Navigating Tardive Dyskinesia Risk in Antipsychotic Treatment Decisions

How can clinicians balance the need for antipsychotic therapy with the risk of tardive dyskinesia (TD)? In this video, Psych Congress Journal Clinical Editor Kristian Dambrino, DNP, PMHNP-BC, explores how TD considerations may influence antipsychotic treatment decisions. With a focus on maintaining treatment adherence and a strong patient-provider relationship, Dambrino discusses the impact of untreated TD, underscores the importance of stabilizing psychiatric symptoms, and encourages clinicians to ensure patients’ perspectives are factored into the care plan. She also uses a patient case to illustrate a practical framework for weighing TD risk in clinical practice.

• Untreated or undertreated TD may negatively affect medication adherence and patient-provider trust when patients associate involuntary movements with medications prescribed for psychiatric conditions.
• Antipsychotics may provide meaningful improvements in psychiatric symptoms and daily functioning despite TD risk, underscoring the importance of weighing potential benefits against adverse effects.
• Clinicians should discuss the potential for TD when prescribing antipsychotics, exercise empathy regarding the impact of abnormal movements, and incorporate patient preferences into treatment decisions.

Kristian Dambrino, DNP, PMHNP-BC: Hey, I'm Kristian Dambrino. I'm a psychiatric nurse practitioner based in Nashville, Tennessee, where I own my own clinic. I'm also on faculty at Belmont University College of Nursing.

Psych Congress Network: In your experience, how does untreated or undertreated TD affect medication adherence and the broader therapeutic relationship between patients and their psychiatric providers?

Dambrino: Imagine you're a patient and you're going to see your provider, and your provider writes you a medication that is helping your depression. They add that medication onto your oral antidepressant, or you're someone who has a mood disorder and you have an antipsychotic that's really helping with that. 

But then you start to develop mouth movements or you have truncal movements, and you know that that medication caused those movements. For me, if that's the case, I'm going to want to stop that medication. I'm going to stop taking it. I may not even trust my provider because I'm going to say, “This provider wrote me [this] medication.” 

Even if the provider teaches about the risk of TD, sometimes that trust can be impacted between the patient and the provider. 

It's really important to remember that and really try to exercise empathy when we are prescribing and think about the day-to-day impact on our patients. 

PCN: How can clinicians balance the need for ongoing antipsychotic treatment with concerns about TD risk?

Dambrino: I think the best way to answer this question is actually with a patient case. In Nashville, Tennessee, I work with a lot of artists and musicians that either they're well-known or they make their living by writing music or playing music. 

We know that artists and creatives often can have a history of having mental health issues. That career is not an easy one. Anxiety can be present, mood mobility. We know of many famous artists that have had bipolar disorder, for example, or schizophrenia. If we don't treat that, then that does impact creativity.

If someone's really struggling with depression and they don't have the motivation to write music or to engage in something that they love, then that's really negligence if I don't treat that as a clinician. If I use an atypical antipsychotic, they can be very therapeutic and really change the course of someone's functionality. [Even if] that medication causes a risk of TD, it is still very much worth presenting as a treatment option. 

There have been cases with patients that I've treated that are artists where they've said, “Please, Kristian, will you please consider that treatment? I know you're worried about TD, and changes in lipid panels and all those side effects, but I really need to experience change because I'm just not myself.”  That's where we really weigh those risks and benefits and make sure we're transparent about the risk of TD. But we don't need to neglect offering an antipsychotic as an option.

Thank you so much for joining me today, and I hope to see you at the next Psych Congress.

Kristian Dambrino, DNP, PMHNP-BC, is a board-certified psychiatric nurse practitioner and the founder of Dambrino Wellness, a mental health clinic in Nashville, Tennessee. She holds a Master of Science in Nursing from Vanderbilt University and a Doctor of Nursing Practice from Belmont University.

A Fulbright Scholar, she is conducting research in Indonesia and India on reducing mental health stigma through nursing capacity building, and serves as adjunct faculty at Belmont University College of Nursing, with prior faculty appointments at Michigan State University and Marian University. As a national speaker and consultant, she serves in leadership as co-chair of Psych Congress Elevate and brings her clinical and research expertise to stages and institutions across the country.

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