Abnormal Involuntary Movement Scale (AIMS) – NRNP 6635 Discussion

Abnormal Involuntary Movement Scale (AIMS) – NRNP 6635 Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

To Prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.
By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Initial post, Abnormal Involuntary Movement Scale
The tool I was assigned to elaborate on was the Abnormal Involuntary Movement Scale. The AIMS tool is used to detect Tardive Dyskensia in patients receiving neuroleptic medications. “Tardive dyskinesia is a movement disorder characterized by irregular, stereotyped, and choreiform movements associated with the use of antipsychotic medication (Ricciardi, 2019).”

The AIMS tool measures the presence, severity, and changes in TD.  Medications associated with TD are normal given for schizophrenia and similar mental disorders these are known as antipsychotic drugs. Antidepressants can also cause TD, but studies show this is less prevalent in these types of medications. Since antipsychotic and antidepressants are used frequently in psychiatric care, it is important to pay attention and be aware of the signs and symptoms of TD. This is done by using the AIMS tool (Lepping, 2011).

Not only is assessing patients with AIMS for TD important when they are medicated, but interview tools, are extremely vital for the patient treatment plan. One of the most important areas to investigate is the patient’s psychiatric history, including chief complaint, history of present illness, family history, and past history. Family history is a vital concept because of the common genetic factors found in mental disorders. “Scientists have long recognized that many psychiatric disorders tend to run in families, suggesting potential genetic roots. Such disorders include autism, attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depression and schizophrenia. Symptoms can overlap and so distinguishing among these 5 major psychiatric syndromes can be difficult. Their shared symptoms suggest they may also share similarities at the biological level. In fact, recent studies have turned up limited evidence of shared genetic risk factors, such as for schizophrenia and bipolar disorder, autism and schizophrenia, and depression and bipolar disorder (Lancet, 2013).”

Another valuable piece of the psychiatric interview is the role and activity of the interviewer. “In the structured approach, the interviewer must faithfully ask in a pre-determined sequence, a series of closed pre-defined questions, corresponding to the diagnostic criteria. To maintain the purity of the quasi-experimental framework, it is crucial to minimize variance in the interviewer’s performance and, especially, to quash any potential tendency to inference and interpretation or any tendency for the patient to veer from the initial question (Nordgaard, 2013.”

Suicidal intent is a question that should be addressed by any interviewer in any health care situation. “Because of the frequency of depressive disorders and their association with suicide, it always is necessary to address the possibility of suicidal intent in a first interview. Asking about suicide will not provoke the act. Such discussion may need to be extended until it is clear whether the patient may safely leave or needs hospital admission (Waldinger).”

Ricciardi, L., Pringsheim, T., Barnes, T., Martino, D., Gardner, D., Remington, G., Addington, D., Morgante, F., Poole, N., Carson, A., & Edwards, M. (2019). Treatment Recommendations for Tardive Dyskinesia. Canadian journal of psychiatry. Revue canadienne de psychiatrie64(6), 388–399. https://doi.org/10.1177/0706743719828968

Lepping. P., Antipsychotic medication and oxidative cell stress: a systematic review. J Clin Psychiatry. 2011 3; 72 3: 273- 285. doi: 10.4088/JCP.09r05268yel. pmid:20673558

CrossRefPubMedGoogle Scholar

Lancet. 2013 Feb 27. pii: S0140-6736(12)62129-1. doi: 10.1016/S0140-6736(12)62129-1. [Epub ahead of print]. PMID: 23453885

Waldinger, R., Brown University. Retrieved from www.brown.edu/Courses/BI_278/Other/Clerkship

Nordgaard, J., Sass, L. A., & Parnas, J. (2013). The psychiatric interview: validity, structure, and subjectivity. European archives of psychiatry and clinical neuroscience263(4), 353–364. https://doi.org/10.1007/s00406-012-0366-z


Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

Abnormal Involuntary Movement Scale (AIMS) post
Antipsychotic medications are a central part of the treatment process for those with schizophrenia and other mental health conditions, including depression and bipolar disorder. As a result, the potential for an antipsychotic to contribute to the development of tardive dyskinesia continues to be a clinical concern (CPNA, 2020). Adverse events such as drug induced movement disorders play an important role in treatment considerations when quality of life and medication adherence must be considered (CPNA, 2020). Tardive dyskinesia (TD) has long been thought to be a generally irreversible consequence of the use of dopamine receptor blocking agents.

 

In general, psychiatric assessment tools serve as a tool to determine the severity of an illness and to more effectively use medications. Abnormal Involuntary Movement Scale (AIMS) can be utilized in practice to better assess patients for tardive dyskinesia and learn more about tardive dyskinesia. The AIMS is a 12-item clinician-rated scale to assess severity of dyskinesia (specifically, orofacial movements and extremity and truncal movements) in patients taking antipsychotic and neuroleptic medications. Tardive dyskinesia is considered a late form of extrapyramidal symptoms. Jiajun and colleagues (2019) consider the occurrence of EPS being associated with poor treatment outcome of schizophrenia. Analysis shows that antipsychotics with high D2 receptor antagonistic effect and illness duration are the risk factors of EPS for individuals who suffer from schizophrenia (Jiajun et al., 2019). As a PMHNP, offering quality care is being able to assess the effectiveness and tolerability of medication using movement disorder assessment tools to help identify both the presence and severity of movements. Once the severity of tardive dyskinesia is determined, providers can consider alternative medication regimen in order to slow the process, thus improving a patient’s quality of life.

 

Citrome, L. (2017). Clinical management of tardive dyskinesia: Five steps to success. Journal of

the Neurological Sciences383, 199–204. https://doi-            org.ezp.waldenulibrary.org/10.1016/j.jns.2017.11.019

 

College of Psychiatric & Neurologic Pharmacists. (2020). The AIMS Assessment and Tardive

Dyskinesia. Retrieved from https://cpnp.org/aims

 

Jiajun Weng, Yan Zhang, Huafang Li, Yifeng Shen, & Wenjuan Yu. (2019). Study on risk

factors of extrapyramidal symptoms induced by antipsychotics and its correlation with symptoms of schizophrenia. Shanghai Archives of Psychiatry32(1), 14–21. https://doi-org.ezp.waldenulibrary.org/10.1136/gpsych-2018-100026

 

 

Responses

Thanks for your post!

When comparing the Hamilton Anxiety Rating Scale (HAM-A) to the Abnormal Involuntary Movement Scale (AIMS), the differences are most apparent. Though they are both designed to illustrate the severity of symptoms, and not necessarily to diagnose a problem, that is where the similarity ends. The HAM-A looks at symptoms of anxiety, which can be a generalized condition or a co-occurring issue that overlaps heavily with symptoms of other psychiatric conditions, such as major depression or obsessive-compulsive disorder (Hamilton, n.d.). In contrast, the AIMS scale is largely targeted at tardive dyskinesia, which is a psychiatric medication induced movement disorder. Because many dopamine blocking agents can result in involuntary movements, it is often the severity of these that determines whether the medication is continued (Montvilo, 2019). The AIMS score is compared to the benefits that client is experiencing from the medication to allow for an educated decision to be made.

References

Hamilton, M. (n.d.). Hamilton anxiety rating scale (HAM-A). Br J Med Psychol 1959; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

Montvilo, R. K. P. D. (2019). Tardive dyskinesia. Salem Press Encyclopedia of Health. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ers&AN=97176629&site=eds-live&scope=site

 

Abnormal Involuntary Movement Scale (AIMS)
Good afternoon Anthony and thank you for your insight into the Abnormal Involuntary Movement Scale (AIMS).  I work with our electronic medical record (EMR) for the documentation of all Behavioral Health within our system.  One assessment tool that we just updated was the AIMS assessment.  Have you ever used this assessment tool?  There are two parallel procedures, the examination procedure, which tells the patient what to do, and the scoring procedure, which tells the clinician how to rate what he or she observes (Sadock, Sadock, & Ruiz, 2015).  As you mentioned, there are 12 assessment items, Items are scored on a 0 (none) to 4 (severe) basis; the scale provides a total score (items 1 through 7) or item 8 can be used in isolation as an indication of overall severity of symptoms.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

 

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