Elsevier

Schizophrenia Research

Volume 77, Issues 2–3, 15 September 2005, Pages 119-128
Schizophrenia Research

Abnormal Involuntary Movement Scale (AIMS) and Extrapyramidal Symptom Rating Scale (ESRS): Cross-scale comparison in assessing tardive dyskinesia

https://doi.org/10.1016/j.schres.2005.03.008Get rights and content

Abstract

Assessing tardive dyskinesia (TD) has been complicated by the use of different research criteria and rating scales. We studied concordance between two commonly used scales, the Abnormal Involuntary Movement Scale (AIMS) and Extrapyramidal Symptom Rating Scale (ESRS), to study interscale concordance and criteria to define TD.

Patients with schizophrenia or schizoaffective disorder (N = 374) were rated at baseline with both scales. Linear and logistic regression models explored relationships between scale ratings and mapped scores for corresponding items. TD was defined as at least mild in ≥ 2 anatomical areas, or moderate or greater symptoms in ≥ 1 area at baseline. Logistic regression was used to find simplified criteria for predicting AIMS-defined TD by ESRS scores.

There was a strong association on corresponding item ratings. “Mild” was defined as AIMS score of 2 and ESRS 2 or 3, and “moderate or greater” as AIMS score ≥ 3 and ESRS ≥ 4. Using these criteria, there was 96.0% (359 / 374) agreement between AIMS- and ESRS-defined TD cases. The ESRS Clinical Global Impressions of severity of dyskinesia (CGI-SD) best predicted AIMS-defined TD. An ESRS CGI-SD ≥ 4 (95% CI: 3.61, 4.76) was associated with ≥ 95% probability of AIMS-defined TD.

High concordance between the scales for dyskinesia scores was found. Findings suggest that the ESRS CGI-SD score can serve as a simplified criterion for identifying AIMS-defined TD, and may be a useful tool for future research-based TD analyses, when occurring in the context of a full movement disorder assessment.

Introduction

Drug-induced movement disorders (DIMD) are a group of diverse neurologic motor disturbances associated with the use of central nervous system active agents (Chouinard, 2004). They may be reversible, occurring shortly after exposure to drug (e.g., acute dystonic reactions). They also may be classified as persistent, chronic, or tardive: appearing after a variable length of time but resolving upon drug discontinuation (e.g., tremor, chorea, myoclonus, drug-induced parkinsonism, akathisia), or appearing during long-term drug exposure and sometimes persisting after its discontinuation (e.g., tardive dyskinesia, tardive dystonia) (Chouinard, 2004). Classes of drugs associated with DIMD include antipsychotics, antidepressants, antiepileptics, antihistaminics, gastrointestinal medications, antiemetics, central anticholinergics, dopamine agonists, and mood stabilizers.

DIMD, particularly tardive dyskinesia (TD), have been extensively studied since the 1950s, when they first were described in association with conventional antipsychotics (Sethi, 2001). TD, which is a serious concern associated with antipsychotic treatment, comprises abnormal, persistent, repetitive, purposeless involuntary movements occurring in patients currently or previously receiving chronic antipsychotic (dopamine receptor–blocking) treatment (Sethi, 2001). Many researchers have studied the risk of TD with the use of conventional antipsychotics. For example, Chouinard et al., 1979, Chouinard et al., 1988, using Schooler and Kane (1982) criteria, examined the prevalence and incidence of TD in a population of outpatients with schizophrenia treated with conventional antipsychotics. They found a 5-year cumulative incidence of TD of 35% and a mean annual incidence, corrected for remissions, of approximately 3%. Jeste and Caligiuri (1993) reported similar rates among younger adults treated with conventional antipsychotics, with an annual cumulative incidence of TD of 4–5%. In middle-aged and elderly patients, the cumulative annual incidence of TD was 29% (Jeste et al., 1999c).

It is generally accepted that atypical antipsychotics are associated with a lower risk of TD compared with conventional agents, a key factor in the widespread use of atypical agents (Kane, 2004). In studies of patients with schizophrenia, reports of persistent TD suggest incidence of ∼1% with olanzapine (Tollefson et al., 1997, Beasley et al., 1999). In older psychotic patients (mean age, 66 years), Jeste et al. (1999b) reported an approximately 8-fold lower cumulative incidence of emergent TD with risperidone than with haloperidol. In a high-risk patient population of older patients with dementia (mean age, 82.5 years), Jeste et al. (2000) reported a 2.6% cumulative incidence of newly emergent TD, evaluated by the Extrapyramidal Symptom Rating Scale (ESRS), with 1 year of risperidone treatment. Similarly, the cumulative incidence of TD with 1 year of quetiapine treatment in older psychotic patients (mean age, 76.7 years) was 2.7%, evaluated by the Abnormal Involuntary Movement Scale (AIMS) (Jeste et al., 1999a). Long-acting, injectable risperidone treatment over 1 year in patients with schizophrenia or schizoaffective disorder was associated with a 0.68% cumulative incidence of emergent TD, evaluated by the ESRS (Chouinard et al., 2003). Finally, a recent systematic review of 1-year studies with atypical antipsychotics supported the concept that atypical agents are associated with a reduced risk of TD. In the 11 studies included in the meta-analysis (six used AIMS, and five used ESRS), the weighted mean annual incidence was 0.8% with atypical antipsychotics and 5.4% with haloperidol (Correll et al., 2004).

Several limitations and variables are encountered in the assessment of TD associated with antipsychotics. These include differences in study design (prospective vs. retrospective), available baseline information (presence of baseline TD, history of antipsychotic drug use and duration, and polypharmacy), duration of study periods, and varying patient populations (patient characteristics and risk factors such as age, sex, and diagnosis) (Chouinard, 2004). Furthermore, although several reports have applied research criteria for TD, different criteria have been used for both severity and duration of dyskinetic symptoms (Tollefson et al., 1997, Beasley et al., 1999, Jeste et al., 1999b, Jeste et al., 1999c, Glazer, 2000, Jeste et al., 2000). Additionally, these criteria (Schooler and Kane, 1982, Morgenstern and Glazer, 1993, Diagnostic and Statistical Manual of Mental Disorders, 2000) generally are based on ratings from either AIMS (Guy, 1976) or ESRS (Chouinard et al., 1980). Cross-scale comparisons between these rating scales have not been performed, further complicating meaningful comparisons and conclusions regarding the published TD literature.

The objectives of the current study were to explore the relationship between the AIMS and ESRS dyskinesia ratings, to determine the concordance between the ratings on these scales for identifying patients with dyskinetic symptoms, and to identify simplified criteria for TD. This analysis used AIMS and ESRS dyskinesia ratings from the baseline assessment of patients with schizophrenia or schizoaffective disorder who participated in two studies. In this cross-sectional analysis, the persistence of dyskinesia was not assessed. For the purpose of this report, the term TD will be used to identify patients who meet the criteria for TD as defined at the baseline visit, with the understanding that this may be more appropriately defined as “probable TD,” since other criteria are required to diagnose drug-induced TD (i.e., duration of dyskinesia, prior antipsychotic treatment, onset of dyskinesia, etc) (Schooler and Kane, 1982, Diagnostic and Statistical Manual of Mental Disorders, 2000).

Section snippets

Analysis populations

Patients were enrolled in the two studies between May 2002 and September 2003. Included patients were male or female patients aged 18–70 years with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Patients were medically stable, and judged to be symptomatically stable for at least 2 months prior to baseline and taking stable doses of antipsychotic medication. Patients were excluded if they were pregnant or nursing, were currently hospitalized for psychiatric treatment or had

Patients

Relevant scale ratings were available for 374 patients. Demographic characteristics are presented in Table 3, which also provides data stratified by ESRS- and AIMS-defined TD. Overall, the mean ± standard deviation age was 40.9 ± 11.5 years; 63.6% were male, and 46.5% were Caucasian, with a mean ± SD duration of illness of 15.4 ± 10.8 years. Sixty-nine percent and 64.2% of patients had baseline scores of 0 on the ESRS dyskinesia (E51–E57) and AIMS total (1–7), respectively. By both the AIMS and ESRS,

Discussion

A significant variable among the different TD criteria in the literature is the use of different ratings to assess severity of dyskinesia. This analysis provides a cross-scale comparison of the AIMS and ESRS dyskinesia ratings from baseline data collected in patients with schizophrenia or schizoaffective disorder. Descriptive analyses suggested a significant relationship between AIMS and ESRS dyskinesia scores. Using transformed values, the scales showed a high level of agreement for

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