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Diagnostic Challenges Revealed from a Neuropsychiatry Movement Disorders Clinic

Published online by Cambridge University Press:  02 December 2014

Heather Rigby ,
Angela Roberts-South ,
Hrishikesh Kumar ,
Leonardo Cortese  and
Mandar Jog
Heather Rigby
Affiliation:
Dalhousie University, Halifax, Nova Scotia
Angela Roberts-South*
Affiliation:
University of Western Ontario London Health Sciences Centre, London, Ontario, Canada
Hrishikesh Kumar
Affiliation:
University of Western Ontario London Health Sciences Centre, London, Ontario, Canada
Leonardo Cortese
Affiliation:
University of Western Ontario London Health Sciences Centre, London, Ontario, Canada
Mandar Jog
Affiliation:
University of Western Ontario London Health Sciences Centre, London, Ontario, Canada
*
c/o Mandar Jog. 334 Windermere Blvd. A10-026, London, Ontario, N6A 5A5, Canada. Email: Asouth4@uwo.ca
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Abstract

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Background:

Abnormal movements are frequently associated with psychiatric disorders. Optimized management and diagnosis of these movements depends on correct labeling. However, there is evidence of reduced accuracy in the labeling of these movements, which could result in sub-optimal care.

Objective:

To determine the consensus inter-rater reliability between a movement disorders neurologist and physicians referring from the community for phenomenology and diagnoses of individuals with co-existing psychiatric conditions and movement disorders.

Method:

Charts of all consecutive patients seen in a combined Movement Disorders and Neuropsychiatry Clinic between 2001-2009 were reviewed retrospectively. Consensus estimates and kappa values for inter-rater reliability were determined for phenomenology and diagnostic terms for the respective referring source and movement disorders neurologist for each patient.

Results:

A total of 106 charts were reviewed (62 men and 44 women). Agreement for phenomenology terms ranged from 0% (psychogenic) to 73% (tremor). Only 3 terms had kappa values that met or exceeded criteria for moderate inter-rater reliability. Agreement for diagnosis terms was highest for tardive dyskinesia (83%), drug induced tremor (33%), and drug induced parkinsonism (20%). In 18 of the 22 charts (82%), a diagnosis was made of drug induced movement disorder (DIMD) by the referring physician. In contrast, a diagnosis of DIMD was made in only 54 of 106 charts (51%) after the patients were assessed in the clinic.

Conclusions:

A movement disorders specialist frequently disagreed with referring physicians' identification of patient phenomenology and diagnosis. This suggests that clinicians would benefit from educational resources to assist in characterizing abnormal movements.

Résumé

RÉSUMÉContexte:

Des mouvements anormaux sont souvent associés à des troubles psychiatriques. L'optimisation du traitement et du diagnostic de ces mouvements dépend de l'exactitude de leur identification. Cependant, certaines données indiquent que l'exactitude de l'identification de ces mouvements a diminué, ce qui peut entraîner un traitement sous-optimal.

Objectif:

Le but de l'étude était de déterminer la fiabilité du consensus interobservateurs d'un neurologue spécialiste des désordres du mouvement et de médecins qui réfèrent les patients, concernant les termes utilisés pour identifier la phénoménologie et le diagnostic respectivement par le médecin référant et le neurologue de la clinique du mouvement pour chaque patient.

Résultats:

Nous avons révisé les dossiers de 106 patients, 62 hommes et 44 femmes. Les termes utilisés pour identifier la phénoménologie concordaient de 0% (psychogénique) à 73% (tremblement). Seulement 3 termes avaient des valeurs kappa qui rencontraient ou excédaient les critères de fiabilité inter évaluateurs modérée. La concordance pour les termes du diagnostic était plus élevée pour les dyskinésies tardives (83%), le tremblement induit par la médication (33%) et le parkinsonisme induit par la médication (20%). Chez 18 des 22 patients (82%), un diagnostic de trouble du mouvement induit par un médicament (TMIM) a été posé par le médecin référant. Par contre, un diagnostic de TMIM a été posé chez seulement 54 des 106 patients (51%) suite à leur évaluation à la clinique.

Conclusions:

L'opinion d'un spécialiste des troubles du mouvement était souvent en désaccord avec celle du médecin référant quant à l'identification de la phénoménologie et du diagnostic chez le patient. Il semble donc que les cliniciens bénéficieraient de ressources éducatives pour les aider à caractériser les mouvements anormaux.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 782 - 788
Copyright
Copyright © The Canadian Journal of Neurological 2012

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