PDF | Drug-induced Extrapyramidal Symptoms Scale (DIEPSS) is developed in the era of second-generation antipsychotics and is Download full-text PDF. 1. 45 item PDF | The Extrapyramidal Symptom Rating Scale (ESRS) was developed to assess four types of drug-induced movement Download full-text PDF. Scientific Reportsvolume 7, Article number: () | Download Citation The Serbian version of DIEPSS has high level of inter-rater and.

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trapyramidal Syndromes (St. Hans EPS),9) and the. Drug-Induced Extrapyramidal Symptoms Scale. (DIEPSS)10)], they are in general rather complicated. and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). .. Psychiatric Association () Diabnostic and Statistical Manual of. Items 1 - 8 Results: The two groups did not differ in terms of PANSS, DIEPSS, . scores, PANSS scores, DIEPSS, and antipsychotic dose in .. (PDF kb).

More recently, certain SGAs have been approved for use as maintenance monotherapy, including risperidone and aripiprazole oral or bi-weekly and monthly formulations Kishi et al. Oral therapy has traditionally been used for treatment of BP-I, but newer long-acting injectable LAI antipsychotic formulations may allow for better adherence rates, more consistent dosing, more regular contact between patients and their healthcare team, and improved patient outcomes Brissos et al.

Randomized controlled trials have demonstrated the efficacy of bi-weekly risperidone LAI as monotherapy and adjunctive therapy in delaying time to recurrence of mood episodes in patients with BP-I Macfadden et al. Clinically relevant weight gain and glucose metabolism-related adverse events AEs have been more frequently reported in patients receiving risperidone LAI versus placebo Quiroz et al.

Aripiprazole has also demonstrated a favorable metabolic side effect profile relative to other antipsychotic medications, which is important given that patients with BP-I exhibit increased risk for cardiometabolic disorders Correll et al.

This bears even greater clinical significance considering that patients are typically required to take the medication long term for maintenance therapy. It has been shown that antipsychotic medications further exacerbate the risk for several cardiovascular and metabolic conditions beyond those experienced inherently by patients with bipolar disorder Correll et al.

Therefore, implementing the use of LAI antipsychotic medication formulations, which can make lower doses clinically effective Kishi et al.

Methods Study overview This open-label, multicenter study ClinicalTrials. Unlike the patients rolling over from the lead-in study, de novo patients were not stabilized on AOM before the maintenance phase although they were required to be stable on oral aripiprazole to enter the study , and use of adjunct rescue medications was permitted. The protocol was approved by an institutional review board or independent ethics committee, as appropriate.

Schizophrenia Quality of Life Scale: validation of the Japanese version

Informed consent was obtained from all patients or their legal representatives as necessary. Safety was assessed by the frequency, severity, seriousness, and discontinuation of AOM due to treatment-emergent adverse events TEAEs. Efficacy was assessed by a the proportion of patients meeting stabilization criteria at the beginning of the maintenance phase who remained stable at the last visit; b mean changes from baseline in Young Mania Rating Scale YMRS Young et al.

Patients This study enrolled 2 cohorts of patients, defined as de novo or rollover.

Eligibility criteria for this study were generally similar to those of the lead-in study Calabrese et al. Additionally, there was no YMRS score criterion for entry into this open-label study. Rollover patients were derived from the lead-in double-blind, placebo-controlled randomized withdrawal trial as previously published Calabrese et al.

Patients were required to have completed the maintenance phase without recurrence to be eligible for this extension study. Because the final phase of the lead-in trial was randomized, patients entering the current study were from both the placebo and AOM maintenance arms, resulting in patients with different levels of AOM exposure before inclusion in the current study. However, all rollover patients had some level of AOM exposure owing to the to week AOM stabilization phase included as part of the lead-in trial protocol Calabrese et al.

Study design This trial had distinct protocols for de novo versus rollover patients. De novo patients entered the study at screening and then proceeded to oral conversion or oral stabilization, depending on their current antipsychotic treatment regimen.

Clinical trials

Because cross-titration and stabilization were completed as part of the lead-in trial, rollover patients entered this study directly at the AOM maintenance phase Calabrese et al. Importantly, only those patients completing the lead-in study through the full week maintenance phase without recurrence of a mood episode were eligible for participation in the current study.

Use of rescue medications was permitted if a patient became unstable. Safety data were summarized using descriptive statistics for the open-label AOM maintenance phase. A TEAE was defined as an AE that emerged after the start of treatment or an AE that continued from baseline of one phase and became serious; was drug related; or resulted in death, discontinuation, interruption, or reduction of dosing during the subsequent phase.

Standard safety measurements, including clinical laboratory tests including serum prolactin concentrations , vital signs, electrocardiogram ECG , body weight, and general physical examination, were recorded.

Central laboratories designated by the sponsor were used for all laboratory testing and ECG review. Nowadays, it is widely used for evaluation of drug-induced extrapyramidal symptoms, as well as the relationship between personal and social functioning It consists of eight individual items and one global domain 12 , 14 , 16 , each rated on 5-point scale While some multi-domain scales could be difficult to score, the DIEPSS scale belongs to group with the most valid, reliable, and easy-to-use scales for use in clinical practice Moreover, this scale has good psychometric characteristics The use of first generation antipsychotics FGA has declined in the last few years, not because of the increase in prescriptions of second-generation agents SGA , but because of the side effects that FGA cause very frequently.

Despite of the discovery of the atypical antipsychotics and their favorable extrapyramidal symptom profile, many studies have shown that some patients are at still at high risk of extrapyramidal symptomatology Therefore, clinicians should be aware of the emergency of extrapyramidal symptoms all the time.


With all these factors in mind the DIEPPS scale was developed for screening extrapyramidal symptoms as practical and standardized rating scale in a simple and easy manner for administration. Serbian version of the DIEPSS was created through translation and back-translation from the original English version, with permission of the author.

Material was used with kind permission of the author. It consisted of video clips, recorded from till Total number of patients who appeared in the video clips was , 47 male and 59 female. Mean age was Subjects were diagnosed with schizophrenia 69 patients and mood disorders 37 patients.

The ethics committee of Seiwa hospital, Institute of Neuropsychiatry, Tokyo, Japan, approved the experimental protocols used in the current study. Written informed consent was obtained from all participants or legal guardians.

Individual items are gait, bradykinesia, sialorrhea, rigidity, tremor, akathisia, dystonia and dyskinesia. Evaluation of individual items is principally based on objective observations.

Global item, overall severity, considers severity and frequency of individual items, subjective distress and influence on daily activities. Each item is rated from normal 0 to severe 4 12 , Global item was excluded considering study design that implied using video clips. Before the initiation of the study the session was held for all raters to clarify the procedure and to distribute scale and instructions.

Raters performed the assessment simultaneously, individually rating one assigned item immediately after seeing the video clip.

Raters were blind to one another during assessments.

Full size table Discussion Nonadherence to medication can have negative consequences for the patient, the provider, the physician, and even the researchers who are working to establish the value of the medication for the target population. It is a common problem induced by many factors, including the medication side effects.


Nonadherence increases the risk of relapse, rehospitalization, and self-harm, increases inpatient costs, and lowers quality of life of patients. The efficacy of antipsychotic medication in the acute and maintenance treatment of several mental disorders is clear from large meta-analyses of placebo-controlled trials Data from the CATIE trial imply that advantages of SGA in significantly reducing extrapyramidal side effects compared with FGA may be diminished when compared with modest doses of lower-potency first generation drugs.

However, the dichotomy between FGA and SGA may be oversimplified, and CATIE trial showed that antipsychotics could be conceptualized as a single drug class with a spectrum of risk for movement disorders depending upon receptor binding affinities and individual patient susceptibility 7.

Especially, the use of SGAs for populations that were drug naive children, adolescents, elderly and adult population with conditions such as bipolar disorder and major depressive disorder, together with a lack of long-term clinical trials that would precisely indicate the rate of DIMD in these populations, portends an increase in the actual number of cases Int Psychogeriatr.

VAS assessment of the injections remained low, with mean patient ratings remaining at 5 or below on a scale of 0— throughout the maintenance phase injections 1— Five training sessions of 3 hours each were conducted, including an explanation of the instrument's characteristics and rules, exercises on BPRS application and ratings, and formal testing of interrater reliability using videotaped interviews.

Baker, F. Discussion To the best of our knowledge, only a single case study has reported that PP induced 5-month persistent EPSs after a single injection.

Thirty-four participants Routledge, London. The average steady-state plasma concentration of risperidone active moiety is higher in the CYP2D6 intermediate metabolizers IMs compared with that in the extensive metabolizers EMs. A drug-induced extrapyramidal symptoms scale DIEPSS was developed in Japan in for evaluating the symptoms seen in psychiatry patients taking antipsychotics [ 15 ].

Efficacy and extrapyramidal side-effects of the new antipsychotics olanzapine, quetiapine, risperidone, and sertindole compared to conventional antipsychotics and placebo.