A group of tardive dyskinesia (TD) experts has concluded that individuals taking antipsychotics should receive regular TD assessments, TD may be indicated by mild movements isolated to 1 body area, an overall assessment of treatment is required for management, and thorough caregiver/patient discussions are required. The modified Delphi consensus study was published in The Journal of Clinical Psychology.

The panel included 23 psychiatrists, 6 neurologists, and an 11 TD expert steering group who recommended articles for review. Bibliographic material was also sourced through a targeted literature search for TD on PubMed. A total of 18 articles met the study criteria and a separate threshold score for inclusion.

Following a modified Delphi consensus method, the panel conducted 2 rounds of questioning between November 2017 and January 2018, with responses anonymously recorded, collated, and collectively assessed. In Round 1, questions took the form of a 5-point Likert scale, rank order, and multiple choice to enable a wide range of opinions. Agreement by the panel was categorized as unanimous (100%), consensus (75%-99%), or majority (50%-74%); for Likert scale questions, a response of 4-5 (agree to strongly agree) constituted consensus. Round 2 results generated final outcomes in the absence of Round 1 consensus. 

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The study authors concluded that “brief screening for TD should be performed at every clinical encounter in all patients taking antipsychotics” and that “even mild movements in 1 body may represent possible TD.” They further concluded that TD management “requires an overall reassessment of pharmacologic treatment including antipsychotics and anticholinergics and the use of [vesicular monoamine transporter 2] inhibitors,” and “informed discussions with patients and caregivers are essential.”

Limitations to the study included the inherent limitations of the Delphi process, the use of 2 rounds of questioning, and the potential for bias resulting from commercial sponsorship. The researchers indicated that further study is needed on “the minimum duration of cumulative antipsychotic exposure for TD to develop, the need for prospective studies on the risk [for] TD associated with the duration and type of antipsychotic exposure, and the long-term course and prognosis of TD.”

Disclosure: This clinical trial was supported by Neurocrine Biosciences. Please see the original reference for a full list of authors’ disclosures.


Caroff SN, Citrome L, Meyer J, et al. A modified Delphi consensus study of the screening, diagnosis, and treatment of tardive dyskinesia [published online January 28, 2020]. J Clin Psychiatry. 2020;81(2):19cs12983.