Screening for Tardive Dyskinesia via Telehealth

Telehealth may be better suited for treatment of some disease states rather than others, but it offers a useful tool to providers for many conditions, including screening for tardive dyskinesia.

Psych Congress Network sat down with Desiree Matthews, PHMNP-BC, at Psych Congress NP Institute In-Person 2023 to discuss her clinical experience treating tardive dyskinesia via telehealth. Matthews describes how providers of all types can screen for TD remotely, and instances where it might be best to adopt a hybrid care plan.

For more expert insights on telehealth practice, visit our Telehealth Excellence Forum.

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Read the Transcript

Desiree Matthews, PHMNP-BC: Hello, my name is Desiree Matthews, and I'm a psychiatric nurse practitioner. I work in a community mental health center out of Charlotte, North Carolina.

When it comes to tardive dyskinesia, or TD, screening via telehealth, I have a few tips for clinicians out there that are utilizing telehealth in their practice. First, with telehealth and TD, you really need to make sure that you have appropriate lighting, that the patient has an appropriate camera. I would say that some patients, they would never need to come to my office unless it was their preference. I find that I can do telehealth TD screening very easily for the right patient. Again, that's somebody that has good lighting, an adequate camera, as well as adequate bandwidth for their internet.

What is really helpful for the AIMS on telehealth is to actually have a care partner—maybe this is a husband, wife, mom, dad, brother, or sister. At the end of my interview, I will go ahead and tell the patient to actually go get their care partner, someone to be the camera person, so that way the person can have their hands free and I can conduct the telehealth visit with the instruction to have the person on the camera, they can back away, I can have them put their hands out and their hands are free, essentially, to be able to conduct that head to toe assessment.

Some of the drawbacks when it comes to TD assessment is that if the bandwidth is poor, the video is choppy, it's grainy, we have poor lighting, I would say a difficult portion of the TD screen is to actually visualize their tongue and their mouth because without adequate lighting, you might not really be able to visualize the tongue, check dentition, and other things that we might be looking for in a screen. If that is the case, then the hybrid model of care is recommended, and I use this in my practice. I may see a patient every six months on site to do a head to toe assessment looking for tardive dyskinesia, doing the AIMS, and there are subsequent or interval visits where maybe I don't need to do a full AIMS and I'm doing a semi-structure interview, I can actually just do that on telehealth. So it really depends on the patient, depends on the equipment, access to lighting, camera that may determine who is an appropriate patient to be solely telehealth.

Now, if a patient doesn't have access to say tele-video, they don't have a camera, it's maybe an audio only check-in. You can't diagnose TD with audio only. This really does require a visual inspection of the patient. However, you can screen for possible TD on audio only. This is done quite often with my nursing staff, checking in on a patient for their nursing check-in, perhaps via telephone or audio only if maybe their camera is not working that day. One questionnaire called the Mind-TD Questionnaire is actually one screening tool that you may use in your clinical practice. The great thing about that is it takes just a few minutes and you don't need to be necessarily a nurse practitioner, a medical doctor, it can be anybody in your office that's been taught how to use the tool.  

Desiree Matthews, PHMNP-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.