Telehealth was found to impair the ability of clinicians to manage drug-induced movement disorders (DIMDs) in patients being treated with either a vesicular monoamine transporter 2 (VMAT2) inhibitor or benztropine, according to study results recently presented at Psych Congress 2021, held from October 29 to November 1, 2021, in San Antonio, Texas.

This observational study, the Real-World Tele-Health Evaluation of Tardive Dyskinesia (TD) Symptoms Communication/Observation Procedure Evaluation in Outpatient Clinical Settings (TeleSCOPE), included 277 clinician respondents (psychiatry, n=168; neurology, n=109). Study participants had at least 3 years of practice, at least 70% of which was spent seeing patients; had prescribed benztropine and/or VMAT2 for a DIMD within the past 6 months; and employed telehealth to conduct visits with at least 15% of patients within the period from December 2020 to January 2021. All participants completed a 20-minute online survey.

Although telehealth visits increased for both specialties during the COVID-19 pandemic, psychiatry experienced a greater increase than neurology for both phone (38% vs 21%) and video (49% vs 42%) visits. Further DIMD assessment was most commonly prompted by mentions of movements or tics by others (89% neurology vs 149% psychiatry), trouble walking/standing or with gait/falls (84% vs 143%), and reported difficulty eating or swallowing (75% vs 131%). However, managing these problems via telehealth proved challenging, and many individuals determined to be at risk (for example, those taking dopamine receptor­-blocking agents) did not undergo DIMD evaluation in visits conducted by phone only (91% vs 76%). The highest risk for a missed DIMD diagnosis was among patients without a caregiver and those with lower function.


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The study authors concluded, “During the COVID-19 pandemic, telehealth significantly reduced clinicians’ ability or willingness to diagnose, assess, and monitor/treat DIMDs,” with multiple factors contributing to this situation.  “In-person evaluation continues to be the gold standard for assessing and treating DIMDs.” The study authors also noted that “the use of pre-visit materials … and specific questions and directions during virtual visits may improvement communication and lead to more accurate assessments.”

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

Findings of a study published in JAMA Network Open suggest written exposure therapy (WET) to be a more efficient treatment approach for post-traumatic stress disorder than cognitive processing therapy (CPT).

Active-duty United States military personnel (N=169) stationed at 2 bases in Texas seeking treatment for PTSD were recruited for this study between 2016 and 2020. Participants were randomized to receive cognitive processing therapy (n=84) or written exposure therapy (n=85). CPT comprised 12 biweekly 1-hour sessions which focused on trauma using progressive worksheets. WET comprised 5 weekly 45 minute to hour-long sessions during which time the participant wrote for 30 minutes about their trauma and the therapist checked whether the patient had any challenges completing the task.

The military personnel were 80.5% men, aged mean 33.65 (standard deviation [SD], 8.43) years, 34.9% were White, 33.7% were Black, 24.9% were Hispanic, 76.9% were married, 61.5% had some college, 0.7% had never been deployed, and they had been in the military for 155.31 (SD, 89.84) months.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PTSD Scale scores were 36.71 (SD, 1.12) and 34.24 (SD, 1.13) at baseline for the WET and CPT cohorts, respectively. At 10 weeks, PTSD Scale scores had changed by -5.16 (SD, 1.17) and -9.12 (SD, 1.28) points for each group, respectively. By week 30, there was little difference in the score changes between cohorts (difference, 0.33; standard error [SE], 2.58).


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At week 30, 37.5% of the CPT and 47.2% of the WET participants exhibited a reliable change in PTSD severity, as defined by a 12-point change in Clinician-Administered PTSD Scale for DSM-5 score.

Most participants (54%) experienced adverse events. The events were primarily psychiatric symptoms of anxiety, depression, and sleep disturbances.

CPT recipients were more likely to drop out of the study (45.2% vs 23.5%; odds ratio [OR], 2.69; 95% CI, 1.39-5.20).

This study was limited by its relatively high drop-out rate and the lack of long-term outcomes.

The study authors concluded, “the option of a brief PTSD treatment is likely to be of high value in the military setting, where military service operations may limit treatment engagement. One clear pattern of findings in this study is the high variability of treatment outcomes among service members. Better understanding of the factors associated with who does and who does not benefit from PTSD treatment is an important direction for the field.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Sloan DM, Marx BP, Resick PA, et al. Effect of written exposure therapy vs cognitive processing therapy on increasing treatment efficiency among military service members with post-traumatic stress disorder: a randomized noninferiority trial. JAMA Netw Open. 2022;5(1):e2140911. doi:10.1001/jamanetworkopen.2021.40911

Reference

Bera R, Franey E, Martello K, Bron M, Yonan C. TeleSCOPE: a real-world study of telehealth for the detection and treatment of drug-induced movement disorders. Presented at: Psych Congress 2021; October 29-November 1, 2021; San Antonio, Texas.  Poster 122. 

This article originally appeared on Psychiatry Advisor