The AIMS Abnormal Involuntary Movement Scale aids in the early detection of tardive dyskinesia as well as providing a method for on-going surveillance. Although the incidence of TD has been relatively low in recent years, changes in prescribing may result in increased occurrence. Clinicians will need to be alert to these possibilities and employ tools that will help them pick up developing problems as soon as possible.
This simple checklist takes only 10 minutes to complete and uses a 5-point rating scale for recording scores for 7 body areas: face, lips, jaw, tongue, upper extremities, lower extremities, and trunk. An instructional video has been created to show how to conduct the AIMS examination and how to score the findings.
Next, the patient is observed for any movements while sitting in the chair with feet flat on the floor, knees separated slightly with the hands on the knees. The patient is asked to open his or her mouth and stick out the tongue twice while the rater watches.
The patient is then asked to tap his or her thumb with each finger very rapidly for 10—15 seconds, the right hand first and then the left hand. Again the rater observes the patient's face and legs for any abnormal movements. After the face and hands have been tested, the patient is then asked to flex bend and extend one arm at a time.
The patient is then asked to stand up so that the rater can observe the entire body for movements. Next, the patient is asked to extend both arms in front of the body with the palms facing downward. The trunk, legs and mouth are again observed for signs of TD. The patient then walks a few paces, while his or her gait and hands are observed by the rater twice.
The total score on the AIMS test is not reported to the patient. A rating of 2 or higher on the AIMS scale, however, is evidence of tardive dyskinesia. If the patient has mild TD in two areas or moderate movements in one area, then he or she should be given a diagnosis of TD. The AIMS test is considered extremely reliable when it is given by experienced raters. If the patient's score on the AIMS test suggests the diagnosis of TD, the clinician must consider whether the patient still needs to be on an antipsychotic medication.
This question should be discussed with the patient and his or her family. If the patient requires ongoing treatment with antipsychotic drugs, the dose can often be lowered. A lower dosage should result in a lower level of TD symptoms.
Another option is to place the patient on a trial dosage of clozapine Clozaril , a newer antipsychotic medication that has fewer side effects than the older neuroleptics. See also Medication-induced movement disorders ; Schizophrenia. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Save my name, email, and website in this browser for the next time I comment.
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