THE ST-HANS RATING-SCALE FOR EXTRAPYRAMIDAL SYNDROMES - RELIABILITY AND VALIDITY

The St. Hans Rating Scale (SHRS) is a multidimensional rating scale fo r the evaluation of neuroleptic-induced hyperkinesia, parkinsonism, ak athisia and dystonia. This scale and the Abnormal Involuntary Movement Scale (AIMS) were tested by 7 raters (2 experienced, 2 less experienc ed and 3 totally inexperienced) in 30 psychiatric patients with tardiv e dyskinesia (TD). The test was performed 3 times in the same patients : 1) live evaluation during a video recording, 2) evaluation 2 weeks l ater from the videotape, and 3) evaluation after another 2 weeks from the same videotape. The intrarater reliability was high in the experie nced group (0.91-0.96 for SHRS hyperkinesia scale, 0.80-0.84 for AIMS, and 0.82-0.97 for SHRS total parkinsonism). No significant changes oc curred from live to video evaluation. The interrater reliability coeff icient for the experienced group was also high: 0.89-0.95 for the SHRS hyperkinesia scale, 0.76-0.85 for the AIMS scale and 0.95-0.98 for th e SHRS parkinsonism scale. The less experienced and the inexperienced raters had coefficients for intra- and interrater reliability that wer e 0.10 and 0.20 lower, respectively. The SHRS parkinsonism scale had a high construct validity, as determined by the homogeneity coefficient s of Cronbach (0.82) and Loevinger (0.43). The corresponding coefficie nts for the hyperkinesia scales were low, in agreement with the indivi dual distribution of TD (only about 50% present extremity dyskinesia a nd less than 25% facial, head and trunk dyskinesia, independent of the severity of the syndrome). Finally, convergent validity was found bet ween the SHRS hyperkinesia scale and AIMS and divergent validity betwe en all of the other scales. It is concluded that the SHRS represents a n easily completed, reliable, valid and sensitive rating scale for ext rapyramidal symptoms that can be used with and without videotapes.