psychiatry neurology

Abnormal Involuntary Movement Scale (AIMS)

Clinician-rated 12-item scale for assessing tardive dyskinesia and other abnormal involuntary movements in patients on antipsychotic medications. Items 1–7 are scored 0–4; items 8–12 are additional assessments.

Facial muscles (muscles of facial expression)*

Lips and perioral area (puckering, pouting, smacking)*

Jaw (biting, clenching, chewing, lateral movement)*

Tongue (rate only increases in movement both in and out of mouth)*

Upper extremities (arms, wrists, hands, fingers — not include tremor)*

Lower extremities (legs, knees, ankles, toes)*

Trunk (neck, shoulders, hips)*

Score interpretation

No Item Rated Mild or Worse 0

All seven items rated none or minimal (0–1).

→ Continue current antipsychotic with regular monitoring (every 3–6 months); document baseline for future comparison

Mild Movements in One Area — Below Schooler–Kane Threshold 1

One area rated mild (2); the Schooler–Kane criteria need moderate movements in one area or mild in two.

→ Re-examine and repeat the AIMS (e.g. in 3 months); review the need for and dose of the antipsychotic; discuss with patient/carer.

Schooler–Kane Criteria for Tardive Dyskinesia Met 2

Moderate (≥ 3) movements in one area or mild (≥ 2) in two or more; tardive dyskinesia also needs ≥ 3 months' antipsychotic exposure and no other cause.

→ Review the antipsychotic: consider dose reduction or switching to clozapine or quetiapine; discuss with patient/carer; psychiatry review (urgent if moderate–severe); functional impact assessment; repeat AIMS in 3 months. VMAT2 inhibitors are approved for TD — Adults: valbenazine (40–80 mg daily) or deutetrabenazine; clonazepam as adjunct. Children: use a children's formulary.

Interpretation bands for the AIMS. Apply clinical judgement and local guidance.

References

Guy W. ECDEU Assessment Manual for Psychopharmacology (Revised). National Institute of Mental Health. 1976.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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