New findings from a 2023 quality improvement study indicate low rates of documented Abnormal Involuntary Movement Scale (AIMS) assessments in clinical practice, alongside American Psychiatric Association (APA) guidelines emphasizing screening for tardive dyskinesia (TD). Tardive dyskinesia is a movement disorder that can develop following exposure to antipsychotic medication, with symptoms often including tongue thrusting, lip smacking, finger tapping, and pelvic rocking.

APA guidelines state that patients on antipsychotics should be assessed for TD and abnormal involuntary movements at each clinical visit. The guidelines advise that screening with a tool such as the AIMS should be performed at a minimum of every 6 months for high-risk patients, and at least every 12 months for other patients. Additionally, if new onset or an exacerbation of preexisting movements is detected, an assessment should occur.

In a random sample of 30 charts from adult patients on antipsychotic medications at a psychiatry outpatient clinic, documentation of the AIMS was found for only one patient. A survey of clinicians revealed that 35% did not use the AIMS due to a lack of formal training, 26% indicated they were not reminded to use it, and 16% were unsure of recommended screening frequency. Some clinicians also cited "extra clicks" and "time constraints" as reasons for non-compliance with AIMS screening.

John Kane, MD, affiliated with the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, stated, "Monitoring and recognition of TD are critical skills for clinicians." Kane added, "TD remains a risk for many patients and should not be ignored." He said, "Regular assessments should take place so that early signs of TD can be identified and appropriate shared decision-making can take place. Even when using telemedicine, TD examinations should be routine."

The AIMS, a 12-item clinician-rated assessment, was developed by the National Institute of Mental Health and has been used for decades to monitor TD symptoms. It typically takes about 5 minutes to administer, with items scored from 0 (none) to 4 (severe). The APA guidelines acknowledge that there is no specific AIMS score threshold indicating a need for intervention. The incidence of TD is approximately 4% to 8% annually in adult patients treated with first-generation antipsychotic agents, but is lower with second-generation agents.

Tsao-Wei Liang, MD, affiliated with Thomas Jefferson University, stated that early TD recognition is important because it allows for potential interventions to prevent the condition from becoming permanent or chronic. "It's not completely a hopeless issue, but it needs to be recognized early so we are aware and oriented to our medications and what they can do," Liang said. Kane's group suggested that renewed education and training regarding AIMS use are necessary to ensure reliability of ratings.

Why It Matters

The low rate of documented AIMS assessments found in a recent quality improvement study indicates a gap between clinical practice and established guidelines. This could result in missed opportunities for early detection and intervention for tardive dyskinesia, a potentially irreversible movement disorder. The reported reasons for non-compliance, such as lack of training and reminders, suggest a need for improved clinician education and standardized protocols to align practice with American Psychiatric Association recommendations for patient care.