropriate to screen for TD at every clinical visit through careful monitoring for abnormal movements and questioning the individual/caregiver regarding abnormal movements or TD-related functional impairments (i.e., speaking, swallowing, eating, ambulating, and social functioning). In this study, 5 individuals with ID and TD received once-daily valbenazine and experienced marked improvement in TD symptoms and daily functioning, resulting in increased quality of life for affected individuals and caregivers.
Highlights
Intellectual disability (ID) is characterized by significant limitations in cognitive functioning and adaptive behaviors that originate before the age of 18 years [1]
To help improve awareness of the clinical presentation and management of tardive dyskinesia (TD) in individuals with ID, the current case series describes the clinical characteristics, symptoms, and outcomes of 5 individuals with ID who were diagnosed with TD and treated with once-daily valbenazine
All 5 individuals had multiple comorbid psychiatric, behavioral, and other medical conditions; a history of antipsychotic exposure; and abnormal movements affecting the tongue or jaw (n = 5), face or eyes (n = 3), head (n = 1), upper extremities (n = 5), lower extremities (n = 3), and trunk (n = 2), which resulted in diminished ability to speak (n = 2), ambulate (n = 3), and perform ADLs (n = 3)
Summary
Intellectual disability (ID) is characterized by significant limitations in cognitive functioning (i.e., learning, reasoning, and problem solving) and adaptive behaviors (i.e., communication, practical skills, and independent living) that originate before the age of 18 years [1]. Individuals with ID commonly suffer from comorbid psychiatric disorders such as depression, schizophrenia, and bipolar disorder and present with challenging behaviors such as aggression, self-injury, or inappropriate social conduct. Antipsychotic medications, both first- and second/third- generation, are frequently used in these individuals to manage these psychiatric and behavioral issues [4,5,6,7,8]. In a Canadian population-based study of approximately 51,000 adults with ID, 39% received antipsychotic treatment, which increased to 56% in individuals living in. To help improve awareness of the clinical presentation and management of TD in individuals with ID, the current case series describes the clinical characteristics, symptoms, and outcomes of 5 individuals with ID who were diagnosed with TD and treated with once-daily valbenazine
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