10. Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine. 1995; 20 :722–8. doi: 10.1097/00007632-199503150-00014. [PubMed ] 17. Hislop HJ, Montgomery J. Muscle testing. 6th ed. Philadelphia: W.B. Saunders; 1995. 24. Stephens JH, Richard P, McHugh PR. Suicide in patients hospitalized for schizophrenia: 1913–1940. J Nerv Ment Dis. 1999; 187 :10–4. [PubMed ] 16. Lewis J, Green A, Reichard Z, Wright C. Scapular position: the validity of skin surface palpation. Man Ther. 2002; 7 :26–30. doi: 10.1054/math.2001.0405. [PubMed ] Nirtal Shah, PT, MSc, DPT, MTC, FAAOMPT, FCAMT, CAFCI: Physical therapist, David L. MacIntosh Sport Medicine Clinic, University of Toronto, Toronto, Ontario. The authors have no commercial or financial association that might pose a conflict of interest in connection with this manuscript. Based on the findings from the patient interview and the signs and symptoms of psychiatric disorders, I explained to the patient that there was a need for further medical investigation. Although the patient did not agree with this initial assessment, he did consent to a follow-up with the referring physician. The signs and symptoms of schizophrenia are classified as either positive or negative. 22 Positive symptoms are an excess of normal function and include delusions, hallucinations pro essays, and disorganized speech; 22 ,27 negative symptoms are a deficiency of normal function and include limited goal-directed behaviour (avolition), limited fluency and productivity of speech and thought, and a flat affect. 22 ,27 The diagnosis of schizophrenia requires the presence of at least two of these positive or negative symptoms lasting at least 6 months. 22 ,27 In this case publishing a dissertation in a journal, the patient presented with delusions (e.g. electrical implants trying to control his and others' actions), including persecutory delusions (e.g. “they are emotionally abusing me”), hallucinations (e.g. hearing voices, seeing signs), and a flat affect. Since the patient was enrolled in university at the time of diagnosis, his cognitive function is assumed to be well preserved. The patient reported no change in symptoms for 2 years. Implication : Cette étude de cas vient réaffirmer l'importance, pour le physiothérapeute, de procéder à des entrevues approfondies avec les patients pour s'assurer qu'il n'y a pas d'autres problèmes que les seules dysfonctions musculosquelettiques. Les patients qui souhaitent obtenir une évaluation et un traitement musculosquelettique peuvent souffrir aussi d'un problème psychiatrique primaire ou secondaire non diagnostiqué qui exige d'être reconnu par le physiothérapeute et qui nécessitera vraisemblablement une attention médicale ultérieure. Special tests were negative for the sulcus sign, Speed's test, the drop arm test, and the empty can test, as described by Magee. 14 Research shows that Speed's test has a sensitivity and specificity of 32% and 61% for biceps and labral pathology respectively; 20 the drop arm test has a sensitivity of 27% and a specificity of 88% as a specific test for rotator cuff tears, and the empty can test has a sensitivity of 44% and a specificity of 90% in diagnosing complete or partial rotator cuff tears. 20 ,21 The Neer and Hawkins-Kennedy impingement tests were both negative. 14 According to a meta-analysis by Hegedus et al. the Neer test is 79% sensitive and 53% specific, while the Hawkins-Kennedy test is 79% sensitive and 59% specific do kids want more homework, for impingement. 21 43. Gater R, Jordanova V, Maric N, Alikaj V, Bajs M, Cavic T. Pathways to psychiatric care in Eastern Europe. Brit J Psychiatr. 2005; 186 :529–35. doi: 10.1192/bjp.186.6.529. [PubMed ] 25. Varma VK, Wig NN, Phookun HR, Misra AK, Khare CB, Tripathi BM, et al. First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology. Acta Psychiatr Scand. 2007; 96 :431–8. doi: 10.1111/j.1600-0447.1997.tb09944.x. [PubMed ] Mesures et résultats : L'évaluation préliminaire du physiothérapeute a permis d'identifier un problème qui nécessitait que le patient soit redirigé vers un médecin. Une gestion plus poussée de la dysfonction musculosquelettique de ce patient a été jugée inappropriée à cette étape. 7. Haggman S, Maher CG, Rafshauge KM. Screening for symptoms of depression by physical therapists managing low back pain. Phys Ther. 2004; 84 :1157–66. [PubMed ] The patient's past medical and family history were unremarkable. He did not use any prescription or over-the-counter medications, but he felt his thoughts about electrical implants were decreased by the use of marijuana, which he used socially. He was a non-smoker and a social consumer of alcohol. He had a normal gait and appeared comfortable in an unsupported seated position. He denied any weight changes, bowel or bladder problems, night pain, or difficulty breathing. 22. First MB. Diagnostic and statistical manual of mental health text revisions. 4th ed. Washington: American Psychiatric Association; 2000. [DSM-IV-TR] I was concerned about a serious pathology or a psychological disorder, given that this 19-year-old had made 10 medical appointments over 22 months for 6 different regions of the body; in my experience of examining and treating patients between the ages of 18 and 25, the frequency of the appointments and the variation in afflicted body parts are not typical of a young patient. The patient's description of his shoulder pain, in terms of location and severity, was not reproducible by physical examination. Throughout our interview, the patient did not maintain good eye contact, spoke in a monotone voice, and had an overall flat affect. Even when he described his beliefs about implants and government control, his voice and demeanour remained expressionless. The patient described persecutory delusions, command hallucinations, and social isolation from friends and family, all of which are signs of psychosis according to the Diagnostic and Statistical Manual of Mental Health. 22 35. Lawrie SM, Abukmeil SS. Brain abnormalities in schizophrenia: a systematic and quantitative review of volumetric magnetic resonance imaging studies. Brit J Psychiatr. 1998; 72 :110–20. doi: 10.1192/bjp.172.2.110. [PubMed ] Although various models of primary-care physical therapy have demonstrated physical therapists' expertise in the realm of neuromusculoskeletal dysfunctions, there is a need for increased competencies in academic, clinical psychology term paper example, and affective domains. 5 Few et al. propose a hypothesis-oriented algorithm for symptom-based diagnosis through which physical therapists can arrive at a diagnostic impression. 11 This algorithm takes into account the various causes of pathology, including psychogenic disorders. 11 Although additional research is necessary to validate Few et al.'s algorithm, it provides one model that considers underlying pathologies in determining the appropriateness of physical therapy intervention. 11 The present case report further illustrates the importance of considering the patient's affective and psychological state in order to more effectively screen for and identify psychiatric disorders that require medical referral. The physician examined the patient, made similar observations, concurred with my assessment, and concluded that the patient was experiencing some form of psychosis. The plan of care involved referral to a psychiatrist, follow-up with the physician, and explaining to the patient that physical therapy would not be appropriate at this time because of the presence of a serious psychiatric disorder. The patient did not believe that he had a psychiatric disorder, but he was willing to follow up with a psychiatrist. The physician noted that the patient was not a threat to himself or others and that he did not report having homicidal or suicidal thoughts. 40. Alnwick GM. Misdiagnosis of serotonin syndrome as fibromyalgia and the role of physical therapy. Phys Ther. 2008; 88 :757–65. [PubMed ] 23. Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Brit J Psychiatr. 1998; 172 :35–7. doi: 10.1192/bjp.172.1.35. [PubMed ] Manual muscle testing based on Hislop and Montgomery revealed 4/5 strength of external rotation at 0° and 45° of abduction, with pain reported along the anterolateral shoulder. 17 Testing also showed 3/5 strength and no pain with resisted abduction with the arm at the side at approximately 30° of abduction. 18 Manual muscle testing is a useful clinical assessment tool, although a recent literature review suggested that further testing is required for scientific validation. 18 Palpation of the shoulder, as described by Hoppenfeld, revealed slight tenderness over the greater tubercle, as well as along the length of the levator scapula muscle. 19 The aetiology of schizophrenia remains unknown. 29 ,30 There is a strong genetic predisposition. 29 ,30 Patients who experience the onset of schizophrenia before age 22 are 10 times more likely to have a history of a complicated caesarean birth than patients with a later onset of schizophrenia, which suggests a possible neurodevelopmental factor in early-onset schizophrenia. 31 Mild childhood head injuries may play a role in the expression of schizophrenia in families with a strong genetic predisposition to this disorder. 32 Psychological stress has also been implicated in the onset of schizophrenia, since it often precipitates the first psychotic episode or increases the likelihood of a relapse. 33 ,34 In this case, the patient described a family “break-up” which may have precipitated the onset of psychosis. Details about his childhood head injuries and the circumstances of his birth were not obtained. After being diagnosed with schizophrenia, the patient revealed to the referring physician that his father had experienced something similar when he was younger, which may point to a genetic predisposition. Copyright © Canadian Physiotherapy Association, 2010. All rights reserved. In the frontal plane free example of term papers, the right scapula was abducted four finger-widths from the mid-thoracic spine, and the left scapula was abducted three finger-widths. The scapulas were superiorly rotated bilaterally. Surface palpation of the acromial angle, inferior angle, and spine of the scapula differed less than 0.98 cm, 0.46 cm, and 0.67 cm, respectively, from the actual bony location, with a 95% confidence interval. 16 There was visible hypertrophy of the pectoralis major muscle bilaterally. Active and passive ROM were tested for the shoulders as recommended by Magee. 14 The patient had full bilateral active ROM, with minimal pain at end-range flexion and abduction that was not increased with overpressure in accordance with Magee. 14 He had full passive ROM with no pain reported. As demonstrated by the World Health Organization's International Classification of Functioning, Disability and Health, it is imperative to take an individual's psychological state into account, since disorders in this area can lead to disability. 6 Many psychiatric conditions are commonly encountered in physical therapy practice; for example, depression, anxiety do my university assignment for me, and fear-avoidance have all been associated with low back, neck, and widespread musculoskeletal pain. 7 –9 These psychiatric disorders have been identified both as risk factors for musculoskeletal dysfunction and as an important secondary psychosocial aspect of disablement. 7 –10 It is therefore important for physical therapists to consider the primary and secondary roles of psychopathology in disability. 31. Verdoux H, Geddes JR, Takei N, Lawrie SM, Bovet P, Eagles JM university admission essay writing, et al. Obstetric complications and age at onset in schizophrenia: an international collaborative meta-analysis of individual patient data. Am J Psychiatr. 1997; 154 :1220–7. [PubMed ] Measures and outcome: The physical therapist's initial assessment identified a disorder requiring medical referral. Further management of the patient's musculoskeletal dysfunction was not appropriate at this time. The patient was a 19-year-old male university student. His recreational activities included skateboarding, snowboarding, break dancing, and weight training. The patient first sought medical attention from a sport medicine physician in January 2006, when he reported right lateral wrist pain since falling and hitting the ulnar aspect of his wrist while skateboarding in October 2005. Plain film radiographs taken after the injury were negative, and the patient did not receive any treatment. The physician found no wrist swelling, minimal tenderness over the ulnar aspect of the right wrist, full functional strength, and minimally restricted range of motion (ROM). The patient was given ROM exercises and was diagnosed with a right wrist contusion. 41. Ross MD, Cheeks JM. Undetected hangman's fracture in a patient referred for physical therapy for the treatment of neck pain following trauma. Phys Ther. 2008; 88 :98–104. doi: 10.2522/ptj.20070033. [PubMed ] 48. Hodges B, Inch C, Silver I. Improving the psychiatric knowledge, skills, and attitudes of primary care physicians, 1950–2000: a review. Am J Psychiatr. 2001; 158 :1579–86. doi: 10.1176/appi.ajp.158.10.1579. [PubMed ] After his tenth visit to a physician, the patient was referred for physical therapy for chronic right levator scapula strain and right supraspinatus strain. During the interview, the patient stated that he had right shoulder pain because of a snowboarding injury sustained 1 year earlier and because of a fall onto the lateral right shoulder 2 years ago. Aggravating activities to the shoulder included pull-ups, rowing, and free weights. No position or movement alleviated his pain, and the pain did not fluctuate over the course of the day. His sleep was disturbed only when lying on the right shoulder. The patient was in generally good health, but he said that his right wrist and left knee occasionally felt cold for no apparent reason. He denied experiencing any loss of sensation, decreased blood flow, or numbness or tingling in the knee and wrist. The patient said he believed that his knee and wrist became cold as a result of electromagnetic impulses sent to the joint via an electrical implant in his body and that this device was the cause of his ongoing shoulder pain. 20. Cools AM, Cambier D, Witvrouw EE. Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology. Brit J Sport Med. 2008; 42 :628–35. doi: 10.1136/bjsm.2008.048074. [PubMed ] Sally is a young girl suffering from schizophrenia. Schizophrenia is a psychotic disorder, or a group of disorders represented by a severe impairment of individual thought process, and behavior (TheFreeDictionary, 2012). According to Meyer, Chapman, and Weaver (2009) “it may be more accurate to refer to schizophrenia as a family of disorders rather than a singular disorder.” (p. 90). Untreated patients suffering from schizophrenia are normally unable to filter various sensory stimuli compare contrast essay topics for high school, and exhibit enhanced perception of color, sound, and other environmental factors. In most cases, a patient suffering from schizophrenia will gradually withdraw from personal interactions, and loose the ability to care for his or her individual basic needs (TheFreeDictionary, 2012). Schizophrenia is considered to be one of the top ten illnesses resulting in long-term disability, and accounts estimate that approximately 1% of the world population is affected by the illness (TheFreeDictionary research proposal writing service, 2012). Schizophrenia is a complex illness that affects both men and women on an equal level. The illness usually starts around the age of ten, or in young adulthood. However, cases of childhood-onset schizophrenia indicates that the illness can start as young as five years of age. This is a more rare case of schizophrenia that can difficult to diagnose in relation to other childhood developmental problems (PubMedHealth, 2012). While researchers have yet to discover the cause of schizophrenia, many suspect genetics to be a major contributor (PubMedHealth, 20120). As the patient matured, she displayed signs of being socially awkward and isolated from her peers, and in early adulthood started to display worsening symptoms like talking to herself, and displaying unusual behavior like stating at the floor for long periods. Her first documented schizophrenia episode requiring hospitalization occurred shortly after the additional symptoms started to be displayed. During her examination, the patient displayed signs of unresponsiveness, and waxy flexibility that allowed her limbs to be easily positioned (Meyer, Chapman, & Weaver, 2009). After the initial hospitalization, the patient was returned home to facilitate a quicker recovery. that was short lived because the patient failed to follow the prescribed treatment regimen which, resulted in a secondary episode shortly after her return to college. Further home-based treatments proved unsuccessful as the patient slowly declined, resulting in unresponsiveness, and displaying hebephrenic symptoms like unprovoked giggling, and rocking movements (Meyer, Chapman, & Weaver, 2009). The primary component of the patient’s episodes appear to be related to stress as the primary factor. However to write a essay, biological factors resulting from her mother’s illness and smoking during pregnancy, and a genetic predisposition related to her grandfather's eccentricity are viable underlying factors resulting in the patient’s illness. In addition to the primary stressor, and the underlying genetic and biological factors, it is possible that the emotions of the patient also contributed to her condition. Further documentation indicates that interfamilial expressed emotion, and communication deviance are probably contributors that appear to be operative in the patient’s case (Meyer, Chapman, & Weaver, 2009). The first of these factors, expressed emotion would be explained by the turbulent relationship, combined with her mother’s over protective nature conflicting with her father’s over critical reactions to the patient’s behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors, communication deviance resulted from the patient’s inability to focus and maintain normal dialog with others (Meyer, Chapman, & Weaver, 2009). Josh is a 27 year-old male who recently moved back in with his parents after his fiancée was killed by a drunk driver 3 months ago. His fiancée, a beautiful young woman he’d been dating for the past 4 years, was walking across a busy intersection to meet him for lunch one day. He still vividly remembers the horrific scene as the drunk driver ran the red light, plowing down his fiancée right before his eyes. He raced to her side, embracing her crumpled, bloody body as she died in his arms in the middle of the crosswalk. No matter how hard he tries to forget, he frequently finds himself reliving the entire incident as if it was happening all over. For the past few weeks Jessica has felt unusually fatigued and found it increasingly difficult to concentrate at work. Her coworkers have noticed that she is often irritable and withdrawn good cover letter for job application, which is quite different from her typically upbeat and friendly disposition. She has called in sick on several occasions, which is completely unlike her. On those days she stays in bed all day, watching TV or sleeping. Kristen is a 38 year-old divorced mother of two teenagers. She has had a successful, well-paying career for the past several years in upper-level management. Even though she has worked for the same, thriving company for over 6 years, she’s found herself worrying constantly about losing her job and being unable to provide for her children. This worry has been troubling her for the past 8 months. Despite her best efforts, she hasn’t been able to shake the negative thoughts. These sample case studies are for illustration only. They should not be used to make a diagnosis. If the symptoms sound similar to those that you (or a loved one) are experiencing, please contact your primary physician or a mental health professional for an evaluation as soon as possible.
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