Dr. Kane Replies

To the Editor: Dr. Rosenheck makes an important point regarding evaluating the impact of adverse effect risk on clinical decision making and patient preference. It is important to recognize that any benefit risk calculation should ultimately be informed by both quality of life and cost considerations (although he does not directly raise the latter). However, it would be important to consider where in the range of potential Quality of Life Interview scores the patients participating in these studies fall. Would tardive dyskinesia be expected to have the same impact at any level in the range of possible Quality of Life Interview scores? Would tardive dyskinesia in a successfully treated first-episode college student or recently employed individual have the same impact on quality of life as a case of tardive dyskinesia occurring in a chronic and partially responsive patient (the population generally included in the studies to which he refers)? It is also important to recognize that some patients who have tardive dyskinesia are not fully aware of the movements and might lack insight into their potential impact in social or vocational settings.