Researchers of a recent retrospective claims-based study examined patients with tardive dyskinesia (TD) living in long-term care (LTC) settings and found that they were typically older, medically complex, and exposed to substantial polypharmacy. Of 2,294 eligible patients, nearly two-thirds were age 65 or older, more than two-thirds were female, and most were covered by Medicare. Repeated LTC stays were common, and most patients lived in skilled nursing facilities or nursing homes. The population had a high comorbidity burden, with mood disorders, schizophrenia, sleep disorders, substance abuse, urinary tract infections, dysphagia, and dementia all frequently reported. Medication use was also extensive, with high rates of antidepressants, anticonvulsants, antipsychotics, and anticholinergics. Nearly half of patients were taking at least three central nervous system-active medications that may increase the risk of falls or cognitive impairment.

Healthcare utilization was also high in this population. Nearly half of patients had at least one emergency department (ED) visit within a year after their index LTC stay. Almost two-thirds had an ED visit at some point during follow-up, with a median of four visits overall. The authors say these findings highlight the considerable clinical burden of TD in LTC residents. Furthermore, it raises concern about the frequent use of anticholinergics, which are not recommended for TD and may worsen symptoms or contribute to cognitive and physical harm in older adults. Overall, the study points to a need for better TD-focused care in LTC settings, including more tailored guidelines, improved medication management, and treatment approaches that account for the needs of older adults, including those with dysphagia and multiple comorbidities.

Reference: Bron M, Aweh G, Jen E, Patel A. Real-World Claims Analysis to Characterize the Burden of Tardive Dyskinesia in Long-Term Care Settings. Neurol Ther. 2025;14(5):2217-2226. doi: 10.1007/s40120-025-00820-z.

A Teva-sponsored retrospective study found significant gaps in the diagnosis and treatment of tardive dyskinesia (TD) among residents in long-term care (LTC) facilities. Among residents receiving antipsychotic drugs, 5.6% were diagnosed with the broader category of extrapyramidal syndrome (EPS), while only 1.1% received a specific TD diagnosis, suggesting that TD may often be misclassified or underrecognized in this setting. The analysis included roughly 700,000 residents on antipsychotics and about 35,000 on metoclopramide, with mood disorders representing the most common underlying psychiatric diagnosis. Common comorbidities among residents at risk for TD included dementia, chronic pulmonary disease, and congestive heart failure.

The study also found that many LTC residents with TD were not receiving recommended care. Fewer than half of residents diagnosed with TD received a VMAT2 inhibitor, the American Psychiatric Association’s recommended standard-of-care treatment. Most were treated with non-FDA-approved options, most commonly benztropine, and about one-quarter received no treatment at all. The findings suggest that inaccurate diagnosis and confusion between TD and broader movement-disorder labels such as EPS may be contributing to undertreatment or inappropriate treatment in LTC settings. Overall, the study highlights the need for better screening, more precise diagnosis, and more timely use of appropriate TD therapies for residents in LTC.

Reference: Teva Pharmaceutical Industries Ltd. New Data from Teva Shows Substantial Rates of Undertreated Tardive Dyskinesia in Long-Term Care Settings at Psych Congress Elevate 2025. Press release. Published May 30, 2025. Accessed March 14, 2026. https://ir.tevapharm.com/news-and-events/press-releases/press-release-details/2025/New-Data-from-Teva-Shows-Substantial-Rates-of-Undertreated-Tardive-Dyskinesia-in-Long-Term-Care-Settings-at-Psych-Congress-Elevate-2025/

In a recent study, researchers used Japan’s JADER adverse drug reaction database to look for safety signals linking antipsychotics to tardive dyskinesia (TD) and other extrapyramidal symptoms (EPS), including akathisia, dystonia, parkinsonism, tremor, and related movement disorders. Across more than 1.19 million reports, both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) showed higher reporting odds of TD and EPS than non-antipsychotic drugs. The signal was especially strong for TD, and the findings remained generally consistent after statistical adjustment. When SGAs were compared directly with FGAs, SGAs overall showed lower reporting signals for TD, dyskinesia, and parkinsonism, but not consistently for akathisia, dystonia, or tremor.

The authors conclude that although SGAs are often viewed as safer than FGAs for movement-related adverse effects, they still carry meaningful TD and EPS risk and should not be considered risk-free. Differences also emerged among SGA subgroups, with some appearing lower risk than others for certain movement disorders. The overall message is that clinicians should actively monitor for TD and EPS with any antipsychotic. The paper also highlights the frequent concomitant use of anticholinergics, noting that long-term use may be inappropriate in some patients and may fail to prevent or even worsen TD. Because the analysis was based on spontaneous reporting data, it identifies reporting “signals” rather than true incidence or causality, but it still offers useful real-world evidence to support careful prescribing and ongoing monitoring.

Reference: Saga Y, Horio H, Chiang CL, Wakamatsu A. Reporting Frequency of Antipsychotics-Induced Tardive Dyskinesia and Other Extrapyramidal Symptoms: Analysis Based on a Spontaneous Reporting System Database in Japan. Neuropsychopharmacol Rep. 2025;45(3):e70049. doi: 10.1002/npr2.70049.