The St. Hans Rating Scale for extrapyramidal syndromes: reliability and validity

Gerlach, Jes; Korsgaard, Søren; Clemmesen, P.; Lauersen, A.-M. Lund; Magelund, G.; Noring, U; Povlsen, Uffe Juul; Bech, Per; Casey, Dympna

doi:10.1111/j.1600-0447.1993.tb03366.x

Cited by 143 publications

(91 citation statements)

References 20 publications

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“…What are the most appropriate measures of TD for trials? The AIMS and St Hans Rating scale have been validated [112,113], but others have also been utilized [91]. Will patients remaining on neuroleptics respond differently to those who can come off them?…”

Section: Resultsmentioning

confidence: 99%

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

2014

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Tardive dyskinesia (TD) is a serious, often disabling, movement disorder that is caused by medications that block dopamine receptors (i.e., neuroleptics, anti-emetics). There is currently no standard treatment approach for physicians confronted with such patients. This may be the result of notions that TD is disappearing because of the switch to secondgeneration antipsychotic agents and that it is largely reversible.In this article we demonstrate that second-generation antipsychotics do, indeed, cause TD and, in fact, the frequency is likely higher than expected because of growing off-label uses and a tripling of prescriptions written in the last 10 years. In addition, studies demonstrate that TD actually remits in only a minority of patients when these drugs are withdrawn. Furthermore, neuroleptic agents are often utilized to treat TD, despite prolonged exposure being a risk factor for irreversibility. The outcome of these trends is a growing population afflicted with TD. We review non-neuroleptic agents that have shown positive results in small, early-phase, blinded trials, including tetrabenazine, amantadine, levetiracetam, piracetam, clonazepam, propranolol, vitamin B6, and Ginkgo biloba. Other options, such as botulinum toxin and deep brain stimulation, will also be discussed, and a suggested treatment algorithm is provided. While these agents are reasonable treatment options at this time there is a need, with a concerted effort between neurology and psychiatry, for full-scale drug development, including multicenter, randomized, blinded trials to confirm the effectiveness of the agents that were positive in phase 2 trials and the development of newer ones.

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Section: Resultsmentioning

confidence: 99%

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

2014

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“…Data were collected at baseline (between four weeks before and one week after randomization) and after 0.5, 1, 1.5, 2, 3, 6, 9, and 12 months. Assessments included data on demographics, diagnosis, psychopathology [PANSS (Kay et al 1986), CGI (Guy 1976), CDSS (Addington et al 1990)], side effects [St Hans rating scale; SHRS (Gerlach et al 1993), UKU-sexual dysfunctions (Scandinavian Society of Psychopharmacology 1987)], quality of life [MANSA (Priebe et al 1999)], compliance (CRS; Kemp & Hayward 1996), and attitude toward drugs (DAI; Hogan et al 1983). …”

Section: Study Setting Patients and Designmentioning

confidence: 99%

Drug attitude as predictor for effectiveness in first-episode schizophrenia: Results of an open randomized trial (EUFEST)

Gäebel

Riesbeck

Wilmsdorff

et al. 2010

European Neuropsychopharmacology

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“…The extrapyramidal symptom rating scale (ESRS) (Chouinard et al, 1980) and St Hans rating scale (Gerlach et al, 1993) are both designed to assess a range of EPS including parkinsonism, akathisia, dystonia and tardive dyskinesia or hyperkinesia. The ESRS was used in three trials and the St Hans rating scale in one trial.…”

Section: Assessment and Reporting Of Epsmentioning

confidence: 99%

Antipsychotic drugs and extrapyramidal side effects in first episode psychosis: a systematic review of head–head comparisons

et al. 2011

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This systematic review aimed to determine whether the risk of extrapyramidal side effects (EPS) differed between antipsychotic drugs used in first episode psychosis (FEP). We identified 11 RCTs comparing two or more antipsychotics in FEP and reporting on EPS. All trials assessed one or more second generation antipsychotics (SGAs), one assessed chlorpromazine, one zuclopenthixol and seven trials assessed haloperidol. Assessment and reporting of EPS varied. Compared with one or more SGA comparators, haloperidol was associated with significantly higher rates/severity of parkinsonism (seven trials) and akathisia (six trials) and greater use of anticholinergics (five trials) and beta-blockers (two trials). Two trials with low-dose haloperidol (≤ 4 mg) showed significantly worse EPS outcomes versus a SGA. Two of four long-term haloperidol trials (≥ 1 year) found a higher dyskinesia-risk with haloperidol versus olanzapine and risperidone respectively; the remaining two trials found no difference (various SGA comparators). There was an EPS advantage for clozapine versus chlorpromazine (one trial) and risperidone versus zuclopenthixol (one trial). There was little evidence of EPS-differences between SGAs, possibly reflecting use of low doses. We conclude that SGAs offer an EPS advantage over FGAs in FEP though the evidence largely relates to comparisons with haloperidol. Standardized assessment and reporting of EPS would assist future research. Keywords Method Search strategyWe conducted a PubMed search, with no starting date limit, up to April 2011 using terms 'first episode schizophrenia' and 'antipsychotic' with limits specified as 'Humans, Randomized Controlled Trial and English'. The abstracts of all papers were reviewed to determine whether they met inclusion/exclusion criteria and if there was doubt the full paper was examined. Additional studies, identified through the reference list of papers in the primary search or known to the authors, were reviewed to see if they met inclusion/exclusion criteria. Inclusion criteria1. RCT comparing two or more antipsychotic drugs. 2. Diagnosis of schizophrenia plus related disorders including schizophreniform disorder and schizoaffective disorder made according to standard criteria (any). 3. Patients explicitly described as 'first episode' by the authors. Although we did not define this further we recorded key criteria that the researchers employed to define this population, e.g. maximum age, maximum duration of illness and maximum cumulative antipsychotic treatment length. 4. EPS assessed using a standard rating scale. 5. Quantitative data on incidence or severity of EPS provided. 6. Paper published in English. Exclusion criteria1. Studies of a single antipsychotic. 2. Non-randomized studies. 3. Studies of early onset schizophrenia (i.e. samples largely composed of subjects < 18 years old). AnalysisKey data from the studies that met the inclusion/exclusion criteria were extracted. This included EPS ratings for parkinsonism, akathisia, dyskinesia and dystonia made us...

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The St. Hans Rating Scale for extrapyramidal syndromes: reliability and validity

Cited by 143 publications

References 20 publications

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

Tardive Dyskinesia: Therapeutic Options for an Increasingly Common Disorder

Drug attitude as predictor for effectiveness in first-episode schizophrenia: Results of an open randomized trial (EUFEST)

Antipsychotic drugs and extrapyramidal side effects in first episode psychosis: a systematic review of head–head comparisons

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