Tardive Dyskinesia Quiz: Scales, Syndromes, and Spontaneity

Question 1 (Answer and question 2 on the next page)

All of the following are rating scales for the assessment of tardive dyskinesia, EXCEPT:

A. AIMS

B. DISCUS

C. ESRS

D. RBANS

The correct answer is D.

The Abnormal Involuntary Movement Scale (AIMS) is an observer-rated scale that takes approximately 5 to 10 minutes to administer. Each item is scored 0-4, where 0=none, 1=minimal, 2=mild, 3=moderate, and 4=severe. The Dyskinesia Identification System: Condensed User Scale (DISCUS) is another standardized rating scale for tardive dyskinesia (TD). The Extrapyramidal Symptom Rating Scale (ESRS) was developed to assess TD and other drug-induced movement disorders.^1,2 By contrast, the RBANS is the Repeatable Battery for the Assessment of Neuropsychological Status.³

Question 2 (Answer and question 3 on the next page)

The prevalence of spontaneous dyskinesias in patients with first-episode psychosis is approximately:

A. 4-9%

B. 14-19%

C. 24-29%

D. 34-39%

The correct answer is A.

Spontaneous dyskinesias (SDs)-indistinguishable from TD-are abnormal involuntary movements that are important to consider in a differential diagnosis, especially in antipsychotic-naïve patients. A pooled analysis of 14 studies found a 4% prevalence of SDs in first-episode schizophrenia.4 Another systematic review of 13 studies found a 9% prevalence of SDs in first-episode psychosis.⁵ These findings suggest that in order to find the true prevalence of antipsychotic-induced TD in patients with schizophrenia, it is necessary to subtract the (estimated) frequency of SDs in the study population.

Question 3 (Answer on the next page)

Tardive syndromes, other movement disorders that can resemble TD, include which of the following

A. Tardive akathisia

B. Tardive dystonia

C. Tardive Tourettism

D. Tardive tremor

E. All of the above

The correct answer isE.

Tardive syndromes include a broad spectrum of abnormal movements, besides TD, due to chronic exposure to dopamine receptor blocking agents. In addition to tardive akathisia, dystonia, Tourettism, and tremor, tardive myoclonus and stereotypy are also recognized as part of this syndrome.6 Multiple tardive phenomenologies may occur simultaneously in the same patient.

This quiz was originally published on November 6, 2017 and has since been updated. -Ed

References:

1. Guy W. ECDEU assessment manual for psychopharmacology: revised. DHEW Publication No. ADM 76-338. Rockville, MD: US Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976: 534-537.
2. Chouinard G, Ross-Chouinard A, Annable L, Jones B. The extrapyramidal symptom rating scale. Can J Neurol Sci. 1980;7(3):233.
3. Kalachnik JE, Sprague RL. The dyskinesia Identification System Condensed User Scale (DISCUS): reliability, validity, and a total score cut-off for mentally ill and mentally retarded populations. J Clin Psychol. 1993;49(2):177-189.
4. Fenton WS. Prevalence of spontaneous dyskinesia in schizophrenia. J Clin Psychiatry. 2000;61(Suppl 4):10-14.
5. Pappa S, Dazzan P. Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review. Psychol Med. 2009;39:1065-1076.
6. Aquino CCH, Lang AE. Tardive dyskinesia sydnromes: current concepts. Parkinsonism and Realted Disorders. 2014;20S1:S113-S117.