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Monoamine oxidase (MAO), located in the outer mitochondrial membrane, is a critical enzyme in the metabolism of a number of neurotransmitters. Two isoforms of the enzyme exist, MAO-A and MAO-B . These differ both in their tissue distribution and substrate selectivity. MAO-A is predominantly located in the periphery (including the gut) and preferentially catalyses the oxidation of 5-hydroxytyptamine (5-HT, serotonin) and norepinephrine . MAO-B selectively metabolizes beta-phenylethylamine, while tyramine and dopamine are substrates for both types . MAO inhibition, either non-specific or selective, increases the synaptic concentrations of the usually metabolized neurochemicals, providing symptomatic benefit in a variety of neurological and psychiatric disorders.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.