Psychogenic movement disorders and other conversion. Psychogenic movement disorders in childhood have been little researched. Bhatia, frcp1 1sobell department of motor neuroscience and movement disorders, institute of neurology, queen square, london, united kingdom. Gender and age determinants of psychogenic movement. This book provides a stepbystep guide to understanding and treating psychogenic voice disorder by combining speech and language therapy with skills drawn from the field of cognitive behaviour therapy cbt. In neurology, other such disorders include psychogenic nonepileptic seizures, paralysis, sensory loss, visual loss, aphonia and even loss of identity.
Psychogenic movement disorders and motor conversion. Functionalpsychogenic movement disorders fpmds, are a. Dsm diagnostic and statistical manual of mental disorders, 4th. Frontiers functional or psychogenic movement disorders. According to the diagnostic and statistical manual of mental disorders, it requires an identifiable trigger. Documents on this evaluation process should be kept as part of the institutional file on the movement disorder fellowship.
Psychogenic movement disorders pmds are movement disorders of presumed psychological cause. The electrophysiological findings were consistent with previous reports of psm. Symptoms can mimic the full range of organic abnormal involuntary movements, a. Psychogenic movement disorders are a heterogeneous group of conditions characterised by functional motor symptoms that cannot be attributed to any known neurological pathologies. About 2% to 3% of new visits to movement disorder specialists are for psychogenic movement disorders, 2,3 most of which are conversion disorders. Psychogenic movement disorders amitabh gupta and anthony e. Lang editor, joseph jankovic editor, stanley fahn editor, peter w. A simplified version of the psychogenic movement disorders.
In addition some patients may have bizarre gait or difficulties with their balance that are caused by underlying stress or some psychological. Generally, psychogenic pain causes the following symptoms. Patients may have astasiaabasia, characterized by the ability to maintain good balance despite bizarre swaying and contortions of the body. Psychogenic pain is a pain disorder associated with psychological factors. International parkinson and movement disorder society 555 east wells street, suite 1100, milwaukee wi 532023823 usa tel. For reporting frequencies and mean scores, each of the three raters scores was considered independently. Characteristics may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction andor body part affected, and greatly decreased or disappearing tremor. Wency leung health reporter published march 4, 20 updated may 11, 2018.
Chorea, ataxia, other movement disorders the movement disorder. Lang introduction psychogenic movement disorders pmds are movement disorders that result from a psychological or psychiatric rather than neurological disturbance. Functional psychogenic movement disorders are a common source of disability and distress. Four signs of gait impairment have been documented in the course of examining patients with clinically definite functional psychogenic movement disorders. Abstract the facial phenotype of psychogenic movement disorders has not been fully characterized. Fmd has a special precaution in movement disorders. Interrater reliability analysis of the presence rating 1 or 2 versus absence rating 0 showed good agreement 2736 or 75%. Results convergence spasm was present in 9 69% psychogenic movement disorders cases, 411 36% nonpsychogenic movement disorders cases and 412 33% controls p0.
Treatment of psychogenic movement disorders begins with ensuring the patients acceptance of the diagnosis during the initial debriefing and includes nonpharmacologic cognitivebehavioral therapy. Physiologically, we cannot tell the difference between voluntary and involuntary. Psychogenic tremor also called functional tremor can appear as any form of tremor movement. Once the diagnosis has been established, treatment options are limited, and the patient generally does not accept the diagnosis. Receiving a diagnosis of psychogenic movement disorder was a huge sigh of relief, kieran porter says.
This groundbreaking volume is the first text devoted to psychogenic movement disorders. Pdf on oct 26, 2011, carlo dallocchio and others published psychogenic movement disorders find, read and cite all the research you need on researchgate. In the absence of such biological evidence of an underlying disease process, it is. Of 842 consecutive patients with movement disorders seen over a 71 month period, 28 3.
Psychogenic gait disorders psychogenic gait disorders can present in various ways and are often associated with other psychogenic movement disorders. Most common movement disorder was involuntary shakingjerky movements 50 % and tremor 43%. Pnes are also known less specifically as nonepileptic attack disorder nead and functional neurological symptom disorder. Anxiety and depression in psychogenic movement disorder. The condition is believed to be the result of a psychiatric problem and symptoms occur subconsciously. Tremor was most common 50% fol lowed by dystonia, myoclonus, and parkinsonism. The frequency of psychogenic movement disorders in a movement disorders practice varies depending on the nature of the practice from 3% 6 to 20% in my clinic. The present study reports the clinical profile of patients with pmd from india. Twenty third annual symposium on etiology, pathogenesis, and treatment of parkinsons disease and other movement disorders pages. We report a case of probable psychogenic propriospinal myoclonus psm in a patient who developed a sudden onset of disabling axial flexor myoclonus following a cosmetic surgical procedure. Alternatively the patient may state that every movement is painful. Psychogenic movement disorders journal of movement disorders.
Psychogenic movement disorders vanessa k hinson, w blake haren diagnosis and treatment of psychogenic movement disorders are challenging for both neurologists and psychiatrists. Neurobiology of functional movement disorder and non. Suspicion also arises when the patient defers an answer or asks for the movement to be done again, so gaining time to formulate a reply. Beginning with a new classification of psychogenic voice disorder, the authors then provide a. Seven tertiaryreferral movement disorders centers using a standardized data collection on a computerized database performed a. Although a psychogenic movement disorder may resemble or accompany an organic disorder, a skilled and experienced neurologist should be able to differentiate the two types of movement disorders. The full text of this article is available in pdf format. Misinterpretation of phenomenologies can be lead to wrong diagnosis and treatments deep brain stimulation, antiparkinsonian drugs and botulinum toxin injections etc.
Disorders of gait and balance are commonly seen in psychogenic patients and represent 8% to 10% of all pmds. Clinical signs are critical in ascertaining the functional nature of a gait disorder. Functional psychogenic movement disorders fmd are part of the spectrum of functional neurological disorders, some of the most prevalent disorders seen in neurological practice. The terminology to classify this disorder is confusing and making the diagnosis is difficult. Treatment of functional psychogenic movement disorders. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed. Psychogenic movement disorders sven wiklund barnneurolog. Recognition of the various types of pmds, differentiation. Psychogenic movement disorders and other conversion disorders cambridge medicine hardcover 1st edition by mark hallett editor, anthony e.
Clinical signs in functional psychogenic gait disorders. Patients without psychogenic pain say straight away that. In the last few years, functional neuroimaging studies have provided insight into their pathophysiology and neural correlates. The psychogenic movement disorders rating scale pmdrs is one of very few outcome measures speci. Physiotherapists and patients with functional psychogenic. These terms are classified in the diagnostic and statistical manual of psychiatric disorders, volume iv dsm iv. Healthy volunteers and people with functional movement disorders fmd or nonepileptic seizures nes who are 18 years of age or older may be eligible for this study. Functional psychogenic neurological symptoms are one of the commonest reasons for patients to seek neurological advice. Clinical neurophysiology of psychogenic movement disorders. Characteristics may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction andor body part affected, and greatly decreased or disappearing tremor activity when the person is being distracted.
Correct diagnosis of psychogenic movement disorders should rely not on the. Limited gait on a cane is partly overcome through the use of a swivel chair. The total psychogenic movement disorder score represents the sum of the total phenomenology score and the total function score. Some types of mental or emotional problems can cause, increase or prolong pain. It is most commonly applied to illnesses where a physical abnormality or other biomarker has not yet been identified. Tremor was most common 50% followed by dystonia, myoclonus, and parkinsonism. Imaging psychogenic movement disorders springerlink. Functionalpsychogenic movement disorders fpmds, are a valuable model for all medically unexplained symptoms and raise arduous challenges for diagnosis and treatment indicating our restricted understanding of the true pathogenesis that causes them. Limited gait given fixed dystonia, rendering the leg unable to bear weight. Psychogenic movement disorders pmds are common, but their physiology is largely unknown. The encyclopedia of movement disorders, threevolume set.
A multiplicity of terms such as conversion, somatization disorder, psychosomatic, neuropsychiatric, dissociative. A yearold caucasian girl with tremor in both wrists, severe enough. Movement problems for which no neurological, chemical or structural cause can be determined. The profile of pmd varies according to country and socioeconomic factors.
International parkinson and movement disorder society 555 east wells street, suite 1100, milwaukee wi 532023823 usa. This situation is likely to have been influenced by the no mans land that such patients occupy between neurologists and psychiatrists, often with neither side feeling a clear responsibility or ability to direct. Symptoms of psychogenic pain psychogenic pain disorders, when chronic, produce a variety of symptoms. Psychogenic movement disorders are characterized by unwanted movements, such as spasms, shaking or jerks involving any part of the face, neck, trunk or limbs. Termsvector search result for movement disorders 1. Visits by patients with psychogenic disorders make up a significant percentage of neurology specialty appointments, 1 but these patients are often treated differently from other patients. They are of psychological origin, and are one type of nonepileptic seizure mimics. Psychogenic movement disorders have been called a crisis for neurology as patients are often unaccepting of the diagnosis, few treatments exist, and few patients have been shown to improve in the published case series. In most situations, the movement is involuntary, but in a minority, when the disorder is malingering or factitious, the patient is lying and the movement is voluntary. Psychogenic voice disorders and cognitive behaviour.
Psychogenic movement disorders symptoms, diagnosis. Psychogenic disease or psychogenic illness is a name given to physical illnesses that are believed to arise from emotional or mental stressors, or from psychological or psychiatric disorders. Psychogenic nonepileptic seizures pnes are events resembling an epileptic seizure, but without the characteristic electrical discharges associated with epilepsy. Psychogenic movement information page national institute. Psychogenic movement disorders pmds represent a challenging dilemma for the treating neurologist. Severe psychogenic tremor of both wrists in a yearold. With the anxiety part of the spielberger questionnaire, three patients with pnes and one patient with pmd had scores 56, and presented with emotional reactions following a stressful stimulus that. Psychogenic movement disorders pmd is a group of disorders that cannot be attributed to any structural or biochemical abnormality, but has an underlying psychiatric illness. Scale development and clinimetric testing vanessa k. The neurobiological basis of psychogenic movement disorders pmds has been elusive, and they remain difficult to treat. Functional psychogenic movement disorders fmd are part of the wide. In the modern neurology clinic, pmds may comprise 225% of the patient population. Statistical manual of mental disorders3 identifies three pertinent.
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