Transcription
Welcome to the Gus Alva Perspective, a podcast that is set up to address different neurosychiatric themes. I am delighted that once again Dr. Jonathan Meyer is joining me to address one of the particular topics that he will be chairing at the Southern California Psychiatry meeting. This particular session will be looking at tardive diskynesia and improving its overall management. When we tackle complex care with targeted treatments, that often times gets us to the end goal that we are seeking. Jonathan, can you share with us some of the particular areas that you're excited about with this particular session?
As we've had two agents now proof or taught of disania in the United States in 2017, I think our focus has shifted over the years. It used to be on teaching people how to do the aims and maybe differentiating TD from drug induced parkinsonism which is still important but now more and more we're really trying to educate everyone out there about talking to people regarding their disynesia getting them on treatment and most importantly as part of that conversation recognizing the huge psychosocial impacts of TD. It's not just a movement disorder. It's a disorder of people. And for many individuals with tardigines, yes, they may have physical manifestations, but the biggest impact on their life is from a psychosocial perspective. Imagine us, Gus. We could not do our job if we had even mild TD. It was involving somehow our face. People would look at us. It would interfere with our lives. For many individuals living with TD, this becomes a huge problem and it leads people to sometimes some bad decisions like should I stop my medication which has kept me stable in order to manage my tarda disanesia. So I'm excited for people to come to this. I think you'll hear about new ways to rate the functional impact of TD beyond just the motor symptoms with AS and also really learn a little bit more about these medicines. And I think the most important aspect is you don't have to change anyone's treatment to use a VMAT 2 inhibitor to manage their tardo diskynesia.
You're so right, Jonathan. And I love the fact that you just threw in so many different rich uh intertwining points that sometimes pop out. I think that for the clinician the more challenging situation is when you see drug induced Parkinsonism in conjunction with tardive disynesia which certainly could coexist and what to do and I think that one of the nice things about the practicality tied in with the session that you'll be chairing is that we'll have an opportunity of illustrating that point. The other really beautiful area that you just bought into is the impact that it has on people, whether it be with their leisure activities, vocationally, physically, emotionally, psychiatrically. And you're right, one out of five people start becoming advocates for the wrong thing to do, and that is counseling people to not take their medicine, which is exactly what we're hoping not doesn't happen. So, yeah, I I I love the the the points that you brought about. You're right also that there's two therapies that are available. It's not a bad idea to understand the nuances associated with each one and then subsequently just take into consideration that there's a great degree of heterogeneity in this patient population. Any other points that pop out Jonathan that that you think would be worthwhile in wetting the appetite of our audience out there?
Well, for one thing you talked about complex cases. you know how do you approach it when somebody has dip and TD at the same time and I think another theme kind of embedded in that is what do you do with the people who are on antiolinerics often inappropriately we know anti-inurgics are not a treatment for disynesia and they tend to make it worse and the question is what do I do with these medications as I'm trying to to treat somebody with a vat 2 inhibitor for their tardive disanesia It's important to think through the problem to understand who your patient is and I think last and more than anything when you make the decision to taper off anti-coronurgics to be patient and do it slowly just like you're tapering off a benzadia.
What a phenomenal pearl, Jonathan. That is excellent because, you know, just like the first session that you're actually going to be, you know, again, spearheading the entire conference through of really talking about, you know, what happens with a new therapy that's more colonurgically driven. I think that that particular pursuit is helping us reframe along the lines of the different medicines that we've initiated and then just allowed to kind of continue without really thinking through the consequences of what that evokes and you're absolutely right anticolinergics I think is a great area of deprescribing or again economizing on their utilization but it's only done so through appropriate education. So, I'm so happy that you're actually going to be leading the charge in helping the clinicians that make it out to the conference to really have the guidance and the appropriate scope as to how to go about doing this.
Well, I'm really excited about it. I think there's always more to learn. I think one thing we've appreciated is TD is underrecognized and it's undertreated and we hope we'll give you the tools not only to use the VMAT 2 inhibitor but to engage in an ongoing conversation with people about trying to manage their tea in a way that doesn't destabilize the psychiatric progress they've made.
I love it. Can't wait. Thank you, Jonathan.