Assessing and monitoring antipsychotic-induced movement disorders in hospitalized patients: a cautionary study

To assess the amount of documentation and level of assessment provided by attending physicians and nursing staff in regard to extrapyramidal symptoms (EPS) experienced by hospitalized patients with varied DSM-IV diagnoses regularly treated with antipsychotic medication.

We examined the medical records of 204 hospitalized patients. All medical records were examined retrospectively from consecutive admissions beginning in January 1996. We identified demographics, length of hospitalization, diagnosis, and antipsychotic and adjunct medication. EPS were classified into dystonia, parkinsonism, akathisia, and tardive dyskinesia (TD). For each type of EPS, 2 independent raters rated the quality of assessment based on dimensions of severity, location, and laterality.

The extent of interrater agreement was found to be 91.1%. Parkinsonism and akathisia were more frequently assessed, compared with TD and dystonia. However, the medical records examined showed generally poor assessment and documentation of EPS. The percentage of medical records with "no description" for each EPS classification was as follows: dystonia (89%), parkinsonism (71%), akathisia (67%), and TD (94%).

The major finding of this study was a high rate of failure to document the assessment and course of EPS. This finding suggests that clinicians do not recognize the importance of documenting these significant adverse events. This shortcoming can be corrected with increased awareness of EPS and increased training in their physical examination.