Psychiatrist urges Georgia panel to update clinical policy on tardive dyskinesia and adopt available treatments

Dr. Sunil Katragada, a psychiatrist and medical director at Peachwood Hospital, told the Health and Human Services Committee that tardive dyskinesia, a drug-induced movement disorder linked to antipsychotic medications, is underdiagnosed and undertreated and urged the Department of Community Health (DCH) to update its policy manual to reflect current treatment standards.

"We have two medications that were approved in 2017," Katragada said, and he described those drugs as effective when TD is identified early. He said TD often begins after three months of exposure to antipsychotic medications and that catching it early is crucial because severe, long-standing TD becomes harder to reverse.

Katragada told the committee that estimates place the number of people with TD in the United States between 600,000 and 1 million, but that only about "10 percent or less" receive treatment. He said older antipsychotics carry higher risk (one in three patients in some settings), while newer agents lower but not eliminate risk (roughly one in 15 in some estimates). He described the Abnormal Involuntary Movement Scale (AIMS) as a simple exam clinicians can use to detect and document TD.

Committee members asked about timelines and coverage. Katragada said the Diagnostic and Statistical Manual (DSM) defines exposure of three months or more for diagnosis and that some patients, especially older adults, can develop TD more rapidly. He told the committee that insurance coverage exists for the newer treatments but that their high cost and lack of generics complicate adoption in community mental health settings.

Senators discussed whether the committee could influence DCH’s policy manual. Katragada recommended aligning the manual with American Psychiatric Association practice guidelines and said committee letters or budget process advocacy could help. He warned that community mental health providers and some state hospitals lag behind private settings in adopting the newer medications and noted clinical and financial barriers.

Katragada said TD can be disabling — affecting movement, speech and the ability to perform daily tasks — and that delayed treatment reduces the drugs' effectiveness. He encouraged the committee to press for policy changes so that diagnosis (AIMS), follow-up and treatment become standardized in public programs.

The presentation was informational; the committee did not take formal action during this segment. Committee members thanked Katragada and indicated willingness to assist with agency outreach and budgetary discussions.