Attachment, Size. PDF icon ESRSA v1 Long Form CRF , KB. PDF icon SDTM CC-ESRSA v1 , KB. V. January 6. Abnormal Involuntary Movement Scale (AIMS) and Extrapyramidal Symptom Rating Scale (ESRS): cross-scale comparison in assessing tardive dyskinesia. rESulTS: Several different types of extrapyramidal symptoms can be .. The Extrapyramidal Symptom Rating Scale (ESRS) (5) was developed to assess four .

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Skip to main content. Log In Sign Up. Cross-scale comparison in assessing tardive dyskinesia. Schizophrenia Research 77 — www. Cross-scale comparison in assessing tardive dyskinesia Georges M. Linear and logistic regression models explored relationships between extrapyramixal ratings and mapped scores for corresponding items. TD was defined as at least mild in z 2 anatomical areas, or moderate or greater symptoms in z 1 area at baseline.

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There was a strong association on corresponding item ratings. Using these criteria, there was High concordance between the scales for dyskinesia scores was found. D Elsevier B. In older psychotic patients mean age, 66 associated with the use of central nervous system yearsJeste et al.

They may be mately 8-fold lower cumulative incidence of emer- reversible, occurring shortly after exposure to drug gent TD with risperidone than with haloperidol. They also may be high-risk patient population of older patients with classified as persistent, chronic, or tardive: Similarly, the cumulative sometimes persisting after its discontinuation e.

Classes of drugs associated with DIMD was 2. Finally, a first were described in association with conventional recent systematic review of 1-year studies with antipsychotics Sethi, TD, which is a serious atypical antipsychotics supported the concept that concern associated with antipsychotic treatment, atypical agents are associated with a reduced risk of comprises sympgom, persistent, repetitive, purposeless TD.

In the 11 studies included in the meta-analysis involuntary movements occurring in patients currently six used AIMS, and five ears ESRSthe weighted or previously receiving chronic antipsychotic dop- mean annual incidence was 0.

For example, Several limitations and variables are encountered Chouinard and colleagues, using in the assessment of TD associated with antipsy- Schooler and Kane criteria, examined the chotics. These include differences in study design prevalence and incidence of TD in a population of prospective vs.

Jeste patient populations patient characteristics and risk and Caligiuri reported similar rates among factors such as age, sex, and diagnosis Chouinard, younger adults treated with conventional antipsy- The AIMS contains seven ESRS dyskinesia ratings, to determine the concord- relevant items, rated on a severity scale of 0—4, ance between the ratings on these scales for which assess abnormal movements in various identifying patients with dyskinetic symptoms, and anatomical locations Table 1including facial to identify simplified criteria for TD.

This analysis and oral, extremity, and truncal movements.

Manual for the Extrapyramidal Symptom Rating Scale (ESRS).

In this cross-sectional analysis, the persis- abnormal movementsalso rated on a scale of 0—4 tence of dyskinesia was not assessed. For the Guy, The ESRS is a more comprehensive purpose of this report, the term TD will be used movement-disorder rating scale and rates symptoms to identify patients who meet the criteria for TD as based on severity and frequency, on a scale of 0—6.

Methods severe Chouinard et al. Analysis scwle Patients were enrolled in the two studies between Table 1 May and September Rater training movementsQ item E51is scored on a scale of 0 none to 6 constant or almost constant complete The same rater performed both the AIMS and protrusion. Raters were trained on both scales by movement-disorder experts at a multi- 2. All patients for raters and to monitor inter-rater reliability. Missing data were not imputed. The scale Table 1 as mild symptoms in dating or more overall F test was used to test that the slope p 0, R 2 anatomical areas two or more scale itemsor provided information on the proportion of variance moderate or greater symptoms in one or more accounted for by the linear relationship with the anatomical areas sers or more scale items independent variable generally, R 2 will be small if Schooler and Kane, ; DSM-IV-TR, Q It should be noted that indicated the degree of association.

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Multiple and other criteria, such as persistence of symptoms, simple logistic regression were used to identify consideration of prior treatments, and onset of demographic characteristics associated with the symptoms, would be required to identify drug- presence of AIMS- or ESRS-defined TD. Such assessments were beyond the gender, race, diagnosis, age at illness onset, number scope of this report. Race was reduced to 2. These scales have scores. In the transformed linear regression models, different rating structures Table 2.

For example, the dependent variables were not transformed; the AIMS item bTongueQ item 4 evaluates involuntary independent variables were transformed by mono- lingual movement on a scale of tating none to 4 tonically scoring the ordered categories so that severe.

Dyskinetic movements Score Occasionala Frequentb Constant or almost so Lingual movements; slow lateral 5 None 0 or torsion movement of tongue Borderline 1 Clearly present within 2 3 4 oral cavity With occasional protrusion 3 4 5 With complete protrusion 4 5 6 a When activated or rarely spontaneous.

Patients bmappingQ was obtained by rounding predicted values to the nearest integer. The GEE logistic Relevant scale ratings were available for patients. Overall, the mean Fstandard deviation SD age was cumulative logit link function, with an independent A bmappingQ was Caucasian, with a mean F SD duration of ratlng of obtained by matching each value of the independ- Sixty-nine percent and Concordance and AIMS scxle 1—7respectively.

Strength of association between ESRS and AIMS scores A bubble plot overlaid with a logistic regression plot was used to graphically map the predicted Linear regression provided a descriptive analysis of the strength of the association of scores exttrapyramidal the two scales. Table 4 reports that represented by a circle whose area is proportional to scle overall F test was significant at the 0. The logistic regression models, with R 2 values ranging from 0. The estimated logistic curve is plotted ments E54 ,Q to 0.

ESRS item bbuccolabial movements E Chi-square tests for sex, race, Axis-I diagnosis; t-tests for AIMS Non-global total, ESRS dyskinetic movements, age, age at onset of primary diagnosis, duration of illness, number of hospitalizations extrapydamidal onset, and time since last hospitalization.

Q Table 4 Linear regression: Transformed linear regression and GEE ordinal logistic Table 7.

Manual for the Extrapyramidal Symptom Rating Scale (ESRS).

AIMS scores were the dependent variable, four of these patients Table 7. For ratings relevant to TD criteria, the mapping of corresponding 3. Table 3 shows a significant difference in age-related 3. Scale agreement in identifying cases of TD demographic factors and race between patients with vs. Regression analyses were AIMS-defined TD was defined as at least two scores of 2 mild or at least one score of z 3 moderate or greater on any individual item, items 1—7.

Only age was identified by both simple A significant variable among the different TD and multiple logistic regression as a significant risk factor criteria in the literature is the use of different ratings to for AIMS- or ESRS-defined TD. Cross- dyskinesia ratings from baseline data collected in tabulation of TD with age of patients shows that 9. Descriptive analyses suggested a significant baseline; 9. Using transformed values, the scales showed a A score of 4 is variables tested sex, race, diagnosis, number of hospital- defined as a moderate global impression of severity on izations since onset, age of onset, or time since last a scale of 0 absent to 8 extremely severe.


This hospitalization were not significant risk factors for TD by finding merits future study. Of note, 15 cases were identified for which there 3. Simplified research criteria for TD was some disparity in dyskinesia ratings between the scales Table 7. This item rates rating but not the ESRS rating. This may in part the severity of dyskinesia from 0 absent to 8 extremely reflect the fact that AIMS may detect dystonia as well severe.

This observation is consistent Furthermore, of all ESRS items, it had the greatest number with other published data. In a study that tested the of concordant pairs AIMS scores and both the dystonia and dyskinesia Fig. The area of each bubble is proportional to the number of observations. It provided evidence of high interscale detection of tardive dystonic symptoms, the high agreement for these two commonly used rating scales concordance between scales for the dyskinesia results for dyskinesia.

It further suggested simplified criteria strongly suggests that this did not have a substantial for the severity of dyskinetic symptoms such that a impact on the results. However, the ESRS, with its 7- References point rating system, permits greater flexibility in scoring than the 5-point rating system used by the Beasley, C. Randomised terminology of the clinical presentation of dyskinesia, double-blind comparison of the incidence of tardive dyskinesia as opposed to the simpler terms of bmildQ or in patients with schizophrenia during long-term treatment with olanzapine or haloperidol.

Psychiatry23 — New nomenclature for drug-induced move- Overall the dyskinesia severity scores were low in ment disorders including tardive dyskinesia. Psychiatry this population, possibly limiting the generalizability 65 Suppl.

However, with the wider use of better- Factors related to tardive dyskinesia. Psychiatry79 — Extrapyramidal Symptom Rating Scale. Consistent with previous reports in other A 5-year prospective longitudinal study of tardive dyskinesia: Psycho- populations, the regression analyses identified age as a pharmacol. Lower risk for tardive in this population have TD as defined in this study dyskinesia associated with second-generation antipsychotics: This was a systematic review of 1-year studies.

Psychiatrycross-sectional assessment of TD prevalence that — As described in Methods, the term Glazer, W. Extrapyramidal side effects, tardive dyski- TD was used in this report to refer only to the severity nesia, and the concept of atypicality.

Psychiatry 61, of dyskinetic symptoms at a single time point, and 16 — The present results are relevant to address a Jeste, D. Rarity of tardive dyskinesia with quetiapine treatment of M. The schedule for the Assessment of psychotic disorders in the elderly.

Acapulco, Mexico, December 12— Identifying risk factors for Caligiuri, M.