NRNP-6635 week 2 discussion – Abnormal Involuntary Movements scale (AIMs) Psychiatric Evaluation and Evidence-Based Rating Scale
Psychiatric interviews and evaluations are essential for developing the provider-patient relationship, improving diagnostic accuracy, and guiding the treatment of a psychiatric patient (American Psychiatric Association, 2016). The psychiatric interview comprises 15 components, each assessing different variables that indicate or show signs of psychopathology (Boland & Verduin, 2022). Clinicians must take a multi-dimensional approach to assessing and accurately diagnosing psychiatric patients, and the format for psychiatric interviews encompasses a biopsychosocial approach. The following is a summary of three components of the psychiatric interview and why they are important, as well as the psychometric properties of the Abnormal Involuntary Movement Scale (AIMs), its importance, and how the scale is helpful for psychiatric mental health nurse practitioners (PMHNPs) during psychiatric assessment.
The first chosen component of the psychiatric interview is the HPI, which is a focused portion of the interview covering symptoms of the patient’s current mental health issues, including a description of symptoms, when they first started, and how they affect the patient’s functioning and daily life (Boland & Verduin, 2022). The HPI also includes information about changes in the patient’s interests, habits, physical health, behaviors, and interpersonal relationships as well as current or ongoing stressors (Boland & Verduin, 2022). As in medical care, clinicians obtain the HPI for each patient because it helps gain insight into potential medical diagnoses and treatment options, and the HPI in psychiatric care is just as important for generating psychopathology diagnoses and treatment (Carlat, 2024). It is important to note that subjective information obtained regarding the HPI may not come from the patient themselves but from family, friends, or other healthcare providers (Boland & Verduin, 2022).
The second component of the psychiatric interview is substance use, abuse, and addiction. In the United States, roughly one-third of people with substance use disorder (SUD) also suffer from at least one co-occurring psychopathology, and more than fifty percent never receive treatment (Marel et al., 2023). The co-occurrence of psychopathology and SUD presents complex challenges in diagnosing and selecting evidence-based interventions for patients, requiring clinicians to take a multi-dimensional approach (Bahji, 2024). When interviewing patients, it is essential to determine if SUD or psychopathology symptoms occurred first because treatment approaches will differ, such that certain drugs elicit psychopathological symptoms (Bahji, 2024). Some psychopathologies illicit symptoms that mimic drug use, and many patients with psychopathologies often turn to substances to alleviate symptoms (Bahji, 2024). Untangling the relationship between drug abuse and misuse and psychopathology ties to the HPI in gaining an understanding of the timeline and progression of symptoms, which is crucial for accurate patient diagnosis and treatment (Bahji, 2024). With the high prevalence of substance use and psychopathology, this portion of the interview is critical in ensuring accurate diagnosis and approach to treatment in order to optimize patient quality of life and outcomes.
Lastly, the mental status exam (MSE) is part of the psychiatric interview. According to Boland and Verduin, the MSE and the psychiatric clinician are comparable to the physical exam and the healthcare provider (2022). The MSE is a continuous, mostly observational, assessment of a patient during the psychiatric interview that provides clues to a patient’s current cognitive, behavioral, and emotional functioning (Lenouvel et al., 2022). Observations during the MSE include the patient’s appearance, behavior, speech, affect, thought processes and content, and cognitive examination (Carlat, 2024). Conducting the MSE while also obtaining other components of the psychiatric interview helps build a therapeutic relationship, obtain patient history and physical, develop a diagnosis, and determine treatment options (Lenouvel et al., 2022). Information obtained through direct inquiry enhances the MSE, which is critical for accurate diagnosis and treatment (Boland & Verduin, 2022).
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Like the psychiatric interview, psychiatric rating scales also influence the assessment, diagnosis, and treatment of mental health patients. Psychiatric rating scales comprise assessment instruments, including questionnaires, interviews, checklists, and outcome measures, used in research and psychiatric practice (Boland & Verduin, 2022). From a clinical practice perspective, psychiatric rating scales are useful in assessing patients’ current level of functioning, aiding patient diagnosis, and determining treatment plans (Rajachandrasekar & Vaiyapuri, 2023). Psychiatric rating scales are useful for monitoring symptom severity, the effectiveness of treatment interventions, and patient quality of life over time (Rajachandrasekar & Vaiyapuri, 2023). From a research perspective, psychiatric rating scales help generate quantitative data from qualitative information, enabling accurate interpretation and results (Rajachandrasekar & Vaiyapuri, 2023).
For example, a widely used psychiatric rating scale is the abnormal involuntary movements scale (AIMs) introduced in the 1970’s by the National Institute of Mental Health and is used both clinically and in research (Baminiwatta et al., 2021). The purpose of AIMs is to detect, diagnose, and track symptoms of tardive dyskinesia (TD) or other movement disorders over time (Chakrabarty et al., 2023). The AIMs are generally conducted and repeated every three to six months with patients on antipsychotic medications because the delayed onset of TD occurs in roughly twenty to fifty percent of patients, and only half of the patients’ TD symptoms disappear after medication discontinuation (Baminiwatta et al., 2021). Clinicians’ proper use and documentation of AIMs in clinical practice not only help providers detect and track TD symptoms but also support clinical research.
Psychometric properties assess the quality and efficacy of a given psychiatric rating scale, and reliability and validity are its primary indicators (Boland & Verduin, 2022). In simple terms, reliability is consistency and reproducibility, and validity is the ability to repeat measurements of the same thing, which represents the truth (Rajachandrasekar & Vaiyapuri, 2023). The reliability and validity of AIMs have proven adequate for assessing and monitoring TD symptoms, and they have been translated into other languages that have since been shown to be reliable and valid (Baminiwatta et al., 2021). In a recent study, small variations in AIMs scores are clinically significant in changes in patient symptoms, demonstrating the validity and efficacy of using AIMs (Hauser et al., 2022).
AIMs may be implemented across various healthcare settings, given their use in both psychiatric and neurological disorders (Chakrabarty et al., 2023). The AIMs scale should be utilized in patients on antipsychotics to include baseline assessment prior to initiating neuroleptic medications, routine monitoring, usually every three to six months, with any medication changes, or if new involuntary movements occur (Matthews, 2025). The AIMs scale is helpful to PMHNPs because it can detect the severity of involuntary movements, monitor changes over time, and guide patient treatment (Matthews, 2025). Additionally, routinely implementing the AIMs in patients taking neuroleptic medications improves patient outcomes through early detection and intervention (Matthews, 2025) NRNP-6635 week 2 discussion – Abnormal Involuntary Movements scale (AIMs) Psychiatric Evaluation and Evidence-Based Rating Scale.
The previously discussed components of the psychiatric interview and psychiatric rating scales are both an integral part of the multi-dimensional approach to diagnosis, treatment, and monitoring psychopathology. Additionally, the MSE and AIMs are used to detect psychiatric abnormalities through observation rather than to enhance the overall psychiatric picture, as the patient’s reports and behaviors may be inconsistent (Boland & Verduin, 2022). The PMHNP needs to utilize all elements of the psychiatric interview, along with appropriate psychiatric rating scales, in clinical practice to achieve the most accurate diagnosis and treatment plan, thereby improving patients’ overall quality of life.
References
American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. (3rd ed.). https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760
Bahji, A. (2024). Navigating the complex intersection of substance use and psychiatric disorders: A comprehensive review. Journal of Clinical Medicine, 13(4), 999. https://doi.org/10.3390/jcm13040999
Baminiwatta, A. K., Harshini, M. L., Bandara, T. R., Gunesekara, T., Perera, K. M., Kuruppuarachchi, K. A., & Hapangama, A. (2021). Validity and clinical utility of a Sinhalese version of the abnormal involuntary movement scale (AIMS). Sri Lanka Journal of Psychiatry, 12(1), 25-30. https://doi.org/10.4038/sljpsyc.v12i1.8281
Boland, R. & Verduin, M. L. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Carlat, D. J. (2024). The psychiatric interview (5th ed.). Wolters Kluwer.
Chakrabarty, A. C., Bennett, J. I., Baloch, T. J., Shah, R. P., Hawk, C., & Natof, T. (2023). Increasing abnormal involuntary movement scale (AIMS) screening for tardive dyskinesia in an outpatient psychiatry clinic: A resident-led outpatient lean six sigma initiative. Cureus, 15(5), e39486. https://doi.org/10.7759/cureus.39486
Hauser, R. A., Barkay, H., Wilhelm, A., Wieman, M., Savola, J.-M., & Gordon, M. F. (2022). Minimal clinically important change in Abnormal Involuntary Movement Scale score in tardive dyskinesia as assessed in pivotal trials of deutetrabenazine. Parkinsonism and Related Disorders, 97, 47–51. https://doi.org/10.1016/j.parkreldis.2022.02.017
Lenouvel, E., Chivu, C., Mattson, J., Young, J. Q., Klöppel, S., & Pinilla, S. (2022). Instructional design strategies for teaching the mental status examination and psychiatric interview: A scoping review. Academic Psychiatry, 46(6), 750–758. https://doi.org/10.1007/s40596-022-01617-0
Marel, C., Madden, E., Wilson, J., Teesson, M., & Mills, K. L. (2023). Effectiveness of online training for improving knowledge, attitudes, and confidence of alcohol and other drug workers in relation to co-occurring mental health conditions. Drugs: Education, Prevention & Policy, 30(2), 115–123. https://doi.org/10.1080/09687637.2021.1983520
Matthews, D. (2025). From assessment to intervention: evidence-based approaches in tardive dyskinesia. CNS Spectrums: The International Journal of Neuropsychiatric Medicine, 30(1), 1–5. https://doi.org/10.1017/S1092852925000082
Rajachandrasekar, B., & Vaiyapuri, S. (2023). Rating scales in psychiatric disorders – why? International Journal of Community Medicine and Public Health, 10(11), 4502-4511. https://dx.doi.org/10.18203/2394-6040.ijcmph20233502 NRNP-6635 week 2 discussion – Abnormal Involuntary Movements scale (AIMs) Psychiatric Evaluation and Evidence-Based Rating Scale