Systematic Study of Structured Diagnostic Procedures in Outpatient Psychiatric Rehabilitation: A Three-Year, Three-Cohort Study of the Stability of Psychiatric Diagnoses.

Systematic Study of Structured Diagnostic Procedures in Outpatient Psychiatric Rehabilitation: A Three-year, Three-cohort Study of the Stability of Psychiatric Diagnoses.

Innov Clin Neurosci. 2013 May; 10(5-6): 14-9
Kotwicki R, Harvey PD

Background. Psychiatric diagnoses are important for treatment planning. There are a number of current challenges in the area of psychiatric diagnosis with important treatment implications. In this study, we examined the differential usefulness of two semi-structured interviews of differing length compared to clinical diagnoses for generation of diagnoses that did not require modification over the course of treatment. Methods. We performed a three-year, three-cohort study at an outpatient psychiatric rehabilitation facility, comparing the stability of admission diagnoses when generated by unstructured procedures relying on referring clinician diagnosis, the SCID, and the MINI. We examined changes in diagnoses from admission to discharge (averaging 13 weeks) and, during the second two years, convergence between referring clinician diagnoses and those generated by structured interviews. The same three interviewers examined all patients in all three phases of the study. Results. Admission and discharge diagnoses were available for 313 cases. Diagnoses generated with the unstructured procedure were changed by discharge 74 percent of the time, compared to four percent for SCID diagnoses and 11 percent for MINI diagnoses. Referring clinician diagnoses were disconfirmed in Years 2 and 3 in 56 percent of SCID cases and 44 percent of MINI cases. The distinctions between unipolar and bipolar disorders were particular points of disagreement, with similar rates of under and over-diagnosis of bipolar disorder. The rate of confirmation of referring clinician diagnoses of schizoaffective disorder was 10 percent with the SCID and 11 percent with the MINI. Discussion. In this setting, there appears to be a reasonable trade-off between brevity and accuracy through the use of the MINI compared to the SCID, with substantial improvements in stability of diagnoses compared to clinician diagnoses. Clinical diagnoses were minimally overlapping with the results of structured diagnoses, suggesting that structured assessment, particularly early in the illness or in short term treatment settings, may improve treatment planning. HubMed – rehab

Evaluation of the objective posturo-locomotor-manual method in patients with parkinsonian syndromes.

Front Neurol. 2013; 4: 95
Zackrisson T, Bergquist F, Holmberg B, Johnels B, Thorlin T

Objective methods for quantifying patients’ movement capacity would be useful in evaluating progression and interventions in neurodegenerative diseases. The Posturo-Locomotor-Manual (PLM) test is a standardized automated movement test developed to measure hypokinetic movements in patients with Parkinsonism. Our hypotheses were that the PLM movement time (MT) correlates with the Unified Parkinson’s disease rating scale (UPDRS III) motor section, and that the components of the PLM test correlate with the corresponding constructed domains of UPDRS III. We also evaluated the coherence between the results of the two assessment methods after a test dose of levodopa (l-DOPA). We assessed motor function using the PLM method and UPDRS III in parallel, in the absence of medication and after administration of 200?mg l-DOPA, in 73 patients with moderate to advanced Parkinsonism: 47 with Parkinson’s disease (PD), 17 with multiple system atrophy (MSA), and 9 with progressive supranuclear palsy (PSP). There was a fair correlation between the two assessment tools in the PD patients but not in the MSA or PSP patients. In the full dataset, there was a fair to good correlation between UPDRS III and the PLM MT. At group level, the UPDRS III l-DOPA test differentiated PD from MSA/PSP, whereas the PLM l-DOPA test differentiated between all three diagnoses. HubMed – rehab

Is DOPA-Responsive Hypokinesia Responsible for Bimanual Coordination Deficits in Parkinson’s Disease?

Front Neurol. 2013; 4: 89
Almeida QJ, Brown MJ

Bradykinesia is a well-documented DOPA-responsive clinical feature of Parkinson’s disease (PD). While amplitude deficits (hypokinesia) are a key component of this slowness, it is important to consider how dopamine influences both the amplitude (hypokinesia) and frequency components of bradykinesia when a bimanually coordinated movement is required. Based on the notion that the basal ganglia are associated with sensory deficits, the influence of dopaminergic replacement on sensory feedback conditions during bimanual coordination was also evaluated. Bimanual movements were examined in PD and healthy comparisons in an unconstrained three-dimensional coordination task. PD were tested “off” (overnight withdrawal of dopaminergic treatment) and “on” (peak dose of dopaminergic treatment), while the healthy group was evaluated for practice effects across two sessions. Required cycle frequency (increased within each trial from 0.75 to 2?Hz), type of visual feedback (no vision, normal vision, and augmented vision), and coordination pattern (symmetrical in-phase and non-symmetrical anti-phase) were all manipulated. Overall, coordination (mean accuracy and standard deviation of relative phase) and amplitude deficits during bimanual coordination were confirmed in PD participants. In addition, significant correlations were identified between severity of motor symptoms as well as bradykinesia to greater coordination deficits (accuracy and stability) in PD “off” group. However, even though amplitude deficits (hypokinesia) improved with dopaminergic replacement, it did not improve bimanual coordination performance (accuracy or stability) in PD patients from “off” to “on.” Interestingly, while coordination performance in both groups suffered in the augmented vision condition, the amplitude of the more affected limb of PD was notably influenced. It can be concluded that DOPA-responsive hypokinesia contributes to, but is not directly responsible for bimanual coordination impairments in PD. It is likely that bimanual coordination deficits in PD are caused by the combination of dopaminergic system dysfunction as well as other neural impairments that may be DOPA-resistant or related to non-dopaminergic pathways. HubMed – rehab

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