Article

Validity of Simpson-Angus Scale (SAS) in a naturalistic schizophrenia population

Department of Psychiatry, University of Helsinki, Helsinki, Uusimaa, Finland
BMC Neurology (Impact Factor: 2.04). 04/2005; 5(1):5. DOI: 10.1186/1471-2377-5-5
Source: PubMed

ABSTRACT

Simpson-Angus Scale (SAS) is an established instrument for neuroleptic-induced parkinsonism (NIP), but its statistical properties have been studied insufficiently. Some shortcomings concerning its content have been suggested as well. According to a recent report, the widely used SAS mean score cut-off value 0.3 of for NIP detection may be too low. Our aim was to evaluate SAS against DSM-IV diagnostic criteria for NIP and objective motor assessment (actometry).
Ninety-nine chronic institutionalised schizophrenia patients were evaluated during the same interview by standardised actometric recording and SAS. The diagnosis of NIP was based on DSM-IV criteria. Internal consistency measured by Cronbach's alpha, convergence to actometry and the capacity for NIP case detection were assessed.
Cronbach's alpha for the scale was 0.79. SAS discriminated between DSM-IV NIP and non-NIP patients. The actometric findings did not correlate with SAS. ROC-analysis yielded a good case detection power for SAS mean score. The optimal threshold value of SAS mean score was between 0.65 and 0.95, i.e. clearly higher than previously suggested threshold value.
We conclude that SAS seems a reliable and valid instrument. The previously commonly used cut-off mean score of 0.3 has been too low resulting in low specificity, and we suggest a new cut-off value of 0.65, whereby specificity could be doubled without loosing sensitivity.

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    • "It consists of one item measuring gait (hypokinesia), six items measuring rigidity, and three items measuring glabella tap, tremor, and salivation, respectively. The cut-off value for screening NIP is 0.65 or more[11]. The use of two or more antipsychotic drugs at a time/simultaneously for a given patient for at least 30 days was taken as antipsychotic polypharmacy. "
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    • "Drug-related extrapyramidal side effects (EPS) were assessed using Simpson Angus Scale (SAS) [48], Barnes Akathisia Rating Scale (BARS) [49], and Abnormal Involuntary Movement Scale (AIMS) [50]. The diagnostic threshold scores for the presence of pseudoparkinsonism and akathisia were ≥7 in SAS [51] and ≥2 in BARS global clinical assessment item [49], respectively. A score of 3 or more on any of the first 7 AIMS items, or a score of 2 or more on any two of the first 7 AIMS items, was taken to be indicative of dyskinesia [52]. "
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