Evaluation and diagnosis of psychogenic disorders in neurological patients

Patients with psychogenic neurological symptoms present a diagnostic challenge. There are certain elements in a history that are indicative of a psychogenic condition. These include sudden onset of symptoms, highly emotional events at the time of symptom onset, paroxysmal nature of symptoms, and migrating or changing complaints. Likewise, some findings on examination are more often seen in psychogenic cases than in organic disorders. Multiple symptoms that do not correspond to any identifiable neuroanatomical abnormality, distractibility, entrainment, and false weakness or sensory complaints, are all possible clues that a condition is emotional rather than organic. However, none of these features is an absolute indication of psychogenicity and each must be taken in the context of the complete clinical picture.