Sometimes drug-induced movement disorders occur acutely.

1 day ago

Kristie Healy

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Simpson-Angus Extrapyramidal Symptom Rating Scale

Among patients treated with antipsychotics, it is estimated that approximately 20% – 25% have primary negative symptoms that are sever enough to warrant clinical attention. Reported prevalence for neuroleptic-induced parkinsonism (NIP) in schizophrenia patients are usually in the range 19% to 36% ((Farreny, Savill, & Priebe, 2018). The Simpson-Angus Extrapyramidal Rating Scale (SAS) is an old and well known tool used to evaluate adverse effects from antipsychotic medication. This scale has 10 items to measure extrapyramidal side-effects rated from 0 to 4. It consists of one item measuring gait (hypokinesia), six items measuring rigidity and three items measuring glabella tap, tremor, and salivation (Janno, Holi, Tuisku, & Wahlbeck, 2015). The higher the score, the greater severity.

It should be pointed out, those patients being treated with second-generation antipsychotics such as Zyprexa, Risperdal and Seroquel have been shown to have less extrapyramidal side-effects. The SAS does not measure efficacy of medications, rather it measures the possible negative side-effects of the medication. It is appropriate to use the SAS whenever a client begins treatment with an antipsychotic. Sometimes drug-induced movement disorders occur acutely. They may be dose dependent and they may also have a tardive character and augment upon a dose reduction (Van Strien, Keijers, Derijks, & Van Marum, 2015). When on an inpatient psychiatric unit, it is appropriate to evaluate the client for movement disorder symptoms on a daily basis. When being treated outpatient, the client should be educated about monitoring for movement disorder symptoms and reporting them promptly to their provider.

References

Farreny, A., Savill, M., & Priebe, S. (2018). Correspondence between negative symptoms and potential sources of secondary negative symptoms over time. European archives of psychiatry and clinical neuroscience, 268(6), 603–609. https://doi.org/10.1007/s00406-017-0813-y

Janno, S., Holi, M. M., Tuisku, K., & Wahlbeck, K. (2015). Validity of Simpson-Angus Scale (SAS) in a naturalistic schizophrenia population. BMC neurology, 5(1), 5. https://doi.org/10.1186/1471-2377-5-5

Van Strien, A. M., Keijsers, C. J., Derijks, H. J., & Van Marum, R. J. (2015). Rating scales to measure side effects of antipsychotic medication: A systematic review. Journal of psychopharmacology (Oxford, England), 29(8), 857–866. https://doi.org/10.1177/0269881115593893

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