Abnormal Involuntary Movement Scale (AIMS) and Extrapyramidal Symptom Rating Scale (ESRS): Cross-scale comparison in assessing tardive dyskinesia
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
References (21)
- et al.
Conventional vs. newer antipsychotics in elderly patients
Am. J. Geriatr. Psychiatry
(1999) - et al.
Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol
Br. J. Psychiatry
(1999) New nomenclature for drug-induced movement disorders including tardive dyskinesia
J. Clin. Psychiatry
(2004)- et al.
Factors related to tardive dyskinesia
Am. J. Psychiatry
(1979) - et al.
Extrapyramidal Symptom Rating Scale
Can. J. Neurol. Sci.
(1980) - et al.
A 5-year prospective longitudinal study of tardive dyskinesia: factors predicting appearance of new cases
J. Clin. Psychopharmacol.
(1988) - et al.
Does a long-acting atypical antipsychotic offer a low risk of tardive dyskinesia in patients with schizophrenia?
Biol. Psychiatry
(2003) - et al.
Lower risk for tardive dyskinesia associated with second-generation antipsychotics: a systematic review of 1-year studies
Am. J. Psychiatry
(2004) - Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revised (DSM-IV-TR), 2000. American Psychiatric...
Extrapyramidal side effects, tardive dyskinesia, and the concept of atypicality
J. Clin. Psychiatry
(2000)
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