Yes, perform AIMS assessments regularly on patients taking Latuda
You should perform baseline AIMS assessments before starting Latuda and then repeat them every 3-6 months during ongoing treatment. This monitoring schedule is essential for early detection of tardive dyskinesia (TD), which can occur with all antipsychotic medications including atypical agents like lurasidone (Latuda).
Rationale for AIMS Monitoring with Latuda
While Latuda is an atypical antipsychotic with theoretically lower risk of extrapyramidal symptoms compared to typical antipsychotics, it still carries risk for tardive dyskinesia and other movement disorders 1. The FDA label data shows that in clinical trials, 7.4% of adult schizophrenia patients on Latuda shifted from normal to abnormal on AIMS assessments (compared to 5.8% on placebo), and 2.8% of adolescent patients shifted to abnormal (compared to 0.9% on placebo) 2.
Specific Monitoring Protocol
Baseline assessment:
- Perform AIMS before initiating Latuda to document any pre-existing abnormal movements
- This establishes your medicolegal baseline and allows you to track changes 1
Ongoing monitoring:
- Repeat AIMS every 3-6 months during maintenance treatment 1
- More frequent assessments may be warranted in high-risk patients (youth, elderly, those with prior movement disorders)
Additional movement disorder scales:
- Consider also using the Simpson Angus Scale (SAS) for parkinsonism
- Barnes Akathisia Scale (BAS) for akathisia
- These were all used in Latuda clinical trials and provide comprehensive movement disorder monitoring 2
Why This Matters for Patient Outcomes
Early detection is critical because there is no specific treatment for TD other than discontinuing or switching the medication 1. The guideline evidence emphasizes that "strategies for prevention and early detection need to be followed" since TD may persist even after stopping the antipsychotic 1. In youth, up to 50% may experience some form of tardive or withdrawal dyskinesia with antipsychotic use 1.
Common Pitfalls to Avoid
- Don't assume atypical antipsychotics are risk-free: While Latuda has lower EPS rates than typical antipsychotics, movement disorders still occur 3
- Don't skip baseline assessment: Without baseline documentation, you cannot definitively attribute new movements to the medication
- Don't wait for symptoms: TD screening should be proactive, not reactive - patients may not report subtle early signs
- Don't forget informed consent: Document that patients/families understand the risk of TD before starting treatment 1
Interestingly, one case report suggests Latuda may actually improve pre-existing TD in some patients 4, though this requires further study and should not change your monitoring approach.