Division of Medical Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
Division of Medical Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
J Acad Consult Liaison Psychiatry. 2024 Sep-Oct;65(5):471-481. doi: 10.1016/j.jaclp.2024.07.004. Epub 2024 Jul 27.
Consultation-liaison (CL) psychiatrists are frequently asked to consult on various abnormal movements (1). CL psychiatrists can be instrumental in aiding the primary teams to identify and manage these movement disorders. In this manuscript, we provide an illustrative case of a patient presenting with myoclonus and offer a review on this important topic. Myoclonus accompanied by delirium represents a rare post-transplant complication and can be associated with heightened morbidity and mortality. The incidence of this complication in solid organ transplant recipients is scarcely documented, and its pathophysiology remains inadequately understood. Potential etiologies in the intensive care unit are numerous and likely multifactorial. The literature lacks detailed descriptions of the correlation and association between myoclonus and uremia. Management of this condition requires a multimodal approach, focusing on resolving underlying metabolic disturbances and providing symptomatic treatment.
This manuscript describes the clinical presentation of myoclonus in a liver transplant recipient accompanied by delirium and precipitated by uremia. We aim to highlight the diagnostic and therapeutic complexities, help providers distinguish myoclonus from other movement disorders, and aid appropriate management.
We present a case of acute myoclonus in an elderly female liver transplant recipient precipitated by uremia and improved after continuous renal replacement treatment. In addition, we conducted a systematic review utilizing EMBASSE and PubMed of reported cases of myoclonus, delirium, and/or encephalopathy accompanied by uremia. We included 12 manuscripts in our review and discussed their findings.
CL psychiatrists are frequently consulted for a range of movement disorders in the intensive care unit, including myoclonus. Accurate diagnosis and identification of contributing etiologies are critical in these cases. Management typically involves addressing the underlying disorder, such as using dialysis for uremia, alongside symptomatic treatment with benzodiazepines to mitigate the frequency and amplitude of myoclonus. This approach helps to alleviate both the physical burden and psychological distress associated with the condition. This case underscores the pivotal role of the CL psychiatrist within a complex multidisciplinary team, contributing to diagnostic precision and optimization of management strategies for movement disorders.
会诊联络（CL）精神科医生经常被要求会诊各种异常运动（1）。CL 精神科医生可以帮助主要团队识别和管理这些运动障碍。在本文中，我们提供了一个以肌阵挛为表现的患者的说明性病例，并对这个重要的主题进行了回顾。伴有谵妄的肌阵挛代表一种罕见的移植后并发症，可与更高的发病率和死亡率相关。实体器官移植受者中这种并发症的发生率很少有记录，其病理生理学仍未得到充分理解。在重症监护病房中，潜在的病因很多，可能是多因素的。文献缺乏关于肌阵挛与尿毒症之间的相关性和关联的详细描述。这种情况的管理需要采用多模式方法，重点解决潜在的代谢紊乱，并提供对症治疗。
本文描述了一名肝移植受者在尿毒症的诱发下出现肌阵挛伴谵妄的临床表现。我们旨在强调诊断和治疗的复杂性，帮助提供者区分肌阵挛与其他运动障碍，并有助于进行适当的管理。
我们介绍了一例老年女性肝移植受者因尿毒症引起的急性肌阵挛，在接受连续肾脏替代治疗后得到改善。此外，我们使用 EMBASSE 和 PubMed 对伴有尿毒症的肌阵挛、谵妄和/或脑病的病例进行了系统回顾。我们共纳入了 12 篇文献，并讨论了他们的发现。
CL 精神科医生经常被咨询各种在重症监护病房中的运动障碍，包括肌阵挛。在这些病例中，准确的诊断和识别促成因素至关重要。管理通常包括解决潜在的疾病，如使用透析治疗尿毒症，同时使用苯二氮䓬类药物对症治疗以减轻肌阵挛的频率和幅度。这种方法有助于减轻与该病症相关的身体负担和心理困扰。该病例突出了 CL 精神科医生在复杂多学科团队中的关键作用，有助于提高运动障碍的诊断精度和优化管理策略。
