786 - Discerning cervical pathology versus psychiatric overtones and medication side effects in a hospital rehab setting utilizing Functional Abilities and Goals scoring

Case Diagnosis: Schizophrenia; Drug Side effects; Cervical Pathology

Case Description: This case involves an elderly male who self-admitted to a psychiatric facility due to intrusive thoughts and delusions. He also became immobile and unable to care for himself and even developed a sacral pressure ulcer. His course further included dehydration and hypotension. He was then transferred to an acute care facility where he had an assisted fall due to ongoing impaired function. He had episodes of hyperglycemia, and his doxazosin was increased due to urinary retention secondary to presumed benign prostatic hypertrophy. Behavioral health followed and did not recommend return to the inpatient psychiatric unit. He was started on abilify and zoloft and referred to inpatient rehabilitation since he also had concomitant psychomotor retardation and somewhat catatonic features and diminished vocalization. Later he was noticed to stop using his arm and also became dependent with lying to sitting on the side of the bed.

Discussions: At baseline his Functional Abilities and Goals scores were low, and he continued to have psychomotor abnormalities confounded by schizophrenia, while his physical exam remained largely unchanged throughout his hospitalization without obvious significant upper or lower motor neuron findings. There was also concern for worsening psychomotor drug side effect from the abilify. He underwent further tests ruling out conditions and of most significance was found to have moderate to severe multilevel degenerative changes, with severe spinal stenosis C3-4 through C5-6. EMG was unable to be performed and he underwent cervical decompression with subsequent clinical improvement.

Conclusions: We'll review literature on psychiatric conditions and psychomotor impacts on functional mobility and discuss psychiatric drug side effects such as abilify as well as incorporate these factors on further discussion of cervical pathology and utilizing Functional abilities and Goals scoring to guide if additional investigations are needed to explore treatments sooner in complex psychiatric cases.