Working With an Apprehensive Patient When Conducting an AIMS Exam Via Telehealth

In this expert conversation excerpt, Psych Congress Network Section Editor and Psych Congress Steering Committee Member Craig Chepke, MD, FAPA, discusses how to work with patients who aren't fully cooperating during an Abnormal Involuntary Movement Scale (AIMS) exam conducted via telehealth. Dr Chepke offers clarifying questions to ask the patient and suggested next steps to ensure high-quality care.

Dr Chepke answered this question 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. Okay, here's [a] 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 Craig 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.