Patient Awareness of Tardive Dyskinesia: Insights From Cherian Karunapuzha, MD

Cherian Kanupuzha, MD, a movement-disorder neurologist, highlighted the substantial clinical, psychosocial, and economic burden of tardive dyskinesia (TD), emphasizing its persistent underrecognition. TD remains a common complication of antipsychotic therapy—affecting an estimated 20 to 25% of patients exposed to second-generation agents. Only a small minority (approximately 6%) receive US Food and Drug Administration approved VMAT2-inhibitor treatment, he said. Kanupuzha attributed this treatment gap partly to the subtlety of TD manifestations and a lack of patient awareness. Individuals often present for mood, psychotic, or anxiety symptoms without recognizing that involuntary movements, such as excessive blinking or jaw clenching, reflect an enduring disorder rather than a transient side effect.¹

He stressed the importance of structured, practical assessment approaches to improve detection, including targeted questioning, functional-impact probing, and emphasizing collateral information. Clinicians should explore impairment not only from the patient’s perspective but also within home and workplace environments, where the burden is often more visible, he said. Because TD persists long after discontinuation of medication, failure to identify and treat it can undermine psychiatric recovery, reinforcing social withdrawal and reversing therapeutic gains.²

Kanupuzha highlighted the need to clearly differentiate neuroleptic-induced movement disorders rather than grouping them under outdated EPS terminology, as distinct pathophysiology warrants specific treatment strategies. Patient engagement, particularly fostering self-recognition of abnormal movements, is critical for achieving commitment to pharmacologic therapy.

He also emphasized the value of professional networking at conferences, where clinicians can integrate pathophysiologic knowledge with practical management strategies and learn operational insights from peers. Such collegial exchange, Kanupuzha noted, enhances both diagnostic accuracy and real-world implementation of effective TD care.

Dr Kanapuzha is a neurologist specializing in movement disorders, practicing in Oklahoma City. He is an assistant professor of neurology at the University of Oklahoma Health Sciences Center.

References

1. Hauser RA, Meyer JM, Factor SA, et al. Differentiating tardive dyskinesia: a video-based review of antipsychotic-induced movement disorders in clinical practice. CNS Spectr. 2022;27(2):208-217.

2. Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017;17(2):162-174.