PubMed Health⌕ Search

Biomedical subjects

M R Munetz

Publications and source records attributed to M R Munetz.

At least 37 records · Page 2Linked to original sources
PubMed1990

Who should perform the AIMS examination?

Psychiatrists and nonphysician mental health professionals working in community mental health centers have difficulty establishing the scope of their expertise, defining the limits of their roles, delegating responsibility, and sharing professional liability. The clinical, political, and administrative aspects of these tensions are examined in the context of arguments for and against physicians' delegating to nonphysician mental health professionals the task of screening CMHC patients for tardive dyskinesia using the Abnormal Involuntary Movement Scale. In 43 percent of mental health centers in Massachusetts surveyed by the authors, nonphysicians perform tardive dyskinesia screening. The authors suggest that the benefits of involving nonphysicians in tardive dyskinesia screening in the CMHC setting outweight the disadvantages.

Antipsychotic Agents↗
PubMed1988

How to examine patients using the Abnormal Involuntary Movement Scale.

The Abnormal Involuntary Movement Scale (AIMS) examination has been widely recommended for periodic screening for tardive dyskinesia and follow-up of patients diagnosed with the disorder. However, few guidelines exist about how to use the examination in clinical practice. The authors discuss for whom, when, and how the AIMS examination can be used in a multidisciplinary setting; amplify the original instructions for the examination; and propose conventions to clarify scoring. Noting that the AIMS examination is not specific for tardive dyskinesia, they discuss a clinical approach to the patient who is found to have abnormal movements. The AIMS examination is best conducted within the context of an ongoing treatment program, the authors say, and should be part of the informed consent process necessary with patients treated with neuroleptic drugs.

Antipsychotic Agents↗
PubMed1986

Minimization and overreaction to tardive dyskinesia.

Psychiatry's response to the risk of tardive dyskinesia (TD) from long-term neuroleptic drug use continues to swing from one extreme (overreaction) to the other (minimization or denial). The potential negative effects on psychiatric practice of these extreme responses are reviewed. We suggest that while concerns about litigation may partially account for the continued overreaction and minimization, a more fundamental explanation is psychiatry's continuing inability to integrate itself fully as a medical discipline. We suggest that four basic concepts about schizophrenia and its long-term treatment need to be accepted before TD can be responded to objectively: schizophrenia is a serious brain disease; neuroleptics are helpful when properly used; there are limits to the value of neuroleptic drugs in the treatment of schizophrenia; and neuroleptic drugs can cause serious side effects.

Antipsychotic Agents↗
PubMed1986

Screening for tardive dyskinesia.

A program of routine Abnormal Involuntary Movement Scale (AIMS) examinations is contrasted with a referral system for detection of tardive dyskinesia in an outpatient schizophrenia clinic. Routine clinical use of the AIMS examination may have improved the early detection of tardive dyskinesia, which could result in a decrease in the morbidity associated with this disorder. Routine AIMS examinations also facilitated repeat discussions with patients about tardive dyskinesia, which provide an opportunity to obtain ongoing informed consent for treatment with neuroleptics.

Ambulatory Care↗
PubMed1985

Informing patients about tardive dyskinesia.

The effects of a formal (written) approach v an informal (oral) approach to obtaining informed consent for neuroleptic treatment were compared in 25 schizophrenic outpatients with tardive dyskinesia. Both groups had significant increases in knowledge, but only the informal/oral presentation group retained significant new knowledge at two-month follow-up. Overall, patients did not learn the information deemed most relevant for rational decision making about neuroleptic treatment. Younger patients started out with more knowledge and retained significant new knowledge at follow-up. All study patients remained in treatment and all but one remained on neuroleptic regimens. There was no increase in relapse or treatment noncompliance in the study population compared with a comparison group. While information about tardive dyskinesia can be safely disclosed to schizophrenic outpatients, such disclosure is evidently most meaningful when repeated informally in the context of a therapeutic relationship.

Adult↗
PubMed1985

Overcoming resistance to talking to patients about tardive dyskinesia.

The American Psychiatric Association's task force report on tardive dyskinesia recommends that when a clinician wishes to prescribe a maintenance regimen of neuroleptic drugs, patients and families be advised of the risks and benefits so that a mutual decision can be made. However, there is significant resistance to talking to patients about tardive dyskinesia. The author reviews institutional, clinician, and patient sources of this resistance and describes ways that obstacles to obtaining informed consent can be overcome. He concludes that with strong institutional support, clinicians functioning as a team can learn to view patient education and involvement in decision-making as an integral part of treatment.

Antipsychotic Agents↗
PubMed1985

Informed consent and incompetent medical patients.

The mentally incapacitated patient is frequently encountered in the general medical hospital. Incapacity is the clinical state in which a patient is unable to participate in a meaningful way in medical decisions. Mentally incapacitated patients relinquish the authority, that is the competent patient's right, to choose among professionally acceptable alternative treatments. Such patients, therefore, require a surrogate decision-maker. There are certain clinical situations in which questions of incapacity are especially important to consider. In a study for the President's Commission for the Study of Ethical Problems in Medical Biomedical and Behavioral Research, the most common problem in recognizing incapacity was found with previously capable patients who became transiently incapacitated during the course of hospitalization. Questions of incapacity or the authority of surrogate decision-makers also arose with comatose, mentally retarded, mentally ill, and physically handicapped patients. While standards to determine capacity remain unclear, a practical approach is to demonstrate that a patient is able to describe the physician's view of the situation and to understand the physician's opinion as to the best intervention. When a patient is deemed to be incapacitated, the physician should turn to family members, whenever possible, to make decisions.

Aged↗
PubMed1984

Pharmacogenic depression among outpatient schizophrenic patients: a failure to substantiate.

Impaired affect in recovering schizophrenic patients has been viewed as either an integral part of the disease, a postpsychotic depression, or, increasingly, as a pharmacogenically determined effect secondary to the use of antipsychotics. Two months following hospital discharge, operationally defined groups of "depressed" and "not depressed" drug-treated and nonrelapsed schizophrenic patients were randomly assigned to chlorpromazine or placebo and followed for 4 months. Among depressed schizophrenic patients, there was no evidence that drug either contributes to the depression or that depressive signs are primarily extrapyramidal symptom phenomena (akinesia). Equal numbers of nondepressed patients on drug and placebo manifested a subsequent postpsychotic depression.

Adolescent↗
PubMed1983

Barriers to informed consent.

The law of informed consent seeks to actively involve patients in decision making. Most authorities agree that this involvement has not occurred but disagree about why. Some suggest that patients are incapable of understanding medical issues and others that physicians have not explained issues clearly or extensively enough. We observed decision making in several hospital settings and found other significant barriers to patient participation. These barriers include the fact that treatment decisions take place over a long period; there are often many decisions to be made; although patients want information about treatment, they typically believe that decision making is the physician's task; physicians do not understand the rationale for the patient's role in decisions; and the medical decision-making process often involves so many people that the patient does not know who is responsible.

Aged↗
PubMed1983

Distinguishing akathisia and tardive dyskinesia: a review of the literature.

Akathisia and tardive dyskinesia, both side effects of neuroleptic drugs, should be easily distinguishable. Akathisia is fundamentally a subjective disorder characterized by a desire to be in constant motion resulting in an inability to sit still and a compulsion to move. Tardive dyskinesia is an involuntary movement disorder characterized by repetitive purposeless movements which typically involve the buccolingual masticatory areas but which can include choreoathetoid limb movement. Clinicians, however, are not always able to distinguish akathisia and tardive dyskinesia. The authors review the literature on akathisia and tardive dyskinesia in an attempt to understand the basis for this diagnostic confusion. They suggest six areas of inquiry which may help in distinguishing the two disorders: (1) the nature of the subjective distress, (2) the voluntary or involuntary nature of the movements, (3) the time of onset of the disorder, (4) the location of signs and symptoms, (5) the presence of other extrapyramidal symptoms, and (6) the response to pharmacologic interventions. In addition to diagnostic confusion, the literature review suggests an association between akathisia and tardive dyskinesia. Because this association is poorly understood, three possibilities are suggested: (1) The occurrence of akathisia may predispose to subsequent tardive dyskinesia; (2) Akathisia may evolve into tardive dyskinesia; and/or (3) There may be a third group of disorders, distinct from akathisia and tardive dyskinesia, which the authors call tardive akathisia. Each of these possibilities are discussed.

Anti-Anxiety Agents↗