Dalhousie University, Halifax, Nova Scotia.
Can J Neurol Sci. 2012 Nov;39(6):782-8. doi: 10.1017/s0317167100015614.
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.
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.
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.
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.
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.
异常运动常与精神疾病有关。这些运动的优化管理和诊断依赖于正确的标记。然而，有证据表明这些运动的标记准确性降低，这可能导致护理效果不佳。
确定运动障碍神经科医生与来自社区的医生之间在存在共病精神疾病和运动障碍的个体的现象学和诊断方面的共识评估者间可靠性。
回顾性分析了 2001-2009 年间在联合运动障碍和神经精神病学诊所就诊的所有连续患者的病历。确定了每个患者的现象学和诊断术语的共识估计值和评估者间可靠性的kappa 值，以及各自的转诊来源和运动障碍神经科医生。
共回顾了 106 份病历（62 名男性和 44 名女性）。现象学术语的一致性范围从 0%（心因性）到 73%（震颤）。只有 3 个术语的kappa 值符合或超过评估者间可靠性的中度标准。迟发性运动障碍（83%）、药物引起的震颤（33%）和药物引起的帕金森病（20%）的诊断术语的一致性最高。在 22 份病历中的 18 份（82%），转诊医生做出了药物引起的运动障碍（DIMD）的诊断。相比之下，在诊所评估后，只有 106 份病历中的 54 份（51%）做出了 DIMD 的诊断。
运动障碍专家经常不同意转诊医生对患者现象学和诊断的识别。这表明临床医生将受益于教育资源，以帮助描述异常运动。
