This domain mainly consists of two parts—EPS and non-EPS adverse effects. As for the former, the combination of the AIMS (tardive involuntary movement), BARS (akathisia) and SAS (parkinsonism) appear to have been ‘a standard’. The ESRS has been much less commonly used although comprehensive, well presumably due to a lengthy process to complete. This topic has recently been reviewed in detail elsewhere.24 A major challenge here is how to interpret different scales with different item numbers as ‘an overall EPS burden’ within the subject in question. The drug-induced extrapyramidal symptoms scale: DIEPSS25 (nine items) might represent a useful alternative.
Non-motor adverse effects, including anticholinergic, metabolic, autonomic and sexual problems, have been usually described without the usage of the scales and sometimes reported in the table, for which standardization is warranted.26 Evaluations that depend on the spontaneous reports may result in underestimation. Although the UKU side effect rating scale has been occasionally used, it still lacks some crucial elements such as metabolic parameters, for which a significant impact in this population is noted27 and regular monitoring is recommended.28 This may be due to the fact that it was published before newer antipsychotic medications, which are relatively more problematic in terms of metabolic disturbances in general, have become widely available in the market.
An obvious difficulty for the scales with multiple items is an inherent non-comparability of the same total score for differently endorsed problems (e.g., the possibly non-uniform implication of moderate severity in metabolic versus sexual adverse effects) as well as validity and pragmatic usefulness in severity differentials (e.g., 0–3 (none, mild, moderate, and severe) versus more detailed 0–5 (none, equivocal, mild, moderate, marked and severe)).
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