title: Diagnostic challenges revealed from a neuropsychiatry movement disorders clinic.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dalhousie University, Halifax, Nova Scotia.
authors.forename: Heather
authors.initials: H
authors.lastname: Rigby
authors.forename: Angela
authors.initials: A
authors.lastname: Roberts-South
authors.forename: Hrishikesh
authors.initials: H
authors.lastname: Kumar
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cortese
authors.forename: Mandar
authors.initials: M
authors.lastname: Jog
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis*; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications* / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult