Expert-Driven Psychiatry Case: Tardive Dyskinesia

In this tardive dyskinesia (TD) case report, psychiatrist Craig Chepke, MD introduces his patient, James, a 50-year-old man retired from the Army who has been diagnosed with bipolar disorder and comorbidities that include overweight and T2D. James recently discussed an altercation at the grocery store and he’s been experiencing abnormal movement by way of tremors.

Through this case journey, Dr. Chepke will reveal an effective diagnostic process and best practices for tardive dyskinesia treatment, including the only two FDA-approved therapies, patient care, and optimal outcomes. 

“Don’t look for TD, you’re never going to find it,” warns Dr. Chepke, advising clinicians to overcome diagnostic muscle memory. This expert-driven case report video series is an opportunity to learn new approaches for the betterment of patient outcomes.

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Craig Chepke, MD introduces this expert-driven psychiatry case report for a patient named James. He’s 50-year-old, retired from the Army, and has been diagnosed with bipolar disorder. He sees Dr. Chepke for psychiatric care, and recently discussed an altercation at the grocery store where he became very angry and “exploded.” His comorbidities include overweight and T2D. He’s also been experiencing abnormal movement by way of tremors.

In this and the following five episodes, Dr. Chepke reviews the patient case and audits his medications, saying that “Reducing the dosage of the antipsychotic medication is not always best practice in some types of movement disorders.”

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Psychiatrist Craig Chepke, MD reviews the case of a 50-year-old patient with a history of bipolar disorder who has recently presented with abnormal movement by way of tremors. He talks through a diagnostic journey, ruling out dystonia, akathisia, and drug-induced Parkinson’s to ultimately conclude that the patient’s symptoms are most suggestive of tardive dyskinesia (TD).

He discusses the characteristics of and screening for these movement disorders based on APA guidelines. And leans on his adage that diagnostic tools like AIMS are “nothing but a number,” reminding clinicians that “it’s more important to think about how TD is impacting the patient’s function and their quality of life.”

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Psychiatrist Craig Chepke, MD reviews the case of a 50-year-old patient with a history of bipolar disorder whose abnormal movements and tremors have been newly diagnosed as tardive dyskinesia (TD).

Dr. Chepke reviews data-supported best practices for treatment and the only two FDA-approved VMAT2 inhibitors. He also explains the research in the KINECT 3 trial and AIMS-TD study.

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Psychiatrist Craig Chepke, MD reviews the case of a 50-year-old patient with a history of bipolar disorder whose abnormal movements and tremors have been newly diagnosed as tardive dyskinesia (TD). 

Dr. Chepke explains a patient-first treatment approach that consider biological, physical, social, and psychological factors that can improve quality of life and functional outcomes. For this patient case, he found that giving James a more accessible dosing schedule that James can manage and adhere to made notable improvements.

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Psychiatrist Craig Chepke, MD reviews the case of a 50-year-old patient with a history of bipolar disorder whose abnormal movements and tremors have been newly diagnosed as tardive dyskinesia (TD).

Dr. Chepke explains that the keys to patients having the best chance of success and desirable outcomes with prescribed therapies include:

- Patient education and setting appropriate expectations
- Being clear about results: as early as two weeks or up to six weeks for full benefits
- Monitor with the AIMS score at baseline
- Monitor efficacy and adverse events to be more responsive

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.

Psychiatrist Craig Chepke, MD reviews the case of James, a 50-year-old patient with a history of bipolar disorder whose abnormal movements and tremors have been newly diagnosed as tardive dyskinesia (TD) and treated with FDA-approved therapies.

“Don’t look for TD, you’re never going to find it,” warns Dr. Chepke. Because tardive dyskinesia can be difficult to identify, he recommends these best practices:

- Routinely monitor every patient on every antipsychotic
- Utilize structured AIMS or DISCUS, or semi-structured exams
- Ask the right questions to tease out functionality and QOL
- Once you’ve determined TD, pursue the right treatment

Clinicians have to overcome diagnostic muscle memory to learn new approaches for the betterment of patient outcomes.

Presented by The Journal of Clinical Psychiatry and Dramatic Life.

Craig Chepke, MD is the medical director for Excel Psychiatric Associates,  adjunct assistant professor of psychiatry at the University of North Carolina School of Medicine, and adjunct associate professor of psychiatry for Atrium Health.

Access clinical resources and learn more at Psychiatrist.com.