January 18th 2013
The goal of this article is to improve recognition of comorbid psychiatric and movement disorders and to help the reader formulate a management strategy using a multidisciplinary approach.
November 1st 2007
Nonmotor PD Symptoms Are Many and Deserve AttentionAugust 1st 2007
Nonmotor symptoms of Parkinson disease [PD] are diverse and include sleep disorders, depression, and pain," reported Carlo Colosimo, MD, assistant professor of neurology at La Sapienza University in Rome. He noted that a screening tool is needed.
Huntington Disease: Hopes for the FutureAugust 1st 2007
Initial symptoms include personality changes and the gradual appearance of small involuntary movements. These move- ments progress to frank chorea, ballism, and dystonia. Later in the disease course, a bradykinetic parkinsonian phenotype manifests. It is characterized by rigidity, severe dystonia, and contractures. Falls are common. Dysphagia is common as well and is progressive, becoming severe and often contributing to death from aspiration pneumonia.
Understanding Tourette Syndrome and Providing ReliefAugust 1st 2007
Thus, a young woman describes her ex-boyfriend who had Tourette syndrome (TS), the impact of which caused their breakup. TS affects approximately 1 in 100 Americans and is marked by a fluctuating course of multiple motor and phonic tics, which can have devastating social, physical, and psychological consequences for the patient.
Methods to Evaluate and Treat HD on the HorizonMay 1st 2007
Novel approaches for the evaluation and symptomatic treatment of Huntington disease (HD) were presented at the 59th Annual Meeting of the American Academy of Neurology held April 29 to May 5 in Boston. Interventions included use of tetrabenazine (TBZ) (as yet unapproved for the symptomatic treatment of hyperkinetic movement disorders in the United States but granted orphan drug status in 2004) and deep brain stimulation (DBS) of the globus pallidus externus (GPe).
Clinical Pearls on Best Approaches to Psychogenic Movement DisordersApril 1st 2007
Five words that are guaranteed to annoy your patientwith a diagnosis of psychogenic movementdisorder (PMD) are It's all in your head.It's the worst thing you can say, said Katie Kompoliti,MD, associate professor of neurological sciencesat Rush University Medical Center in Chicago.
Delirium: Emergency Evaluation and TreatmentMarch 1st 2007
Delirium is a disorder that lies at the interface of psychiatry and medicine. It is an acute organic syndrome caused by an underlying medical condition and is defined clinically by disturbances in cognitive function, attention, and level of consciousness.1 Delirium is considered a syndrome because of the constellation of signs and symptoms associated with the disorder, coupled with a wide variety of potential etiologies.
Differentiating Epileptic Seizures From Other SpellsNovember 1st 2006
It can be difficult to determine whether unusual, paroxysmal behavior represents a seizure or a nonepileptic event. Patients with convulsive, clonic movements may, in fact, be experiencing psychogenic events.
Pinpointing the Cause of Non-Alzheimer DementiaNovember 1st 2006
Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.
Understanding and Treating Complex Regional Pain SyndromeOctober 1st 2006
The Reflex Sympathetic Dystrophy Syndrome Association estimates that the CRPS affects between 200,000 and 1.2 million Americans. The underlying causes of the syndrome have yet to be defined, and no definitive diagnostic test exists even though CRPS was first described in the late 19th century by the neurologist Silas Weir Mitchell. Mitchell referred to the cluster of symptoms he noticed in some of the Civil War soldiers who were under his care as "causalgia.
Intrathecal Baclofen Therapy UnderusedOctober 1st 2006
Intrathecal baclofen therapy (IBT; Lioresal) may be underused in stroke patients with spasticity, according to a new survey by the National Stroke Association. Of patients responding to the survey, 58% experienced spasticity. Of these, only half (51%) received any type of treatment for their condition.
Neurotechnology's New Wave, Part II: Value, Acceptance, and Clinical ApplicationsJune 18th 2006
Neurotechnologic devices are proving themselves in clinical medicine. Many of these devices offer several distinct advantages over traditional pharmaceutical-based therapies: their effects are reversible, they are often cheaper than pharmaceuticals, and they solve therapy adherence issues. "If a problem occurs, you can turn off the device; or if the disease evolves over time, you can dynamically adjust the device," explained Ali R. Rezai, MD, chairman of the Center for Neurological Restoration at the Cleveland Clinic.
Neuropsychiatric Dimensions of Movement Disorders in SleepApril 1st 2006
Sleep-associated movement disorders are common in the general population. When patients complain of sleep disturbance, psychiatrists should consider,and question for, features of nocturnal movement disorder.
Use of Restraint and Seclusion in the Emergency DepartmentAugust 1st 2005
Restraints and seclusion have been used for many years in emergency departments (EDs) and psychiatric emergency services (PESs), but anecdotal case reports and newspaper investigations as well as clinical advances have led to restrictions in their use.
Parkinson Disease: The Ups and Downs of Developing TherapiesApril 10th 2005
Levodopa (l-dopa) and dopamine agonists are the main treatment for Parkinson disease (PD), but these therapies are of limited value in the long course of the illness because they counter a neurotransmitter deficit but do not halt neurodegeneration. In this main article and in an accompanying story, we offer an update on the status of Parkinson treatments today.
Spinal Cord Injury: Dealing With More Than Inability to MoveJanuary 22nd 2005
Christopher Reeve’s death this past October from cardiac complications after infection resulting from pressure ulcers is a reminder that patients with spinal cord injury (SCI) are more than their motility impairments. According to the Annual Statistical Report of the National Spinal Cord Injury Statistical Center (NSCISC), published last June, of 3312 patients for whom the cause of death was known, nearly 22% died of respiratory system diseases, 9% of infective and parasitic diseases, 8% of hypertensive and ischemic heart diseases, and 13% of other heart disease.
Movement Disturbances Associated With SSRIsMay 1st 2001
The SSRIs have become the most widely prescribed antidepressants in the United States. With this increased use has come more information on adverse events associated with their use, such as sexual dysfunction. However, movement disturbances associated with SSRI use can adversely impact treatment. This article explains the pathology of movement disorders and describes confounding variables such as other medications, pre-existing neurological insults and the nature of case reviews. Those at risk include the elderly, patients taking neuroleptics and those exposed to high levels of SSRIs.