Psychogenic movement disorders amitabh gupta and anthony e. Eight of ten patients in the primary psychogenic movement disorder group had significant improvements in scales of clinical global impression, depression and anxiety, and seven had a complete remission. Although today we would classify the syndrome as a conversion disorder, it was considered a separate disease by paul blocq 18601896, who described this phenomenon as the inability to maintain an upright posture, despite normal function of the legs in the bed. These terms are classified in the diagnostic and statistical manual of psychiatric disorders, volume iv dsm iv. Characteristics may vary but generally include sudden onset and remission, increased incidence with stress, change in tremor direction and or body part affected, and greatly decreased or disappearing tremor. Most were without major psychiatric diagnoses or personality disorders, although stressful life events were temporally related with acute. Goetz, md, 3and sue leurgans, phd 1department of neurosciences, medical university of south carolina, charleston, south carolina, usa. The terminology to classify this disorder is confusing and making the diagnosis is difficult.
Prevalence estimates of somatic symptom disorder ssd in the pediatric population are highly variable, due in part to the evolution of terminology and diagnostic criteria used to define. While many of the case series of psychogenic movement disorders or motor conversion document precipitating or exacerbating life events of these patients, 7, 1119 only one of these studies reports rates of distant life events such as childhood abuse or trauma. Gait abnormalities in psychogenic movement disorders. Two meetings on functional movement disorders in 2005 and 2011, both held in the usa, led to the publication of influential textbooks and an awareness that these disorders are much more common than had previously been thought hallett et al. Buy psychogenic movement disorders and other conversion disorders cambridge medicine hardcover 1 by edited by mark hallett, anthony e. Patients with idiopathic torsion dystonia have no other. While it may be a manifestation of brainstem pathology, this sign is often associated with conversion somatisation disorders and, if unrecognised as a sign of a psychogenic disorder, it may lead to unnecessary and occasionally invasive. The diagnosis of psychogenic pain is made only when all other causes of pain are ruled out. Electrophysiological testing shows limitations in distinguishing between psychogenic and organic propriospinal myoclonus and dystonia.
Rating scale for psychogenic movement disorders pmd. May 11, 2011 psychogenic movement disorders pmd and other conversion disorders cd with apparent neurologic signs neurologic cd plague patients and perplex physicians. Mental illness was a label for most people with any type of disorder and it was common for people with emotional and behavioral disorders to be labeled with a mental illness. Psychogenic movement disorders an d other co nversion disorders, ed. Treatment for patients with a functional neurological disorder conversion disorder. Cranial movement disorders affecting the eyes, face, jaw, tongue, or palateare an underrecognised feature of patients with functional symptoms. Somatic symptom and related disorders conversion disorder functional neurological symptom disorder criteria for conversion disorder fnsd are modified to. Psychogenic movement disorders sven wiklund barnneurolog. Treatment of functional psychogenic movement disorders. While it may be a manifestation of brainstem pathology, this sign is often associated with conversion somatisation disorders and, if unrecognised as a sign of a psychogenic disorder, it may lead to unnecessary and. Psychogenic disorders of gait occur at all ages, though caution should be used in making this diagnosis in the elderly hayes et al.
Functional neurologic disorders a newer and broader term that includes what some people call conversion disorder feature nervous system neurological symptoms that cant be explained by a neurological disease or other medical condition. Diagnostic and statistical manual of mental disorders, fifth edition american psychiatric association. Psychogenic movement disorders journal of movement disorders. Psychiatric evaluation led to the diagnosis of conversion disorder. Psychogenic tremor also called functional tremor can appear as any form of tremor movement. The total psychogenic movement disorder score represents the sum of the total phenomenology score and the total function score. A clinical approach to paediatric conversion disorder continued nonepileptic seizures. A person with psychogenic pain disorder will complain of pain that does not match his or her symptoms. While the mean age of patients with pmds is 37 to 50 years in most case series, 14 conversion. A psychogenic speech disorder can be defined as a broad category of speech disturbances that represent the manifestation of one or more types of psychological processes. An accompanying cdrom with a video library featuring over 100 reallife examples of movement disorders will aid diagnosis.
Psychogenic movement disorders healthcare baylor college. Functional psychogenic movement disorders tremor, tics, dystonia, ataxiaastasiaabasia 3. Recognition of psychogenic movement disorders pmd has a long and distinguished history in neurology, beginning with charcot in the nineteenth century. Psychogenic movement disorders and other conversion disorders. This book gives neurologists and psychiatrists uptodate information about diagnosis, treatment and pathophysiology, providing a foundation for both clinical practice and research. Frontiers functional or psychogenic movement disorders. The term functional psychogenic movement disorders fmd has historically been applied to disorders that manifest with physical symptomsspecifically abnormal movements gait disorders, tremor, dystonia, etc. Older people often exhibit a combination of physical disability and an exaggerated compensatory response, particularly if there is apprehension and fear of falling. Many of these conditions acquired exotic names like dubinis electric chorea and the variable chorea of brissaud that are no longer. Results we studied 9 patients five females with psychogenic tics representing 4. A multiplicity of terms such as conversion, somatization disorder.
Other terms, including functional, nonorganic, conversion disorder. Carlotta canavese, claudia ciano, federica zibordi, giovanna zorzi, vanessa cavallera and nardo nardocci, phenomenology of psychogenic movement disorders in children, movement disorders, 27, 9, 11531157, 2012. Functional psychogenic 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. Psychogenic movement disorders pmd and other conversion disorders cd with apparent neurologic signs neurologic cd plague patients and perplex physicians. Other terms, including functional, nonorganic, conversion disorder, psychosomatic, medically unexplained, dissociative motor disorder, and hysterical, when. Unlike other psychogenic symptoms, with the advent of eegvideo monitoring, the diagnosis is generally not difficult. The clinical features of psychogenic movement disorders. Cranial functional psychogenic movement disorders the. Different groups of pmds might have distinctive gait. Gait abnormalities in psychogenic movement disorders baik.
About 2% to 3% of new visits to movement disorder specialists are for psychogenic movement disorders,2,3 most of which are conversion disorders. Positive symptoms such as nonepileptic seizures and psychogenic movement disorders are only encountered in pubertalaged and older children. There are a variety of pmds including tremor, dystonia, parkinsonism, gait disorders and, even. Patients may have astasiaabasia, characterized by the ability to maintain good balance despite bizarre swaying and contortions of the body. Psychogenic movement disorders and other conversion. Diagnosis and treatment of psychogenic movement disorders are challenging for both. For reporting frequencies and mean scores, each of the three raters scores was considered independently. Due to a lack of objective evidence of underlying brain lesions, cd were largely abandoned by neurologists and remained poorly understood psychiatric diagnoses throughout most of the. The greek term astasiaabasia literally translates to mean inability to stand and to walk. Chapter section 106 psychogenic movement disorders and other conversion disorders trauma and dissociation. The rating scale for psychogenic movement disorders rates 10 phenomena rest tremor, action tremor, dystonia, chorea, bradykinesia, myoclonus, tics, athetosis, ballism, cerebellar incoordination, two functions gait, speech, and 14 body regions. This condition reveals itself typically as a conversion disorder.
Patients with psychogenic movement disorders are usually diagnosed by neurologists and referred to psychiatrists for treatment. Psychogenic disorder an overview sciencedirect topics. Aug 29, 2012 psychogenic movement disorders pmds are best defined as hyper or hypokinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in most cases from psychological or psychiatric causes. Other psychogenic movement disorders, psychogenic neurological signs and multiple somatizations were common. Paul blocq and psychogenic astasia abasia okun 2007. Aug 10, 2015 what is a psychogenic speech disorder. Functional movement disorders represent a challenge for the clinical practitioner as the diagnosis and treatment are usually difficult, and the prognosis may be poor in some patients. A functional neurological disorder fnd is a condition in which patients experience neurological symptoms such as weakness, movement disorders, sensory symptoms and blackouts. Pdf on jan 1, 2011, bethany brand and others published chapter section 106 psychogenic movement disorders and other conversion disorders trauma and dissociation.
Lang introduction psychogenic movement disorders pmds are movement disorders that result from a psychological or psychiatric rather than neurological disturbance. Psychogenic nonepileptic seizures, conversion, and somatic. Functional neurological symptom disorder wikipedia. Psychogenic nonepileptic seizures pnes are common at epilepsy centers, where they represent 30%40% of referrals. A conversion disorder with accompanying psychogenic movements is defined by the dsmiv as a movement disorder which is not related to organic damage to the nervous system. Conversion disorder is likely the most common mechanism of pmds. The current conversion disorder diagnosis requires that conflicts or other.
A multiplicity of terms such as conversion, somatization disorder, psychosomatic, neuropsychiatric, dissociative. It is most commonly applied to illnesses where a physical abnormality or other biomarker has not yet been identified. Book release psychogenic movement disorders and other. Functional neuroanatomy and neurophysiology of functional. Conversion disorder functional neurological symptom disorder. The patient who couldnt stop vomiting mdedge psychiatry. Correct diagnosis of psychogenic movement disorders should rely not on the exclusion of.
It is most commonly applied to illnesses where a physical abnormality or other biomarker has. Functional psychogenic movement disorders fmd are part of the spectrum of functional neurological disorders, some of the most prevalent disorders seen in neurological practice. This can include, but is not limited to, anxiety, depression, conversion disorders, or an emotional response to a traumatic event. Recent evidence cautions against the uncritical acceptance of all cases of posttraumatic myoclonus and jumpy stump as being. The group with psychogenic movement disorder plus other somatoform disorder did not show improvement. Functional neurological disorder rare disease report. This is a pdf file of an unedited manuscript that has.
Psychogenic movement disorders pmds are heterogeneous disturbances of motor function that are not fully explained by organic conditions and which occur in association with underlying psychiatric disease. Diagnosing psychogenic movement disorderswhich criteria. Once the diagnosis has been established, treatment options are limited, and the patient generally does not. This volume is the outcome of the second international conference on psychogenic movement disorders and other conversion disorders, which was held in washington, dc, in april 2009. This book comes with a dvdrom with videos of psychogenic tremor including how to find physical signs of it, psychogenic dystonia, organic dystonia potentially misdiagnosed at functional dystonia, psychogenic myoclonus, psychogenic parkinsonism, psychogenic gaits, organic gaits potentially confused with psychogenic ones, and miscellaneous other functional movement disorders fmds. 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. Nov 09, 2015 conversion disorder, as stated in the diagnostic and statistical manual of mental disorders, fourth edition, text revision dsmivtr, involves symptoms or deficits affecting voluntary motor or sensory function that suggest a neurologic or other general medical condition. Psychogenic movement disorders healthcare baylor college of. In 1988, fahn and williams proposed diagnostic criteria for psychogenic movement disorders pmds that included abrupt onset, inconsistency, distractability, false weakness, false. Psychogenic movement disorders pmds are best defined as hyper or hypokinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in.
Correct diagnosis of psychogenic movement disorders should rely not on the exclusion. Background convergence spasm refers to transient ocular convergence, miosis and accommodation associated with disconjugate gaze mimicking abducens palsy. The editors gathered an international team of 78 psychiatrists, neurologists, psychologists, and students who authored 43 chapters. The subject is alive and well in the uk, where the uk functional neurological symptoms. Videos may be accessed by clicking on links provided in the html, pdf, and ipad. Psychogenic movement disorders pmds represent a challenging dilemma for the treating neurologist.
Functional neurologic disordersconversion disorder. Movement disorders can be defined as neurological syndromes in which there is either an excess of movement hyperkinesias or a paucity of voluntary and automatic movements, unrelated to weakness or spasticity hypokinesias. This groundbreaking volume is the first text devoted to psychogenic movement disorders. Psychogenic gait disorders can present in various ways and are often associated with other psychogenic movement disorders. Psychogenic movement information page national institute. Lang, joseph jankovic, stanley fahn, pet er halligan, v alerie v oon, and c. Conversion disorder in adults management and treatment. Figure 1, jerks, or other combinations of abnormal. Cranial movement disordersaffecting the eyes, face, jaw, tongue, or palateare an underrecognised feature of patients with functional symptoms. Sometimes also referred to as functional, conversion, or psychogenic, these disorders must be differentiated from organic disorders. For chorea and hemiballism, in addition to the characteristics shared with other functional paroxysmal movement disorders, there are no other specific clinical signs yet reported to suggest a functional origin. In the past, the brain of a patient with functional neurological symptom disorder was believed to be structurally normal, but functioning incorrectly. Phenomenology of psychogenic movement disorders in children.
The terminology, diagnosis, differential diagnosis, epidemiology, pathogenesis, prognosis, and treatment are discussed separately, as are conversion disorder with attacks or seizures functional or psychogenic nonepileptic seizures and conversion disorder with abnormal movements functional or psychogenic movement disorders. 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. They can present in isolation or in the context of other functional symptoms. Movement disorder an overview sciencedirect topics. Due to a lack of objective evidence of underlying brain lesions, cd were largely abandoned by neurologists and remained poorly understood psychiatric diagnoses throughout most of the 20th century. Psychogenic movement information page national institute of. A clinical approach to paediatric conversion disorder. Psychogenic gait disorders psychogenic gait disorders can present in various ways and are often associated with other psychogenic movement disorders. Functionalpsychogenic movement disorders fpmds, are a valuable model for all. Previous studies have not evaluated the gait characteristics of patients with a variety of pmds and there are no reports comparing pmds with and without gait disturbances. Written by experts in neurology, psychiatry, psychology, neuroimaging, neurophysiology and genetics, this book covers psychogenic movement disorders and other conversion disorders from all of the most relevant clinical angles. Patients with psychogenic movement disorders pmds present with tremor, fixed postures of limbs typically an inverted ankle or clenched fist.
Psychogenic movement disorders and motor conversion. However, those terms were avoided when describing children as it seemed too stigmatizing. To better characterise this neuroophthalmologic sign, 36. Functional psychogenic neurological symptoms are frequently encountered in neurological practice. An abnormal gait is not uncommon in patients with medically unexplained neurological symptoms, including those with other psychogenic movement disorders pmds. Prominent involvement of truncal muscles arching and pelvic thrusting, as well as lateral rolling of head and body.
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. Most common movement disorder was involuntary shakingjerky movements. Conversion disorder, hysteria, psychogenic movement disorder, stress. Onset tends to be more gradual than occurs with epileptic seizures.
Somatoform disorder is divided into conversion disorder and. An update on psychogenic movement disorders springerlink. Longterm follow up was available for less than onehalf of the patients. Pdf chapter section 106 psychogenic movement disorders. Several other terms have been used to describe psychogenic movement disorders and there has been considerable debate regarding the appropriate naming of the disorder. Scale development and clinimetric testing vanessa k. The hotch potch of miscellaneous and largely unclassified phenomena which comprise a significant and fascinating part of movement disorders are a challenge for neurologists working on the borderlands of psychiatry, sleep disorders, and epilepsy. In the late 1900s the term behaviorally disordered appeared. Pdf psychogenic movement disorders pmd are challenging to diagnose and to treat. Psychogenic movement disorders pmds are movement disorders that result from a. Methods we aimed to characterise the prevalence and clinical features of pmds resembling tics during the last 3. Background psychogenic movement disorders pmds may be difficult to differentiate from organic abnormal movements. Functional neurological disorder fnd is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends andor receives signals, rather than a structural disease process such as multiple sclerosis or stroke.
Psychogenic movement disorders are a common medical condition at the boundary of neurology and psychiatry. In one study, the most common characteristic was a. Original publication view the scale pdf year published. Out of 24 patients with psychogenic vomiting examined by rosenthal, 18 received psychological evaluation and testing.
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