ABSTRACT
LEARNING OBJECTIVES: After participating in this CME activity, the psychiatrist should be better able to:⢠Categorize and describe different types of abnormal involuntary movements (AIMs).⢠Identify assessment tools and treatment options for AIMs. ABSTRACT: Abnormal involuntary movements (AIMs) comprise a diverse group of movement disorders characterized by uncontrolled and unintended movements (e.g., tremors, tics, dystonia). AIMs can occur at any stage of life and pose significant challenges for clinicians. It is difficult to determine their underlying causes due to the complex neurobiological mechanisms involved. Therefore, it is crucial to quantify the severity and progression of AIMs using well-validated measurement scales, such as the Abnormal Involuntary Movement Scale (AIMS). By employing reliable assessment approaches, clinicians can objectively evaluate the motoric manifestations of AIMs and track them over time. Treatment of AIMs varies depending on their nature and etiology. While AIMs often respond to treatment, serious side effects can undermine treatment efficacy. In this clinically focused narrative review, we categorize different types of AIMs and discuss their neurobiological aspects. Further, we emphasize the importance of using well-validated measurement scales for accurate assessment and discuss available treatment modalities that target the specific AIMs manifestations. Additionally, we cover the need for comprehensive care to address the multifaceted nature of AIMs, accounting for their physical manifestations as well as their psychological, social, and functional toll on patients. By embracing a multidisciplinary approach, health care professionals can provide patient-centered care that promotes overall well-being and enhances the lives of patients coping with AIMs. Regular follow-up assessments are necessary to monitor treatment response, adjust medications when needed, and provide ongoing support for individuals affected by AIMs.
Subject(s)
Dyskinesias , Dystonia , Movement Disorders , HumansABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Mental Disorders , Psychiatry , Humans , Restraint, Physical , Mental Disorders/diagnosis , Mental Disorders/therapy , Emergency Service, Hospital , Hospitals, General , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Mental Disorders , Psychiatry , Humans , Prevalence , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Hospitals, General , Comorbidity , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Mental Disorders , Psychiatry , Psychotic Disorders , Humans , Diagnosis, Differential , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Mental Disorders/epidemiology , Comorbidity , Hospitals, General , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Mental Disorders , Psychiatry , Humans , Diagnosis, Differential , Mental Disorders/complications , Mental Disorders/diagnosis , Mental Disorders/therapy , Emergency Service, Hospital , Hospitals, General , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Bipolar Disorder , Mental Disorders , Psychiatry , Aged , Bipolar Disorder/complications , Bipolar Disorder/diagnosis , Bipolar Disorder/therapy , Diagnosis, Differential , Female , Hospitals, General , Humans , Mental Disorders/therapy , Paranoid Disorders/complications , Paranoid Disorders/diagnosis , Paranoid Disorders/therapy , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Mental Disorders , Psychiatry , Smoking Cessation , Hospitals, General , Humans , Mental Disorders/diagnosis , Mental Disorders/therapy , Primary Health Care , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Clozapine , Mental Disorders , Psychiatry , Clozapine/adverse effects , Hospitals, General , Humans , Mental Disorders/diagnosis , Mental Disorders/drug therapy , Primary Health Care , Referral and ConsultationABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Antipsychotic Agents , Deprescriptions , Schizophrenia , Antipsychotic Agents/therapeutic use , Humans , Polypharmacy , Prescriptions , Schizophrenia/drug therapyABSTRACT
The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
Subject(s)
Benzimidazoles/poisoning , Mental Disorders , Respiratory Insufficiency , Eating , Humans , Infant , Inpatients , Intubation, Intratracheal , Male , Mental Disorders/chemically induced , Referral and Consultation , Respiratory Insufficiency/chemically induced , Respiratory Insufficiency/therapySubject(s)
Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/psychology , Quality of Life/psychology , Schizophrenia/physiopathology , Schizophrenic Psychology , Adolescent , Adult , Aged , Cognitive Dysfunction/etiology , Diagnostic Self Evaluation , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Schizophrenia/complications , Young AdultABSTRACT
Antipsychotic polypharmacy (APP) is a common practice while treating severe mental illness but the benefits of APP over antipsychotic monotherapy is controversial. This is a retrospective analysis comparing risk factors for people on APP and those on non-APP in inpatient psychiatry units. Two years data with 72 people in non-APP group and 82 people in APP group were analyzed quantitatively. The diagnoses of schizoaffective disorder (OR 11.5), schizophrenia (OR 4.65) and depression (OR 0.31), and history of > 2 psychiatric admissions (OR 3.2) and > 2 psychiatric emergency visits (OR 2.87) in 2 years were studied as potential risk factors for APP. Similarly, history of violence (OR 1.7) and history of substance abuse (OR 0.51) were also studied. Schizophrenia spectrum disorder, higher number of psychiatric hospitalizations, and psychiatric emergency visits were positively associated while depression and substance abuse were negatively associated with APP in our study.
Subject(s)
Antipsychotic Agents/administration & dosage , Hospitals, Community , Inpatients , Polypharmacy , Adolescent , Adult , Aged , Child , Female , Humans , Male , Mental Disorders/drug therapy , Middle Aged , Retrospective Studies , Risk Factors , Young AdultABSTRACT
Shared Decision Making (SDM) is an essential component of recovery oriented treatment for clients with severe and persistent mental illnesses. SDM has been found to be effective in improving outcome of treatment of non-psychiatric ailments, and studies of SDM in community mental health settings are limited. We designed and implemented a low tech SDM program in a non-academic community mental health center and evaluated the outcome on decisional certainty and satisfaction with services. The results suggest that SDM can be effectively integrated with evidence based psychiatric rehabilitation practices utilizing already existing resources.
Subject(s)
Community Mental Health Centers/organization & administration , Decision Making , Aged , Female , Humans , Male , Mental Disorders/psychology , Mental Disorders/rehabilitation , Middle Aged , Models, Organizational , Patient SatisfactionABSTRACT
Village health worker (VHW) programs are known to be effective means of promoting health of communities. Comprehensive rural health project in India recently trained VHWs to identify, refer, and help people with mental health issues. This study evaluated knowledge, attitude, and behavior of VHWs regarding depression. Cluster sampling was used including all 36 VHWs trained in mental health. Among these, 24 were available and willing to participate in the study. Five FGDs were conducted among 24 VHWs, and the results were analyzed qualitatively. Four out of five groups were able to diagnose the presented case correctly as depression. VHWs were able to identify many symptoms and to suggest management options for depression. They showed supportive and empathetic attitudes towards depressed patients. VHWs are likely to be useful at identifying and assisting people with depression in the communities with lack of adequate resources provided they receive ongoing training and supervision.
