Abstract：
BACKGROUND: 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.
OBJECTIVE: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：咨询联络（CL）精神科医生经常被要求就各种异常运动进行咨询（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。在这份手稿中,我们提供一例出现肌阵挛症的患者的说明性病例,并对这一重要主题进行综述.伴有谵妄的肌阵挛症是一种罕见的移植后并发症，可能与发病率和死亡率升高有关。这种并发症在实体器官移植（SOT）受者中的发生率几乎没有记录，其病理生理学仍未得到充分理解。重症监护病房（ICU）的潜在病因很多，并且可能是多因素的。文献缺乏对肌阵挛症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多式联运方法，专注于解决潜在的代谢紊乱并提供对症治疗。
目的：本手稿描述了肝移植受者肌阵挛症的临床表现，伴有谵妄和尿毒症。我们的目标是突出诊断和治疗的复杂性，帮助提供者区分肌阵挛症与其他运动障碍，并协助适当的管理。
结果：我们介绍一例老年女性肝移植受者因尿毒症而出现急性肌阵挛症，并在连续肾脏替代治疗后得到改善。此外,我们利用EMBASSE和PubMed对报道的肌阵挛症病例进行了系统评价，谵妄,和/或伴有尿毒症的脑病。我们在评论中包括了12份手稿，并讨论了他们的发现。
结论：ICU中的一系列运动障碍经常咨询CL精神科医生，包括肌阵挛症.在这些情况下，准确诊断和确定病因至关重要。管理通常涉及解决潜在的疾病，比如用透析治疗尿毒症，同时使用苯二氮卓类药物进行对症治疗，以减轻肌阵挛症的频率和幅度。这种方法有助于减轻与病症相关的身体负担和心理困扰。这个案例强调了CL精神病学家在一个复杂的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。
目的：本手稿描述了肝移植受者肌阵挛症的临床表现，伴有谵妄和尿毒症。我们的目标是突出诊断和治疗的复杂性，帮助提供者区分肌阵挛症与其他运动障碍，并协助适当的管理。
结果：我们介绍一例老年女性肝移植受者因尿毒症而出现急性肌阵挛症，并在连续肾脏替代治疗后得到改善。此外,我们利用EMBASSE和PubMed对报道的肌阵挛症病例进行了系统评价，谵妄,和/或伴有尿毒症的脑病。我们在评论中包括了12份手稿，并讨论了他们的发现。
结论：ICU中的一系列运动障碍经常咨询CL精神科医生，包括肌阵挛症.在这些情况下，准确诊断和确定病因至关重要。管理通常涉及解决潜在的疾病，比如用透析治疗尿毒症，同时使用苯二氮卓类药物进行对症治疗，以减轻肌阵挛症的频率和幅度。这种方法有助于减轻与病症相关的身体负担和心理困扰。这个案例强调了CL精神病学家在一个复杂的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。
