Development and clinimetric assessment of a nurse-administered screening tool for movement disorders in psychosis

Bettina Balint; Helen Killaspy; Louise Marston; Thomas Barnes; Anna Latorre; Eileen Joyce; Caroline S Clarke; Rosa De Micco; Mark J Edwards; Roberto Erro; Thomas Foltynie; Rachael M Hunter; Fiona Nolan; Anette Schrag; Nick Freemantle; Yvonne Foreshaw; Nicholas Green; Kailash P Bhatia; Davide Martino

doi:10.1192/bjo.2018.55

Development and clinimetric assessment of a nurse-administered screening tool for movement disorders in psychosis

BJPsych Open. 2018 Sep 27;4(5):404-410. doi: 10.1192/bjo.2018.55. eCollection 2018 Sep.

Authors

Bettina Balint¹, Helen Killaspy², Louise Marston³, Thomas Barnes⁴, Anna Latorre⁵, Eileen Joyce⁶, Caroline S Clarke⁷, Rosa De Micco⁸, Mark J Edwards⁹, Roberto Erro¹⁰, Thomas Foltynie¹¹, Rachael M Hunter¹², Fiona Nolan¹³, Anette Schrag¹⁴, Nick Freemantle¹⁵, Yvonne Foreshaw¹⁶, Nicholas Green¹⁶, Kailash P Bhatia¹¹, Davide Martino¹⁷

Affiliations

¹ Neurologist, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, UK and Department of Neurology, University of Heidelberg, Germany.
² Psychiatrist, Division of Psychiatry, Department of Primary Care and Population Health, University College London and Priment Clinical Trials Unit, University College London, UK.
³ Research Associate, Department of Primary Care and Population Health, University College London and Priment Clinical Trials Unit, University College London, UK.
⁴ Psychiatrist, Department of Psychiatry, Imperial College London, UK.
⁵ Neurologist, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, UK and Department of Neurology and Psychiatry, Sapienza, University of Rome, Italy.
⁶ Psychiatrist, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, UK.
⁷ Research Associate, Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, UK.
⁸ Neurologist, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences and MRI Research Center SUN-FISM, University of Campania 'Luigi Vanvitelli', Italy.
⁹ Neurologist, Institute of Cardiovascular and Cell Sciences, St George's University, UK.
¹⁰ Neurologist, Neurodegenerative Diseases Center (CEMAND) Department of Medicine, Surgery and Dentistry, University of Salerno, Italy.
¹¹ Neurologist, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, UK.
¹² Research Associate, Department of Primary Care and Population Health, and Priment Clinical Trials Unit, University College London, UK.
¹³ Research Nurse, School of Health and Social Care, University of Essex, UK.
¹⁴ Neurologist, Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, University College London, UK.
¹⁵ Statistician, Department of Primary Care and Population Health, University College London and Priment Clinical Trials Unit, University College London, UK.
¹⁶ Research Nurse, Camden and Islington NHS Foundation Trust, St Pancras Hospital, UK.
¹⁷ Neurologist, Department of Clinical Neurosciences, University of Calgary, Canada.

Abstract

Background: Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.

Aims: To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.

Method: Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.

Results: Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.

Conclusions: The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.

Declaration of interest: None.

Keywords: Drug interactions and side effects; antipsychotics; clinical neurology.