The Clinician’s Tardive Inventory (CTI): A New Clinical Tool for Documenting and Rating Tardive Dyskinesia

Richard M. Trosch, MD; Cynthia L. Comella, MD; Stanley N. Caroff, MD; William G. Ondo, MD; Alicia C. Shillington, PhD, MPH; Brandon J. LaChappelle, MPH; Robert A. Hauser, MD; Christoph U. Correll, MD; Joseph H. Friedman, MD

J Clin Psychiatry 2024;85(1):23m14886

ABSTRACT

Objective: Current clinician-rated tardive dyskinesia (TD) symptom scales have not addressed the expanding clinical signs and functional impact of TD. The study objective was to develop and test the reliability of a new integrated instrument.

Methods: A movement disorder neurologist devised the outline of the rating scale. A Steering Committee (5 neurologists and 2 psychiatrists) provided revisions until consensus was reached. The Clinician’s Tardive Inventory (CTI) assesses abnormal movements of the eye/eyelid/face, tongue/mouth, jaw, and limb/trunk; complex movements defined as complicated movements different from simple patterned movements or postures; and vocalizations. The CTI rates frequency of symptoms from 0 to 3 (ranging from absent to constant). Functional impairments, including activities of daily living (ADL), social impairment, symptom distress, and physical harm, are rated 0–3 (ranging from unawareness to severe impact). The CTI underwent interrater and test-retest reliability testing between February and June 2022 based on videos and accompanying vignettes, which were reviewed by 2 movement disorder specialists to determine adequacy. Four clinicians rated each video/vignette. Interrater agreement was analyzed via 2-way random-effects intraclass correlation (ICC), and test-retest agreement was assessed utilizing the Kendall tau-b.

Results: Forty-five video/vignettes were assessed for interrater reliability and 16 for test-retest reliability. The most prevalent movements were those of the tongue and mouth (77.8%) and jaw (55.6%). ICCs for movement frequency for anatomic symptoms were as follows: anatomic symptom summary score 0.92, abnormal eye movement 0.89, abnormal tongue/mouth movement 0.91, abnormal jaw movement 0.89, abnormal limb movement 0.76, complex movement 0.87, and abnormal vocalization 0.77; ICCs for functional impairments were as follows: total impairment score 0.92, physical harm 0.82, social embarrassment 0.88, ADLs 0.83, and symptom bother 0.92; Retests were conducted a mean (SD) of 15 (3) days later with correlation coefficients ranging from 0.66 to 0.87.

Conclusions: The CTI is a new integrated instrument with proven reliability in assessing TD signs and functional impacts. Future validation study is warranted.

J Clin Psychiatry 2024;85(1):23m14886

Author affiliations are listed at the end of this article.

Continue Reading...

Did you know members enjoy unlimited free PDF downloads as part of their subscription? Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Purchase PDF for $40

Members enjoy free PDF downloads on all articles. Join today

References (35)

Bhidayasiri R, Boonyawairoj S. Spectrum of tardive syndromes: clinical recognition and management. Postgrad Med J. 2011;87(1024):132–141. PubMed CrossRef
Aquino CC, Lang AE. Tardive dyskinesia syndromes: current concepts. Parkinsonism Relat Disord. 2014;20(suppl 1):S113–S117. PubMed CrossRef
Woerner MG, Correll CU, Alvir JMJ, et al. Incidence of tardive dyskinesia with risperidone or olanzapine in the elderly: results from a 2-year, prospective study in antipsychotic-naïve patients. Neuropsychopharmacology. 2011;36(8):1738–1746. PubMed CrossRef
Caroff SN, Ungvari GS, Cunningham Owens DG. Historical perspectives on tardive dyskinesia. J Neurol Sci. 2018;389:4–9. PubMed CrossRef
Woods SW, Morgenstern H, Saksa JR, et al. Incidence of tardive dyskinesia with atypical versus conventional antipsychotic medications: a prospective cohort study. J Clin Psychiatry. 2010;71(4):463–474. PubMed CrossRef
Carbon M, Hsieh CH, Kane JM, et al. Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry. 2017;78(3):e264–e278. PubMed CrossRef
Woerner MG, Alvir JM, Saltz BL, et al. Prospective study of tardive dyskinesia in the elderly: rates and risk factors. Am J Psychiatry. 1998;155(11):1521–1528. PubMed CrossRef
Lerner V, Miodownik C. Motor symptoms of schizophrenia: is tardive dyskinesia a symptom or side effect? a modern treatment. Curr Psychiatry Rep. 2011;13(4):295–304. PubMed CrossRef
Lerner PP, Miodownik C, Lerner V. Tardive dyskinesia (syndrome): current concept and modern approaches to its management. Psychiatry Clin Neurosci. 2015;69(6):321–334. PubMed CrossRef
Ward KM, Citrome L; Tardive Dyskinesia-Key Differences in Pathophysiology and Clinical Management. Antipsychotic-related movement disorders: drug-induced Parkinsonism vs tardive dyskinesia—key differences in pathophysiology and clinical management. Neurol Ther. 2018;7(2):233–248. PubMed CrossRef
Waln O, Jankovic J. An update on tardive dyskinesia: from phenomenology to treatment. Tremor Other Hyperkinet Mov (N Y). 2013;3(0):tre-03-161-4138-1. PubMed CrossRef
Factor SA. Management of tardive syndrome: medications and surgical treatments. Neurotherapeutics. 2020;17(4):1694–1712. PubMed CrossRef
Burke RE, Fahn S, Jankovic J, et al. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology. 1982;32(12):1335–1346. PubMed CrossRef
Kiriakakis V, Bhatia KP, Quinn NP, et al. The natural history of tardive dystonia: a long-term follow-up study of 107 cases. Brain. 1998;121(Pt 11):2053–2066. PubMed CrossRef
Skidmore F, Reich SG. Tardive Dystonia. Curr Treat Options Neurol. 2005;7(3):231–236. PubMed CrossRef
DeLeon ML, Jankovic J. Clinical features and management of tardive dyskinesias, tardive myoclonus, tardive tremor, and tardive tourettism. In: Sethi K, ed. Drug Induced Movement Disorders. New York: Marcel Dekker, Inc.; 2004:77–109.
Burke RE, Kang UJ, Jankovic J, et al. Tardive akathisia: an analysis of clinical features and response to open therapeutic trials. Mov Disord. 1989;4(2):157–175. PubMed CrossRef
Stacy M, Cardoso F, Jankovic J. Tardive stereotypy and other movement disorders in tardive dyskinesias. Neurology. 1993;43(5):937–941. PubMed CrossRef
Tominaga H, Fukuzako H, Izumi K, et al. Tardive myoclonus. Lancet. 1987;1(8528):322. PubMed CrossRef
Fahn S, Jankovic J. Principles and Practice of Movement Disorders. Philadelphia: Churchill Livingstone, Elsevier; 2007.
Yagi G, Takamiya M, Kanba S, et al. Mortality rate of schizophrenic patients with tardive dyskinesia during 10 years: a controlled study. Keio J Med. 1989;38(1):70–72. PubMed CrossRef
Ballesteros J, González-Pinto A, Bulbena A. Tardive dyskinesia associated with higher mortality in psychiatric patients: results of a meta-analysis of seven independent studies. J Clin Psychopharmacol. 2000;20(2):188–194. PubMed CrossRef
McEvoy J, Gandhi SK, Rizio AA, et al. Effect of tardive dyskinesia on quality of life in patients with bipolar disorder, major depressive disorder, and schizophrenia. Qual Life Res. 2019;28(12):3303–3312. PubMed CrossRef
Browne S, Roe M, Lane A, et al. Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand. 1996;94(2):118–124. PubMed CrossRef
Solmi M, Pigato G, Kane JM, et al. Treatment of tardive dyskinesia with VMAT-2 inhibitors: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2018;12:1215–1238. PubMed CrossRef
Kane JM, Correll CU, Nierenberg AA, et al; Tardive Dyskinesia Assessment Working Group. Revisiting the abnormal involuntary movement scale: proceedings from the tardive dyskinesia assessment workshop. J Clin Psychiatry. 2018;79(3):17cs11959. PubMed CrossRef
Abnormal Involuntary Movement Scale. (117-AIMS). In: Guy W, ed. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: National Institute of Mental Health; 1976:534–537.
Bhidayasiri R, Kane JM, Frei KP, et al. Expanding phenomenologic heterogeneity of tardive syndromes: Time for an updated assessment tool. Parkinsonism Relat Disord. 2020;77:141–145. PubMed CrossRef
Jackson R, Brams MN, Citrome L, et al. Assessment of the impact of tardive dyskinesia in clinical practice: consensus panel recommendations. Neuropsychiatr Dis Treat. 2021;17:1589–1597. PubMed CrossRef
Stacy M, Sajatovic M, Kane JM, et al. Abnormal involuntary movement scale in tardive dyskinesia: minimal clinically important difference. Mov Disord. 2019;34(8):1203–1209. PubMed CrossRef
Hauser RA, Barkay H, Wilhelm A, et al. Minimal clinically important change in Abnormal Involuntary Movement Scale score in tardive dyskinesia as assessed in pivotal trials of deutetrabenazine. Parkinsonism Relat Disord. 2022;97:47–51. PubMed CrossRef
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155–163. PubMed CrossRef
Matheson GJ. We need to talk about reliability: making better use of test-retest studies for study design and interpretation. PeerJ. 2019;7:e6918. PubMed CrossRef
Savitt D, Jankovic J. Tardive syndromes. J Neurol Sci. 2018;389:35–42. PubMed CrossRef
Barnes TR, Trauer T. Reliability and validity of a tardive dyskinesia videotape rating technique. Br J Psychiatry. 1982;140(5):508–515. PubMed CrossRef