Is high blink rate a symptom of Tardive Dyskinesia? With Dr Craig Chepke

Psych Congress Network Section Editor and Psych Congress Steering Committee Member Craig Chepke, MD, FAPA, discusses whether or not a high blink rate should be cause for further investigation into a Tardive Dyskinesia (TD) diagnosis. He also explores how to work with patients who aren't fully cooperating during an Abnormal Involuntary Movement Scale (AIMS) exam conducted via telehealth.

Dr Chepke answered these questions and more in a recent live Q&A session moderated by Rakesh Jain, MD, MPH, at the virtual Psych Congress Regionals.

For more information on Psych Congress Regionals, visit the meeting website.

Dr Craig Chepke, MD, FAPA, is a board-certified psychiatrist and a Fellow of the American Psychiatric Association. He attended NYU School of Medicine and completed his residency training at Duke University. Dr Chepke is the medical director of Excel Psychiatric Associates in Huntersville, North Carolina, as well as a clinical assistant professor of psychiatry at SUNY Upstate Medical University and an adjunct associate professor of psychiatry for Atrium Health. He is a member of the Huntington Study Group and serves on the board of directors for the CURESZ foundation, a nonprofit organization dedicated to improving the lives of people living with schizophrenia.

Read the transcript:

Dr Rakesh Jain:

Well, Dr Chepke, it's so nice to have you with us and what a great [Psych Congress Regionals] session we had on tardive dyskinesia. We have lots of great questions from our attendees. So, let's go ahead and get started. The most popular question for you is: Is eye blinking, considered tardive dyskinesia?

Dr Craig Chepke:
The answer is maybe, it certainly can be. Increased blink rate is a potential symptom of TD. But, you are going to want to rule out [if it] is that their eyes are dry or certain things like that, obviously. But, that should be a clue. If you do see it, just inquire with the patient, "What's going on? I noticed you're blinking a lot. Are your eyes dry?" And don't rule that out.

It is very subtle if you're not thinking about it as a potential symptom of TD but it is a common one. Many, many of my patients with TD do have an excess blink rate; like all symptoms of TD, it's variable, it can wax and wane. So, you may not notice it all the time, but be on the lookout for it because it is a possible flag that it could be a symptom of TD.

Dr Jain:
I like that. So it's a red flag. It's waving in your face. Do something about it, which is to talk to the patient, and conduct a full-length examination.

Dr Chepke:
Exactly.

Dr Jain:
No wonder that got voted the most popular question!

Dr Chepke:
Great question.

Dr Jain:
Clinicians have seen that, and they want to not make either error by ignoring it or over-diagnosing it.

Okay, here's another question. How do you handle a patient who isn't cooperative with the movement you're asking them to do during a telehealth AIMS exam? What are your thoughts?

Dr Chepke:
Well, I would say I would do the exact same thing as a patient who's live in my office and who isn't cooperative for an AIMS exam. Sometimes, people just don't want to do [the exam] if they're having a bad day, or may if they have some impulsive behaviors, whatever it is. You just do the best you can, get as much of it as you can. And ultimately, it's something you can revisit the next time.

So, if they're having a bad day, even if they're due for the AIMS, show it for that day. Wait until the next visit. Say, "Hey, look, sounds like you're struggling today. Let's try this again next month, and we'll do it then. That sound good to you?" Whatever it is, just get as much info as you can and then try again the next time.

Dr Jain:
Great. So don't get too frustrated, be patient, and obviously, there's visit number 2. And why are they uncooperative? I like your point about let's explore that. It could be because they're embarrassed, [that] they're so embarrassed, they don't want you to see the movements.

Dr Chepke:
Absolutely. That's a good point that many patients will say with their words that TD doesn't bother them, but their actions and behaviors betray that they actually are bothered by it, and they don't want to talk about it. They push back hard on wanting to do exams or wanting treatment when it's because it bothers them.

Dr Jain:
So with that, folks, in addition to thanking Dr. Chepke, let's just remember the plight of our patients with tardive dyskinesia and do our very best to address them. See you very soon. Thanks.