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Signs and Symptoms in Psychiatry
Published in Mohamed Ahmed Abd El-Hay, Essentials of Psychiatric Assessment, 2018
Psychomotor agitation: there is excessive motor activity that is usually repetitious, and not goal-directed (e.g., ringing fingers, rubbing hands, fidgeting feet, finger and foot tapping, frequent change of posture, rhythmic leg movements, frequent standing to walk around, unexpected leaving of the room) and associated with a feeling of inner tension that may appear in raising voice or shouting, and raising hands. Agitation may be found in mania, psychosis, anxiety, agitated depression, ADHD, stimulant intoxication, and in delirium.
Anxiety Disorders: Panic, Social, Obsessive-Compulsive, Generalized, and Post-Traumatic Anxiety
Published in Thomas L. Schwartz, Practical Psychopharmacology, 2017
Proper diagnosis is often confounded as patients present often initially with MDD or SUD. In these situations, the anxiety disorder creates enough social distress (loss of work, family, finances, etc.) that MDD or SUD ensues secondarily. When MDD is detected, good clinicians should always screen for anxiety disorders as well. Alternatively, MDD may generate anxiety symptoms. Many MDD patients are generally anxious, ruminate, or even obsess. There is often psychomotor agitation as well. A clinical convention exists where if the anxiety disorder was premorbid to the depressive disorder, then the patient carries two diagnoses: a depressive one and an anxious one. If the MDD is premorbid and the anxiety only occurs while depressed, then the patient just carries the single MDD diagnosis and all anxiety falls under the rubric of the patient having psychomotor agitation. Finally, if a patient carries both an anxiety disorder and MDD simultaneously, failure to gain remission in one disorder creates greater likelihood of recurrence in the other. Therefore, both must be treated aggressively and simultaneously.
Systemic complications
Published in Charles M Court-Brown, Margaret M McQueen, Marc F Swiontkowski, David Ring, Susan M Friedman, Andrew D Duckworth, Musculoskeletal Trauma in the Elderly, 2016
Houman Javedan, Samir Tulebaev
Finally, identification of an altered level of consciousness depends on an observer’s impression of whether a patient looked alert (normal), vigilant (hyperalert), lethargic (drowsy, easily aroused), stuporous (difficult to arouse) or comatose.13 Altered level of consciousness may be formally assessed using the Richmond Agitation and Sedation Scale (RASS), which is a validated measure.14 Additionally there are three variants of delirium based on psychomotor activity and level of consciousness.6 Hyperactive delirium is fairly easily diagnosed and is what most clinicians think of when they mention delirium. It is characterized by psychomotor agitation and disturbed emotional state with patients calling out, screaming, cursing, muttering, moaning or making other sounds. Psychomotor agitation may significantly interfere with patient care, safety as well as the safety of healthcare personnel and is a frequent reason for indiscriminate administration of antipsychotic medications or sedatives. A less recognized form of delirium is the hypoactive variant with decreased level of consciousness and apathy. The hypoactive form has been shown to carry a poorer prognosis.15 Finally, delirium may fluctuate between hyperactive and hypoactive forms, which is referred to a mixed delirium.
How significant is the assessment of the DSM-5 'anxious distress' specifier in patients with major depressive disorder without comorbid anxiety disorders in the continuation/maintenance phase?
Published in International Journal of Psychiatry in Clinical Practice, 2021
Tempei Otsubo, Choryo Hokama, Nana Sano, Yoshinori Watanabe, Toshiaki Kikuchi, Katsutoshi Tanaka
Mendlowicz et al. (2005) stated that the cyclothymic subscale scores were significantly elevated in their group of bipolar patients compared to the unipolar depressive group. A potential relationship between anxious distress and bipolar spectrum disorder was also apparent in their unipolar patients, in which the presence of anxious distress was related to cyclothymic and hyperthymic temperament, which have been reported as markers of bipolarity (Ghaemi 2013). In addition, as mentioned earlier, psychomotor agitation has been defined as a severe form of anxious distress (APA 2013), and psychomotor agitation in MDD is reportedly related to bipolarity (Iwanami et al. 2015). These results seem not to rule out the possibility that anxious distress may have a relationship with temperament associated with bipolar disorder.
Barriers to the Recognition of Geriatric Depression in Residential Care Facilities in Alberta
Published in Issues in Mental Health Nursing, 2020
As defined in the Diagnostic and Statistical Manual for Mental Disorders (DSM-V) (American Psychiatric Association [APA], 2013), clinically significant depression can be diagnosed if five to nine following symptoms are present during at least two weeks: 1) depressed mood; 2) loss of interest or pleasure in activities; 3) changes in weight or appetite; 4) changes in sleep patterns; 5) psychomotor agitation or retardation; 6) low energy; 7) feelings of worthlessness; 8) poor concentration; and 9) recurrent suicidal ideation or suicide attempt (APA, 2013). Either depressed mood or loss of interest and pleasure in activities, or both symptoms, must be present. Typically, presence of five to six symptoms indicates mild depression, manifested by mild impairment in functioning (Zuckerbrot et al., 2007). When all nine symptoms are noted, depression and the associated impairment may be severe (Zuckerbrot et al., 2007). Moderate depression falls between these two categories. Older adults may experience depressive symptoms that do not fulfill the DSM-V criteria for clinically significant depression, for instance dysthymic disorder, subthreshold depression disorder, and depression due to dementia (Dillon et al., 2014). According to Zuckerbrot et al. (2007), it is important to pay attention to the less severe forms of depression in older adults who may be at risk for developing clinical depression in addition to facing multiple comorbidities, high levels of stress, and social isolation without being diagnosed and treated (Hasche, Lee, Choi, Proctor, & Morrow-Howell, 2013).
Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement
Published in Scandinavian Journal of Gastroenterology, 2020
Rui de Sousa Magalhães, Tiago Cúrdia Gonçalves, Bernardo Sousa-Pinto, Bruno Rosa, Carla Marinho, José Cotter
As a secondary endpoint, we addressed early PEG dislodgement. Gastrostomy tract formation requires at least 3 weeks for full maturation [8,12]. Accidental PEG tube removal before this timing may imply the greatest impact on morbidity and mortality, with increased risk of peritonitis, sepsis and a rapid decline in patient health status [17,24]. As mentioned above, several cohorts analyzed early PEG dislodgement events one or two weeks after PEG insertion [13,14]. We considered early dislodgement as on occurring before 3 weeks after PEG intervention, aiming for the 3 weeks of gastrostomy maturation. We report a rate of 7.9%, 13 events of early dislodgement, a rate similar to the literature, bearing in mind the disparity of definition of ‘early PEG dislodgement’. Living in a nursing home, dementia and cerebrovascular disease were associated with early PEG dislodgement. We also report a statistical marginal association regarding psychomotor agitation (Table 4). It is important to notice that, in our practice, all patients that underwent early dislodgment were hospitalized and thoroughly monitored until the full closure of the gastro-cutaneous fistula (not fully matured, as stated above). They were discharged with a nasogastric feeding, and further plan management was decided at follow-up appointments. We do not report major complications developed by early dislodgments, namely, peritonitis or death.