The Degree of Uncertainty
Reviewed by Poonam Sachdev on February 18, 2022
Video Transcript
[MUSIC PLAYING]
DR. LAURENCE ADAMS: I think trying as much as possible to be very honest with the patient about the uncertainty of prognosis, whether or not how much we're going to be able to make it better, how much-- the natural history of it, whether it's going to resolve on its own or not, that we just can't be terribly positive with that all the time. But I think if the patient understands that, that's a really big deal.
I think it's very important to explain as much as possible what options that we have, as far as helping you. The options primarily are medical, directly treating it with monoamine depleters, with medications which decrease the amount of dopamine. So, therefore, of course take the stress off the hypersensitive, dopaminergic receptors.
Well, second of all, other medications, which can calm the movements oftentimes don't stop the movements, but at least calm them and could perhaps help the pain associated with them. I think that they need to have a very good understanding of where we stand with the medications that caused it, to begin with. And there are times that stopping those medications, first of all, doesn't guarantee the problem will get better. In fact, frequently, it does not. But second of all, oftentimes, those medicines are required for their continued psychiatric care.
We have other things that we can explore such as botulinum toxin. It can be helpful for the symptoms and things like that. But the really big deal here is in understanding, I think, from the patient's point of view, that our job is not necessarily to erase these movements. We can sometimes do that, but sometimes, this is very much of the perfect is the enemy of good, the side effects that you get from the erasing the movements.
That it's important to stick with the treatment plan simply because you don't want to put more pressure on those already hypersensitive, dopaminergic receptors. That's a really big deal. For example, at times, the treatment is trying to remove or change the neuroleptic, which is causing that. If the patient doesn't stick with that plan, sometimes, you can actually make those receptors even more hypersensitive and actually aggravate the problem. This is one particular case where sticking with such a treatment plan is important. And I think that's a very important point to explain that.
DR. LAURENCE ADAMS: I think trying as much as possible to be very honest with the patient about the uncertainty of prognosis, whether or not how much we're going to be able to make it better, how much-- the natural history of it, whether it's going to resolve on its own or not, that we just can't be terribly positive with that all the time. But I think if the patient understands that, that's a really big deal.
I think it's very important to explain as much as possible what options that we have, as far as helping you. The options primarily are medical, directly treating it with monoamine depleters, with medications which decrease the amount of dopamine. So, therefore, of course take the stress off the hypersensitive, dopaminergic receptors.
Well, second of all, other medications, which can calm the movements oftentimes don't stop the movements, but at least calm them and could perhaps help the pain associated with them. I think that they need to have a very good understanding of where we stand with the medications that caused it, to begin with. And there are times that stopping those medications, first of all, doesn't guarantee the problem will get better. In fact, frequently, it does not. But second of all, oftentimes, those medicines are required for their continued psychiatric care.
We have other things that we can explore such as botulinum toxin. It can be helpful for the symptoms and things like that. But the really big deal here is in understanding, I think, from the patient's point of view, that our job is not necessarily to erase these movements. We can sometimes do that, but sometimes, this is very much of the perfect is the enemy of good, the side effects that you get from the erasing the movements.
That it's important to stick with the treatment plan simply because you don't want to put more pressure on those already hypersensitive, dopaminergic receptors. That's a really big deal. For example, at times, the treatment is trying to remove or change the neuroleptic, which is causing that. If the patient doesn't stick with that plan, sometimes, you can actually make those receptors even more hypersensitive and actually aggravate the problem. This is one particular case where sticking with such a treatment plan is important. And I think that's a very important point to explain that.
