Determining If Your Patient Needs Treatment for Tardive Dyskinesia

Navigating treatment decisions for tardive dyskinesia involves more than just relying on the AIMS scale.

In this video, Desiree Matthews, PMHNP-BC, steering committee, Psych Congress NP Institute, discusses the limitations of AIMS in truly assessing a patient's experience. Some patients may exhibit mild scores, but experiencing significant life disruptions from tardive dyskinesia. Nurse Matthews advocates for proactive treatment, “mild” cases, stressing the need for personalized discussions with patients to uncover the true impact of tardive dyskinesia on their lives.

For more expert clinical guidance, visit our Tardive Dyskinesia Excellence Forum. 

Join us for the second annual Psych Congress NP Institute March 20-23, 2024, in San Diego, California. For more information and to register, visit the meeting website.

Read the Transcript

Psych Congress Network: When should clinicians consider treating tardive dyskinesia in a patient?

Desiree Matthews, PMHNP-BC: So, I get a lot of questions about when should we go ahead and consider treatment for tardive dyskinesia. A lot of people ask me, “is there a certain number on the AIMS scale, or the Abnormal Involuntary Movement Scale, that you're really looking for as your cutoff point to treat or not to treat?”

Now, I'd like to remind you all that the AIMS is, a tool that helps us really measure change over time. Right? Are movement's getting worse? Are they getting less? But what the AIMS is not going to tell you is how your patient is doing. I've had patients with low scores on the AIMS, so maybe a 4, but the movements were so bothersome to them. Right? The movements were interfering with their daily activities.

In fact, I had one patient who had movements in just her eyes. She had an increased rate of blinking, but those movements were so embarrassing to her because her coworkers kept pointing out the movements, asking her, "Why are you squinting? Do you need to go to the eye doctor? Did you need to get some glasses?" So she was really bothered by the movements, even though on the AIMS, we would probably say it was fairly mild.

If you look at the guidelines for tardive dyskinesia with the American Psychiatric Association, or APA, those guidelines actually state that treatment should be offered to patients with mild tardive dyskinesia, if there is psychosocial functioning concerns.

And then certainly if there's moderate or severe tardive dyskinesia, certainly offering treatment with a VMAT2 inhibitor. So, really when I see those guidelines, it means that anybody with tardive dyskinesia can be offered treatment with a VMAT2 inhibitor, and it really depends, again, on talking to the patient. Are they not doing something because of their TD? Do they used to love going out and going shopping, eating out with friends, singing in choir, but maybe now they're not doing those things because of their tardive dyskinesia.

Desiree Matthews, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.