Clinical Pearls to Enhance Tardive Dyskinesia Treatment

Sometimes, there exists a gap between clinical standard of care, and a patient-centered standard of care.

In this video, Tardive Dyskinesia Section Editor Amber Hoberg, MSN, APRN, PMHNP-BC, of Med Management Associates, offers clinical pearls that clinicians can implement to optimize their tardive dyskinesia care. Nurse Hoberg highlights the importance of keeping the patients’ goals at the center of a treatment plan, as well as shares how clinicians can gather a more accurate patient profile through patient education.

For more expert insights on tardive dyskinesia, visit our Tardive Dyskinesia Excellence Forum.

Read the Transcript

Psych Congress Network: What clinical pearls can you offer to our audience to help optimize tardive dyskinesia treatment in their practices?

Amber Hoberg, MSN, APRN, PMHNP-BC: Some clinical pearls I'd like to leave you with on how to really address tardive dyskinesia are, first: talk to your patients. Really make them talk about how this is impacting them. If I can't hit anything enough, it's really to talk about impact. Like I said, I do the AIMS scale for formality. I get the number on the scale—yes,this assessment is important. It meets the standard of care. But, that's not what drives me to treat patients. What drives me to treat patients is what they're saying behind that. Really try to uncover what this disease robbing from your patients. What is this taking away from them? How is this impacting their everyday life? What is this keeping them from doing? That, to me, is way more important and necessary to plan treatment, even more so sometimes than the number on the scale. That's clinical pearl number 1.

Clinical pearl number 2 is look at your patient's regimens. Before they come into your office, look at what they're on. If they're on a dopamine receptor blocking agent (i.e. antipsychotic), then make sure you have that  2-minute discussion with your patient. Let them know what antipsychotic they're on. Talk to them about the length of time they've been on it. Explain that movement disorders are something that can happen while on these medications. Ask them, "Do they have any unwanted movements in their body and what does that look like for them?" If they say “no,” educate your patient. Provide that education on what these movements may look like, and use patient words. For example, when I'm looking at muscles of facial expression, I'm looking at the brow. Does your brow ever furrow like you're mad? Or do people ever say you look mad all the time? Or does your nose squinch up and down like a bunny? Or do your eyes blink very rapidly as if you have dry eyes or that you can't control what's going on with your eyes? What about your mouth? Does your mouth ever move as if you're rubbing them, like you have chapped lips? Or that you're puckering and pursing your lips constantly? Really try to use the patient terminology so that they understand the movements you're looking for so that they can say “yes or no” in an appropriate way.

Finally, empower your patient. Lett them know, "okay, we don't see any movement today, but now you know what to look for. Every day I want you to look in the mirror. Let me know if you notice these movements. If you see these between visits, call me so I can get you in sooner so we can address this." Also, tell your family, friends, loved ones, anybody you live with. What kind of movements could occur from you being on this medication and to help you identify it. And lastly, when you come back to me every visit, we are going to have this discussion every time you come in, so I make sure I'm being proactive about identifying it. That's clinical pearl number 2.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from the University of Texas Health Science Center, San Antonio. She has been working for the past 12 years with the adult and geriatric populations treating all types of psychiatric conditions. Her background, as a psychiatric advanced practice nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Med Management Associates and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.