Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study analyses the physical and physiognomic semiotics characteristic of anxious persons which, together with other symptoms, lead to the diagnosis of the disorder caused by anxiety. The theories of several authors concerning physiognomy, an ancient science based on the assumption that an individual's character and personality traits may be distinguished from his physical form and appearance, are discussed. It is clear that the symptoms apparent in the behaviour and body of the anxious person, such as tremor, sweating, tachycardia and numerous other psychosomatic symptoms, form an important element of assessment in psychiatric diagnosis.
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PMID:[The physiognomic semeiotics of anxiety. A critical review]. 201 18

Of 842 consecutive patients with movement disorders seen over a 71 month period, 28 (3.3%) were diagnosed as having a documented or clinically established psychogenic movement disorder. Tremor was most common (50%) followed by dystonia, myoclonus, and parkinsonism. Clinical descriptions of various types are reviewed. Clinical characteristics common in these patients included distractability (86%), abrupt onset (54%), and selective disabilities (39%). Distractability seems to be most important in tremor and least important in dystonia. Other diagnostic clues included entrainment of tremor to the frequency of repetitive movements of another limb, fatigue of tremor, stimulus sensitivity, and previous history of psychogenic illness. On examination, 71% had other psychogenic features. Over 60% had a clear history of a precipitating event and secondary gain and 50% had a psychiatric diagnosis (usually depression). Twenty five per cent of patients presented with combined psychogenic movement disorder and organic movement disorder; 35% resolved and this subgroup had a shorter duration of disease than those who are unresolved. Psychogenic movement disorder represents an uncommon diagnosis among patients with movement disorders. The ability to make a diagnosis rests on the presence of a multitude of clinical clues and therapeutic action should be taken as early as possible.
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PMID:Psychogenic movement disorders: frequency, clinical profile, and characteristics. 756 21

Classifying neurotoxicity in relation to neuroleptic use has been a longstanding concern with clinical, research, and epidemiologic import. This study examines the clinical manifestations of neurotoxicity and current concepts regarding its classification. The Food and Drug Administration (FDA) Spontaneous Reporting System data base and extant literature were reviewed for lithium/neuroleptic neurotoxicity spectrum cases. Lithium-alone (LI), lithium/haloperidol (LiHal), and lithium/non-haloperidol neuroleptics (Li-NonHal) groups, each paired for recovery and sequelae, were established for 237 cases. Data on demographic factors, psychiatric diagnosis, and symptoms/signs/findings were tabulated. Neuroleptic malignant syndrome (NMS) was used as a paradigm for severe neurotoxicity; the cases were evaluated by two strict, published sets of NMS diagnostic criteria and two "probable" classifications (one published and one established for study) based on these criteria. Altered consciousness was prominent in all groups. Hypertonia/rigidity was most pronounced in both LiHal groups, possibly reflecting higher relative neuroleptic dosing; Li and LINonHal recovery and sequelae pairs showed lower, similar percentages. Among other physical findings, tremor was either most common or prominent. Neither set of strict criteria diagnosed NMS in more than 30 percent of cases in any group. Expansion of classifications to include "probable" diagnoses resulted in appreciable global group percentage increases for only one set of criteria. The high percentage of study cases not meeting even "probable" NMS criteria, despite marked clinical morbidity that at times resulted in permanent sequelae, provides a cautionary note regarding the limitations of formulated diagnostic criteria. Data base caveats notwithstanding, study findings support the consideration of a spectrum approach to classifying and diagnosing psychotropic-related neurotoxicity.
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PMID:Lithium and neuroleptics in combination: the spectrum of neurotoxicity [corrected]. 896 72

The available literature suggests that a sizable proportion of patients placed on neuroleptics develop acute and subacute extrapyramidal side effects, including neuroleptic-induced parkinsonism (NIP). The presence of mild, spontaneous extrapyramidal signs in the elderly makes it difficult to accurately estimate the incidence of NIP in this subgroup of patients. We examined the incidence of NIP in 56 older, newly medicated, psychiatric patients. Fifteen age-comparable, unmedicated psychiatric patients underwent 2 assessments to estimate natural fluctuation in extrapyramidal signs, and 49 normal, healthy, elderly individuals were also studied to establish age-comparable norms for the assessment of parkinsonism. Potential pretreatment predictor variables included instrumental measures of motor function, age, cognitive status, and psychiatric diagnosis. After controlling for spontaneous parkinsonism, 32% of patients met strict criteria for NIP after receiving an average of 43 mg/day chlorpromazine equivalents of a typical neuroleptic. Factors contributing to the development of NIP included older age, instrumentally derived tremor, baseline extrapyramidal signs, type of neuroleptic, and severity of dementia. The use of risperidone in a small subsample was not associated with NIP. These findings indicate that even after controlling for spontaneous extrapyramidal signs at baseline and their natural fluctuations, there is a substantial risk of NIP in older patients who are treated with very low doses of typical neuroleptics.
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PMID:Incidence and predictors of drug-induced parkinsonism in older psychiatric patients treated with very low doses of neuroleptics. 1044 Apr 59

We present the case of a 14-year-old female who had many characteristics of neuroleptic malignant syndrome (NMS) without pyrexia following a single depot injection of 200 mg of zuclopenthixol. The patient presented with a change in mental status that had progressed over the preceding 48 hours. Subsequently, she became increasingly agitated and confused, and developed diffuse muscular rigidity, mutism, tremor, tachycardia, diaphoresis, sialorrhea, and incontinence. Results of laboratory tests showed elevated CPK levels, leukocytosis, and a low serum iron level. Bromocriptine and diazepam were used as initial treatment of a probable NMS and provided significant improvement. During the next seven days, she clinically improved but continued to exhibit emotional lability, logorrhea, elevated mood, and increased psychomotor activity. Therefore, bromocriptine and diazepam were discontinued and lorazepam and lithium were administered as treatment of a bipolar disorder. Four weeks later, she was discharged in stable condition. The presentation of this case report suggests that the primary psychiatric diagnosis is important in antipsychotic usage in the pediatric population, and that young patients receiving neuroleptic treatment should be monitored for the early signs of NMS. Using the diagnostic criteria of a neuroleptic toxicity spectrum may result in greater clinical awareness and earlier recognition of NMS.
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PMID:Zuclopenthixol-induced neuroleptic malignant syndrome in an adolescent girl. 1745 80

Data on psychogenic movement disorders (PMD) in children are scarce, with most existing literature relating to adults only. We report 15 cases with the aim of highlighting the clinical characteristics, risk factors, comorbidity, treatment, outcome, and prognosis of PMD in children. Only 13% of cases had onset before age 10, with the mean age at onset being 12.3 years. Females were predominantly affected (F:M = 4:1). The most common types of movement disorders seen were dystonia (47%), tremor (40%), and gait disorders (13%). Multiple hyperkinetic phenomenologies were observed in many cases. Abrupt onset and precipitation by minor injuries, and stressful life events were commonly reported. Clinical clues on examination suggesting a psychogenic origin were similar to those identified in adults. A distinct feature of PMD in children was the predominant involvement of the dominant limb. The underlying psychiatric diagnosis was conversion disorder in the majority of cases. Time from symptom onset until diagnosis of a PMD varied broadly (between 2 weeks and 5 years). Treatment with cognitive and behavioral therapy and rehabilitation by a multidisciplinary team led to improvement in most cases. However, treatment was much more effective in children with a short time from symptom onset to diagnosis and treatment.
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PMID:Psychogenic movement disorders in children: a report of 15 cases and a review of the literature. 1875 66

Psychogenic movement disorders are a daily challenge for the neurologist. A mistake in its recognition may have important consequences for the patients. As a result, the diagnosis must be considered very carefully in clinical practice. However, psychogenic movement disorders are not unusual, are mainly tremors, and a wrong diagnosis is common. Psychogenic is an unspecific term that usually masks the real mental disorder, and should be called somatoform disorders, factitious disorders, malingering, depression, anxiety and histrionic personality disorder, although the absence of a psychiatric diagnosis does not preclude a psychogenic cause. The diagnosis may often be difficult and should be made by an expert neurologist. Organic movement disorders must be excluded after a detailed neurological history, examination, and appropriate diagnostic studies. Psychogenic tremor is not only a diagnosis of exclusion, it can be diagnosed positively by its neurological signs, mainly: variability in frequency and amplitude, bilateral and sudden onset, non-progressive with frequent remissions, absence of finger, tongue or face tremor and coactivation of antagonistic muscles. Several tests can be useful in diagnosis, such as: accelerometry, EMG and response to placebo or suggestion. The treatment requires close cooperation between the medical team and patient. The problem must never be minimised and early diagnosis and treatment must be attempted.
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PMID:[Psychogenic tremor: a positive diagnosis]. 2038 61