The history of tardive dyskinesia (TD) is intertwined with the development and use of antipsychotic medications.  TD was first observed after the introduction of first-generation antipsychotic drugs (also known as typical antipsychotics) such as chlorpromazine (Thorazine) and haloperidol (Haldol) in the 1950s. These medications revolutionized the treatment of schizophrenia and other psychotic disorders.

Agitation is a common and challenging symptom in Alzheimer's disease, characterized by restlessness, emotional distress, and aggressive behaviors. Managing these symptoms is crucial for improving the quality of life for both patients and caregivers.

As a solo practitioner in a SNF for 40+ years, I have developed a set of decision support tools accessible on my smartphone that address many of the questions that arise while caring for increasingly complex post-acute rehabilitation patients. I have been following the evolving literature on adaptation of AI (Artificial Intelligence) to clinical medicine in medical journals and podcasts, but have not seen practical uses for clinical problem-solving in the SNF setting.

In LTC we sometimes deal with broad-stroke decisions such as “We are a no-antipsychotic facility.”  What that really means is that they should only use antipsychotics for AXIS 1 disorders.  Most facilities do not operate with that self-imposed restriction.  They will take a Part A patient short-term with an antipsychotic onboard, as well as a long-stay patient returning with a newly prescribed antipsychotic.  Many facilities allow a hospital transfer with a PRN low dose of quetiapine.  

The Centers for Medicare & Medicaid Services (CMS) developed the Five-Star Quality Rating System to provide consumers with an easy way to assess the quality of care provided by nursing homes. This rating system, which can be accessed on the CMS Nursing Home Compare website (Find Healthcare Providers: Compare Care Near You | Medicare), is a key resource for families and individuals seeking long-term care options. One critical area that the CMS rating system focuses on is the use of antipsychotic medications in long-stay residents.  This article will explain how the Five-Star Rating System works and why the use of antipsychotics in long-stay patients is an important quality measure.