In this occasional feature, members of the Psych Congress Steering Committee and faculty answer questions asked by attendees at Psych Congress meetings.
QUESTION: How does seeing a patient via telepsychiatry complicate the Abnormal Involuntary Movement Scale (AIMS) exam?
ANSWER: Using telepsychiatry does complicate assessment for tardive dyskinesia (TD) in a susceptible patient, as nothing beats seeing a patient face-to-face. And assessing for muscle rigidity, which is part of an AIMS examination, does require a patient and clinician to be in the same room. But all is not lost if telepsychiatry is how you are seeing your patient! There are multiple ways to minimize the loss of direct, live, face-to-face contact with a patient to assess for TD using an instrument such as the AIMS. Below are some suggestions to consider if you are seeing a patient via telepsychiatry.
1. If feasible, some of the patient visits can be conducted in your office, while the other visits can be conducted using telepsychiatry. This would allow for the full implementation of a movement scale such as the AIMS at periodic intervals.
2. If the patient is at a remote clinic that is staffed by nurses or medical assistants, these individuals can be trained to conduct a full and thorough AIMS examination. This takes care of the issue of the prescribing clinician not being in the room with the patient.
3. If none of these are options, and the patient is at home without a medical staff member around them, a partial AIMS examination can still be conducted. Should that raise concerns, a visit by the patient to the clinic should be requested.
4. Even with the sole use of telepsychiatry, many of the elements of the AIMS can be covered. For example, asking the patient if they have noticed any abnormal movements is possible via telepsychiatry, along with the clinician’s own observations during the consultation. Observing various body regions (such as eyes, lips, face, hands and fingers, shoulders, etc.) at rest, and with activation is quite doable with telepsychiatry. Additionally, the camera can be tilted down for the clinician to observe the patient’s feet and toes (of course, with the socks and shoes off). The tongue also can be examined quite well in a telepsychiatry appointment.
5. The final point is this: let us not let perfection be the enemy of good. While telepsychiatry does indeed create a challenge in conducting full and through examination and completion of a scale such as the AIMS, a fairly adequate exam can be still be conducted despite this roadblock. And of course, if there is any suspicion that even a mild or questionable movement abnormality is present, arranging for a live, face-to-face interview with a competent clinician is a matter of urgent clinical need.
Thank you for asking this important question!
— Psych Congress cochair Rakesh Jain, MD, MPH, Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center School of Medicine, Midland
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