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Of 842 consecutive patients with movement disorders seen over a 71 month period,28(3.3%)were diagnosed as having a documented or clinically established psychogenic movement disorder.Tremor was most common(50%) followed by dystonia,myoclonus,and parkinsonism.Clinical descriptions of various types are reviewed.Clinical characteristics common in these patients included distractibility(86%),abrupt onset(54%)and selective disabilities(39%).Distractibility seems to be most important in tremor and least important in dystonia.Other diagnostic clues included entrainment of tremor to the frequency of repetitive movements of another limb,fatigue of tremor,stimulus sensitivity and previous history of psychogenic illness.On examination,71%had other psychogenic features.Over 60%had a clear history of a precipitating event and secondary gain and 50%had a psychiatric diagnosis(usually depression).Twenty five percent of patients presented with combined psychogenic movement disorder and organic movement disorder; 35%resolved and this subgroup had a shorter duration of disease than those who are unresolved.Psychogenic movement disorder represents an uncommon diagnosis among patients with movement disorders.The ability to make a diagnosis rests on the presence of a multitude of clinical clues and therapeutic action should be taken as early as possible. |
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conversion reaction
depression
dystonia
dystonia,psychogenic
medical-legal aspects of neurology
movement disorder
movement disorder,psychogenic
myoclonus
Parkinson disease
Parkinson disease,psychogenic
prognosis
review article
tremor
tremor,psychogenic
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