Altered arousal during which the patient fails to respond directly to queries (similar in presentation to the effects of dissociative anesthesia); when severe, the patient is mute and immobile and does not withdraw from painful stimuli. A few months afterward, patient presented to the acute psychiatric service with signs of acute dystonia (cervical dystonia and dysphagia). He was treated with biperiden 2 mg and the dystonia almost immediately disappeared. Flupentixol decanoate dosage was lowered to 20 mgs every 2 weeks. Patient denied the use of any drugs except cannabis and urine examination confirmed this. After this episode, patient experienced several other episodes of dystonia, each time successfully treated with biperiden 2 mgs. Altered arousal during which the patient fails to respond directly to queries (similar in presentation to the effects of dissociative anesthesia); when severe, the patient is mute and immobile and does not withdraw from painful stimuli. Despite instructions to the contrary, the patient permits the examiner’s light pressure to move his or her limbs into a new position (posture), which may then be maintained by the patient despite instructions to the contrary. Resistance to the examiner’s manipulations, whether light or vigorous, with strength equal to that applied, as if bound to the stimulus of the examiner’s actions. Odd, purposeful movements, such as holding hands as if they were handguns dissertation writing services in uk, saluting passersby, or exaggerations or stilted caricatures of mundane movements; odd speech cadences and feigned accents are other examples. Despite instructions to the contrary, the patient permits the examiner’s light pressure to move his or her limbs into a new position (posture), which may then be maintained by the patient despite instructions to the contrary. Includes echolalia, in which the patient repeats the examiner’s utterances college written essays, and echopraxia, in which the patient spontaneously copies the examiner’s movements or is unable to refrain from copying the examiner’s test movements, despite instruction to the contrary. The patient’s initial resistance to an induced movement before gradually allowing himself or herself to be postured, similar to bending a candle. Have we used the correct treatments or should we have had other considerations? Exaggerated cooperation in the examiner’s manipulations, even when asked not to do so. Needs to be repeatable. Abnormalities in body temperature, pulse, blood pressure find a dissertation topic, respiration rate, and sweating. The refusal of orders without any specific motive. How is the absence of an effect on the necessary ECT energy level by benzodiazepines to be explained? 25. Varma VK, Wig NN, Phookun HR, Misra AK, Khare CB, Tripathi BM, et al. First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology. Acta Psychiatr Scand. 2007; 96 :431–8. doi: 10.1111/j.1600-0447.1997.tb09944.x. [PubMed ] 2. Ehrmann-Feldman D, Rossignol M, Abenhaim L, Gobeille D. Physician referral to physical therapy in a cohort of workers compensated for low back pain. Phys Ther. 1996; 76 :150–7. [PubMed ] 42. Farrell JL, Goebert DA. Collaboration between psychiatrists and clergy in recognizing and treating serious mental illness. Psychiatr Serv. 2008; 59 :437–40. doi: 10.1176/appi.ps.59.4.437. [PubMed ] 32. AbdelMalik P, Husted J, Chow EW, Bassett AS. Childhood head injury and expression of schizophrenia in multiply affected families. Arch Gen Psychiatr. 2003; 60 :231–6. doi: 10.1001/archpsyc.60.3.231. [PMC free article ] [PubMed ] A recent US study demonstrated that less than one-third of diagnoses provided to physical therapists by primary-care physicians are specific. 1 The same study illustrated that physical therapists must assume a greater diagnostic role and must routinely provide medical screening and differential diagnosis of pathology during the examination. 1 Similarly, studies conducted in Australia and Canada have concluded that the majority of referrals for physical therapy are not provided with a specific diagnosis. 2 ,3 Medical screening is important, since physical therapists are increasingly functioning as the primary contact for patients with neuromusculoskeletal dysfunctions, 4 ,5 which means a greater likelihood of encountering patients with non-musculoskeletal disorders, including psychiatric disorders. I spoke to the referring physician in person and explained to him my findings from the patient interview, specifically the patient's belief that he had electrical implants in his body. I also pointed out the patient's affect and the limited physical findings during the physical examination. I provided the physician with some direct quotes from the patient to demonstrate the level of psychosis he was presenting with. I stated my conclusion that the patient was suffering from some form of psychosis that precluded physical therapy treatment for his shoulder at that time. The referring physician was quite concerned about the patient and called him during our meeting to arrange a follow-up medical appointment. The authors have no commercial or financial association that might pose a conflict of interest in connection with this manuscript. As primary-care practitioners, physical therapists may encounter patients with possible psychiatric disorders such as schizophrenia. However, the physical therapy literature on psychiatric disorders as they relate to musculoskeletal disorders focuses mainly on low back pain (LBP). 7 ,8 In an examination of a large number of physical and psychological factors, one prospective case-control study points to the importance of psychological variables as a risk factor for chronic LBP and widespread musculoskeletal pain. 8 Previous research has also concurred with this study in implicating psychological variables as risk factors for LBP and neck pain. 9 ,10 These articles provide a link between psychological disorders and patients seeking physical therapy for musculoskeletal dysfunctions. The patient reported a maximum verbal numeric pain rating scale (NPRS) score of 8/10 and a minimum score of 0/10, with pain usually present in the shoulder. In a double-blind, placebo-controlled, multi-centre chronic pain study, when the baseline NPRS raw score fluctuated by 0 points, the sensitivity and specificity were 95.32% and 31.80% respectively; 12 ,13 when there was a 4-point raw score change, the sensitivity and specificity were 35.92% and 96.92% respectively. 12 The patient stated that when he experienced shoulder pain, it was located on the anterior, posterior, and lateral aspects of his shoulder and radiated down to his elbow and wrist. He reported 0/10 shoulder pain while seated. 44. Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H, et al. Pathways to care of first-admitted subjects with psychosis in south-western France. Psychol Med. 2004; 34 :267–76. doi: 10.1017/S003329170300120X. [PubMed ] In the frontal plane, the right scapula was abducted four finger-widths from the mid-thoracic spine, and the left scapula was abducted three finger-widths. The scapulas were superiorly rotated bilaterally. Surface palpation of the acromial angle, inferior angle, and spine of the scapula differed less than 0.98 cm, 0.46 cm, and 0.67 cm, respectively psychology coursework a level, from the actual bony location, with a 95% confidence interval. 16 There was visible hypertrophy of the pectoralis major muscle bilaterally. Active and passive ROM were tested for the shoulders as recommended by Magee. 14 The patient had full bilateral active ROM, with minimal pain at end-range flexion and abduction that was not increased with overpressure in accordance with Magee. 14 He had full passive ROM with no pain reported. 43. Gater R, Jordanova V essay writing topics for middle school, Maric N, Alikaj V, Bajs M, Cavic T. Pathways to psychiatric care in Eastern Europe. Brit J Psychiatr. 2005; 186 :529–35. doi: 10.1192/bjp.186.6.529. [PubMed ] Key Words: patient interview, physical therapy assessment, psychiatric disorder, referral source, schizophrenia 45. Addington J, Van Mastrigt S, Hutchinson J research proposal writing services, Addington D. Pathways to care: help seeking behaviour in first episode psychosis. Acta Psychiatr Scand. 2002; 106 :358–64. doi: 10.1034/j.1600-0447.2002.02004.x. [PubMed ] 21. Hegedus EJ, Goode A, Campbell S, Morin A, Tamaddoni M, Moorman CT, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Brit J Sport Med. 2008; 42 :80–92. doi: 10.1136/bjsm.2007.038406. [PubMed ] 6. World Health Organization. International Classification of Function, Disability and Health (ICF) [cited 2010 Jan 11]. Available from: http://www.who.int/classifications/icf/en/ Objectif : L'objectif de cette étude de cas consiste à démontrer l'importance de réaliser des entrevues en profondeur avec les patients. Le cas étudié concerne un homme dirigé vers la physiothérapie en raison d'une dysfonction musculosquelettique. Au cours de l'entrevue avec ce patient, un problème psychiatrique a été décelé; par la suite, de la schizophrénie a été diagnostiquée. Le deuxième objectif de cette étude de cas est d'éduquer et de sensibiliser les physiothérapeutes aux signes et aux symptômes aisément reconnaissables de la schizophrénie. 29. Twang MT, Kendler KK, Gruenberg AM. DSM-III schizophrenia: is there evidence for familial transmission? Acta Psychiatr Scand. 1985; 71 (Suppl 1):77–83. doi: 10.1111/j.1600-0447.1985.tb08524.x. [PubMed ] 10. Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine. 1995; 20 :722–8. doi: 10.1097/00007632-199503150-00014. [PubMed ] 38. Weyerer S. Detection of psychiatric diseases in general practice: results from Germany. Gesundheitswesen. 1996; 58 (Suppl 1):68–71. [PubMed ] 41. Ross MD, Cheeks JM. Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma. Phys Ther. 2008; 88 :98–104. doi: 10.2522/ptj.20070033. [PubMed ] 22. First MB. Diagnostic and statistical manual of mental health text revisions. 4th ed. Washington: American Psychiatric Association; 2000. [DSM-IV-TR] Intervention: The patient was referred for further medical investigation, as he was demonstrating signs suggestive of a psychiatric disorder. The patient was diagnosed with schizophrenia by a psychiatrist and was prescribed Risperdal. 16. Lewis J, Green A, Reichard Z, Wright C. Scapular position: the validity of skin surface palpation. Man Ther. 2002; 7 :26–30. doi: 10.1054/math.2001.0405. [PubMed ] 13. Cole B, Finch E, Gowland C, Mayo N. Physical rehabilitation outcome measures. Baltimore: Williams & Wilkins; 1995. 48. Hodges B, Inch C, Silver I. Improving the psychiatric knowledge essay in the third person, skills, and attitudes of primary care physicians, 1950–2000: a review. Am J Psychiatr. 2001; 158 :1579–86. doi: 10.1176/appi.ajp.158.10.1579. [PubMed ] Copyright © Canadian Physiotherapy Association, 2010. All rights reserved. 12. Farrar JT example of a cover letter, Young JP, La Moreaux L, Werth JL, Poole M. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001; 94 :149–58. doi: 10.1016/S0304-3959(01)00349-9. [PubMed ] Schizophrenia is subdivided into five types: paranoid, disorganized, catatonic, undifferentiated, and residual (see Table Table1 1 ). 22 ,28 Based on these observations and on the literature, the patient's symptoms were suggestive of paranoid schizophrenia, 22 which is the most prevalent form of schizophrenia in most parts of the world. 22 Special tests were negative for the sulcus sign, Speed's test, the drop arm test, and the empty can test, as described by Magee. 14 Research shows that Speed's test has a sensitivity and specificity of 32% and 61% for biceps and labral pathology respectively; 20 the drop arm test has a sensitivity of 27% and a specificity of 88% as a specific test for rotator cuff tears, and the empty can test has a sensitivity of 44% and a specificity of 90% in diagnosing complete or partial rotator cuff tears. 20 ,21 The Neer and Hawkins-Kennedy impingement tests were both negative. 14 According to a meta-analysis by Hegedus et al. the Neer test is 79% sensitive and 53% specific, while the Hawkins-Kennedy test is 79% sensitive and 59% specific, for impingement. 21 Measures and outcome: The physical therapist's initial assessment identified a disorder requiring medical referral. Further management of the patient's musculoskeletal dysfunction was not appropriate at this time. 15. Fedorak C, Ashworth N, Marshall J, Paull H. Reliability of the visual assessment of cervical and lumbar lordosis: how good are we? Spine. 2003; 28 :1857–9. doi: 10.1097/01.BRS.0000083281.48923.BD. [PubMed ] 7. Haggman S, Maher CG, Rafshauge KM. Screening for symptoms of depression by physical therapists managing low back pain. Phys Ther. 2004; 84 :1157–66. [PubMed ] 5. Murphy BP, Greathouse D, Matsui I. Primary care physical therapy practice models. J Orthop Sport Phys Ther. 2005; 35 :699–707. doi: 10.2519/jospt.2005.2167. [PubMed ] Josh is a 27 year-old male who recently moved back in with his parents after his fiancée was killed by a drunk driver 3 months ago. His fiancée, a beautiful young woman he’d been dating for the past 4 years, was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his fiancée right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over. Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day essay body, watching TV or sleeping. Jessica is a 28 year-old married female. She has a very demanding research paper for, high stress job as a second year medical resident in a large hospital. Jessica has always been a high achiever. She graduated with top honors in both college and medical school. She has very high standards for herself and can be very self-critical when she fails to meet them. Lately, she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past. The primary component of the patient’s episodes appear to be related to stress as the primary factor. However, biological factors resulting from her mother’s illness and smoking during pregnancy, and a genetic predisposition related to her grandfather's eccentricity are viable underlying factors resulting in the patient’s illness. In addition to the primary stressor, and the underlying genetic and biological factors, it is possible that the emotions of the patient also contributed to her condition. Further documentation indicates that interfamilial expressed emotion, and communication deviance are probably contributors that appear to be operative in the patient’s case (Meyer, Chapman college essay about writing a college essay, & Weaver, 2009). The first of these factors, expressed emotion would be explained by the turbulent relationship, combined with her mother’s over protective nature conflicting with her father’s over critical reactions to the patient’s behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors, communication deviance resulted from the patient’s inability to focus and maintain normal dialog with others (Meyer, Chapman, & Weaver, 2009). The patient’s second hospitalization and treatments started to show positive results, and she was taken back to her home environment. She was able to obtain a part-time position at work, and maintain daily household chores. However, the patient failed to follow the prescribed treatment regimen. Following the death of her father, and additional stressors resulting from her mother’s added dependency, the patient suffered from a third regression of the illness. Her third hospitalization resulted from local law officials discovering her walking in a local pond while incoherently mumbling to herself. Schizophrenia is a complex illness that affects both men and women on an equal level. The illness usually starts around the age of ten, or in young adulthood. However, cases of childhood-onset schizophrenia indicates that the illness can start as young as five years of age. This is a more rare case of schizophrenia that can difficult to diagnose in relation to other childhood developmental problems (PubMedHealth, 2012). While researchers have yet to discover the cause of schizophrenia, many suspect genetics to be a major contributor (PubMedHealth, 20120). Schizophrenia includes three different subtype, and two over subtypes. The main subtypes include the classifications of paranoid, disorganized, and catatonic, and each of these subtypes displays unique characteristics or symptoms (Hansell, & Damour, 2008). Patients suffering from paranoid schizophrenia will usually display symptoms of hallucinations or delusions. Patients suffering from disorganized schizophrenia are subject to an inappropriate effect, and disorganized speech patterns. Patients suffering from catatonic schizophrenia display symptoms of strange or bizarre sensory motor function (Hansell, & Damour, 2008). Individuals who display symptoms of schizophrenia but lack any symptoms of the three primary classifications are likely to be diagnosed into one of two alternate classifications: residual or undifferentiated schizophrenia (Hansell, & Damour, 2008). Symptoms of schizophrenia are classified into two primary categories. These two categories relate to positive and negative symptoms. Patients displaying positive symptoms exhibit pathological excesses including hallucinations, irrational thinking, and irrational behaviors, whereas patients displaying negative symptoms will exhibit pathological deficits including withdrawal and isolation from social interactions, and poverty of speech capabilities ((Hansell, & Damour, 2008).
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