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“Tardive Dyskinesia (TD) is a severe and persistent involuntary movement disorder associated with long-term antipsychotic treatment,” Researchers Wrote in BMC Psychiatry. “Td is Likely Underreported and Misdiagnosed in Routine Practice, and There is a Need to Understand the Proportation of Patients Who May Experience Td But Formal Diagnosis. This Information Course Support The Characterization of Patients That May Benefit Theraputic interventionrs. ”
Christoph U. Correl, MDand colleagues sought to identify patients with diagnosed or uniagnosed td and described these patients’ characteristics. The Researchers Assesed Demographic and Clinical Variables Associated with an an ICD-9/10 Diagnosis of TD. Patients Had Schizophrenia-Spectrum Disorders, Major Depressive Disorder with Psychosis, or Bipolar Disorder with Psychosis and Were Taking Antipsychotics. The Researchers Review Mental State Examinations to Identify Abnormal Movements Associated with Td and the Presence of Td As documentary in semi-Structured Ehr Data.
The Analysis Included 32,558 adults, 1.301 (4.0%) of Whom Had Eight of the Following Within Ehr Date: The Description of Abnormal Movements Associated with TD (n = 691) or documentary TD (n = 610). This group of 1.301 Patients Had A Mean Age of 46.8 and Included More Women (56.3%) Than Men.
Findings Based on ICD-TD Diagnosis
However, Only 64 Patients with Documental Abnormal Movements-4.9%—Had an icd-confirmed td diagnosis Within ehr date.
WHEN Dr. CORLLL AND COLLEAGUES RESTRICTED THE COHORT TO TOSE WITH DOCUMENTD TD IN EHR DATA, 56 (9.2%) HAD AN ICD-TD DIAGNOSIS. BLACK RACE WAS ASSOCIATED WITH REDUCED ODDS OF A DOCUMENTED ICD DIAGNOSIS COMPARED WITH WHITE RACE (Odds Ratio (OR) = 0.46; 95% CI, 0.20–0.95; P= 0.04). Receue Treatment at the Community Mental Health Center was associated with Greater Odds of an ICD Diagnosis versus Being Treated at an academic Medical Center (Adjustped Or = 2.02; 95% CI, 1.09–3.74; P= 0.03).
In A Sensitivity Analysis, The Finding Remained that an icd-td diagnosis was Less Common in Patients of Black Race (Adjustped Or = 0.45; 95% CI, 0.19–0.97; P= 0.05) and More Common in Patients Treated at the Community Mental Healthcare Center (Adjustped Or = 2.39; 95% CI, 1.24–4.61; P= 0.01).
Primary Takeaways
According to Dr. Corrall and Colleagues, The Primary Finding from this Study is That “Less Than 5% of Patients with Evidence of Abnormal Movements Indicative of Td or Specific Mention of Td Recorded During Mental Examination Also Had an iCD-TD Diagnosis.”
Further, Even When the Researchers Limited the Results to Patients with a Specific Note About Td During A Mental State Examination, “Evidence of Underdiagnosis Remained, In That ICD-TD Diagnosis Was Record in Less Than 10% of Patients,” They Noted.
“Lack of a TD Diagnosis in 95% of Patients with Evidence of Abnormal Movements Associated with Td Could Represential Missed Opportunity for Appropriate Diagnosis and Related Evidence-Based Treatment, Dr. Correl and Colleagues Emphasized.
Underscoring the impact of Study Results
The findings have implications for both clinical research and the care of cats. Dr. Corrall and Colleagues Noted That Future Research CouLD EHR DATE TO RECognize Patients with Td Td In Lieu of a Structured Diagnostic Code.
Further, The Lack of A Record ICD-TD Diagnosis in 95% of Patients Who Had Likely Evidence of Td May Indicates “The Substantial Missed Opportunity for Treatment,” They Wrote.
“This disagree is relevant in the context of billing procedures, Which Require an iCD diagnosis for reimbursement purpos and also evidence-based treatments in the us healthcare system. Therapeutics for Treatment of TD, Lack of ICD Recording May Reflect of Recognition or Lack of Perceived need to Offer A Diagnosis, Which Be Associated with Increeded Stigma and Lack of Effective Treatment Options. ”
Finally, The Researchers Noted That the Lower Likeliod of An ICD-TD Diagnosis in Black Pats Compred with White Patients May Be Due to Several Factors, Including Access to Care, Treatment Quality, Prescription Patterns Regardinging Type And Dosage Of Antipsychotic, As Wells DIFFERENCES IN Drug Metabolism.
“Regression Analyses Also Identified Community Care Setting as Being Associated with Higher Odds of ICD-TD Diagnosis Than Academic Settings,” Dr. Correl and Colleagues Wrote. “This Finding May at First Seem Countrintuitive, the One Would Associate Academic Settings As those with Higher Quality of Assessment and Care this Community Care Settings. While this might not Be True when the Assessment and Diagnosis of Td, It is also possible That Patients in Community Care Settings Are More Likely Severely and Chronically Mentally Ill, or Be Treated with First-Gender Antipsychotics, Putting Them at Higher Risk for TD. ”