Joseph McEvoy, MD, prepared useful Practice Aids pertaining to tardive dyskinesia for this CME activity titled "Advances in Tardive Dyskinesia: A Patient’s Journey From Diagnosis to Management and the Role of New Therapies for Improved Outcomes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2HtesuL. CME credit will be available until March 26, 2019.

1. Access the activity,“Advances in Tardive Dyskinesia: A Patient’s Journey From Diagnosis to Management
and the Role of New Therapies for Improved Outcomes,”at www.peerview.com/UPT40.
AIMS: Abnormal Involuntary
Movement Scale1
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
1. Rush AJ Jr et al, eds. Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association; 2000:166-168.
Movement Ratings:
• Rate highest severity observed in categories I, II, and III.
• Rate movements that occur upon activation one point less
than those observed spontaneously.
• Circle movements as well as code number that applies.
Rater Rater Rater Rater
Date Date Date Date
I. Facial and
Oral
Movements
1. Muscles of Facial Expression
Eg, movements of forehead, eyebrows, periorbital
area, cheeks (including frowning), blinking, smiling,
grimacing
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
2. Lips and Perioral Area
Eg, puckering, pouting, smacking
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
3. Jaw
Eg, biting, clenching, chewing, mouth opening,
lateral movement
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
4. Tongue
Rate only increases in movement both in and out
of mouth, NOT inability to sustain movement.
Darting in and out of mouth
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
II. Extremity
Movements
5. Upper (arms, wrists, hands, fingers)
Include choreic movements (ie, rapid, objectively
purposeless, irregular, spontaneous) athetoid
movements (ie, slow, irregular, complex, serpentine).
DO NOT INCLUDE TREMOR (ie, repetitive, regular,
rhythmic)
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
6. Lower (legs, knees, ankles, toes)
Eg, lateral knee movement, foot tapping, heel
dropping, foot squirming, inversion and eversion
of foot
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
III. Trunk
Movements
7. Neck, shoulders, hips
Eg, rocking, twisting, squirming, pelvic gyrations
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
IV. Global
Judgments
8. Severity of abnormal movements overall 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
9. Incapacitation due to abnormal movements 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
10. Patient’s awareness of abnormal movements
Rate only patient’s report:
No awareness 0
Aware, no distress 1
Aware, mild distress 2
Aware, moderate distress 3
Aware, severe distress 4
0 1 2 3 4 0 1 2 3 4 0 1 2 3 4 0 1 2 3 4
V. Dental
Status
11. Current problems with teeth and/or dentures? Yes No Yes No Yes No Yes No
12. Are dentures usually worn? Yes No Yes No Yes No Yes No
13. Edentia? Yes No Yes No Yes No Yes No
14. Do movements disappear in sleep? Yes No Yes No Yes No Yes No
Patient Name: Date of Visit:
Code: 0 = None 1 = Minimal 2 = Mild 3 = Moderate 4 = Severe

2. Access the activity,“Advances in Tardive Dyskinesia: A Patient’s Journey From Diagnosis to Management
and the Role of New Therapies for Improved Outcomes,”at www.peerview.com/UPT40.
Practical Considerations for Use
of Approved VMAT2 Inhibitors for
Tardive Dyskinesia Management
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
VMAT2: vesicular monoamine transporter 2.
1. Austedo (deutetrabenazine) Prescribing Information. https://www.austedo.com/hd/pi. Accessed February 16, 2018.
2. Ingrezza (valbenazine) Prescribing Information. https://ingrezzahcp.com/PI. Accessed February 16, 2018.
PRACTICE AID
Therapy Dosing Safety
• Initial dose: 12 mg/d
• Titrate at weekly intervals by
6 mg/d based on reduction
of tardive dyskinesia and on
tolerability
• Administer total daily dosage of
12 mg or above in two divided
doses
• Maximum dose: 48 mg/d
• Maximum recommended dosage
in poor CYP2D6 metabolizers:
36 mg/d
• Common adverse events (in 4%
of deutetrabenazine-treated
patients and greater than
placebo): nasopharyngitis and
insomnia
• For patients at risk for QT
prolongation, assess the QT
interval before and after
increasing the total dosage above
24 mg/d
• If switching patients from
tetrabenazine, discontinue and
initiate deutetrabenazine the
following daya
• Initial dose: 40 mg/d
• After 1 week, increase to
recommended dose of 80 mg/d
• Consider dose reduction based
on tolerability in known CYP2D6
poor metabolizers
• Recommended dose for patients
with moderate or severe hepatic
impairment: 40 mg/d
• Most common adverse reaction
(≥5% and twice the rate of
placebo): somnolence
• Avoid use in patients with
congenital long QT syndrome or
with arrhythmias associated with
prolonged QT interval
a
See full prescribing information for recommended conversion table.
O
O
O
O
H
H2
N
N
Valbenazine2
Deutetrabenazine1
CD3
O
O
O
H
N
CD3