背景:抗精神病药相关的运动障碍仍然很常见且致残。由于临床异质性以及精神病医生和神经科医师对命名法的不同使用,他们的筛选和评估具有挑战性。
目的:一个国际帕金森和运动障碍协会小组委员会旨在评估严重程度的心理测量质量和抗精神病药物相关运动障碍的筛查工具。
方法:遵循国际帕金森与运动障碍协会先前小组委员会文件所采用的方法,抗精神病药相关运动障碍的仪器进行了综述,按照“建议”应用分类,\"\"建议与警告,\"\"建议,列出\"或\"。\"
结果:我们的审查确定了23种仪器。达到的最高推荐等级是“建议有警告,\“分配到七个严重程度评级仪器(锥体外系症状评定量表,BarnesAkathisia评定量表,异常非自愿运动量表,药物诱导的金字塔外症状量表,马里兰精神病学研究中心非自愿运动量表,辛普森·安格斯量表,和Matson药物副作用评估)。这七个中只有三个(药物诱导的锥体细胞外症状量表,马里兰精神病学研究中心,药物副作用的Matson评估)也是筛选工具。他们的主要警告是心理测量特性(内部一致性,偏斜,对变化的反应能力)和长期给药。由于心理测量验证不足,八种“建议”仪器不符合“建议”等级的要求。几种仪器共有的其他局限性是在评估抗精神病药相关运动障碍的范围方面缺乏全面性,并且术语含糊不清。
结论:大量的“建议与警告”仪器不支持需要开发抗精神病药相关运动障碍的新仪器。然而,建议下一步采取新的心理测量学研究来解决这些警告,并修改现有工具以提高其术语的清晰度。©2023国际帕金森和运动障碍协会。
Antipsychotic-associated movement disorders remain common and disabling. Their screening and assessment are challenging due to clinical heterogeneity and different use of nomenclature between psychiatrists and neurologists.
An International Parkinson and Movement Disorder Society subcommittee aimed to rate psychometric quality of severity and screening instruments for antipsychotic-associated movement disorders.
Following the methodology adopted by previous International Parkinson and Movement Disorders Society subcommittee papers, instruments for antipsychotic-associated movement disorders were reviewed, applying a classification as \"recommended,\" \"recommended with caveats,\" \"suggested,\" or \"listed.\"
Our
review identified 23 instruments. The highest grade of recommendation reached is \"recommended with caveats,\" assigned to seven severity rating instruments (Extrapyramidal Symptoms Rating Scale, Barnes Akathisia Rating Scale, Abnormal Involuntary Movements Scale, Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre involuntary movements scale, Simpson Angus Scale, and Matson Evaluation of Drug Side effects). Only three of these seven (Drug-Induced Extra-Pyramidal Symptoms Scale, Maryland Psychiatric Research Centre, Matson Evaluation of Drug Side effects) were also screening instruments. Their main caveats are insufficient demonstration of psychometric properties (internal consistency, skewing, responsiveness to change) and long duration of administration. Eight \"suggested\" instruments did not meet requirements for the \"recommended\" grade also because of insufficient psychometric validation. Other limitations shared by several instruments are lack of comprehensiveness in assessing the spectrum of antipsychotic-associated movement disorders and ambiguous nomenclature.
The high number of instruments \"recommended with caveats\" does not support the need for developing new instruments for antipsychotic-associated movement disorders. However, addressing the caveats with new psychometric studies and revising existing instruments to improve the clarity of their nomenclature are recommended next steps. © 2023 International Parkinson and Movement Disorder Society.