Psychogenic tremor and related disorders

Area of Science:

• Neurology
• Psychiatry

Background:

• Psychogenic tremor constitutes 55% of psychogenic movement disorders.
• It predominantly affects females (75%) with abrupt onset, often following accidents or work-related injuries.

Purpose of the Study:

• To outline the clinical characteristics, diagnostic criteria, and management of psychogenic tremor.
• To discuss the common comorbidities and prognosis associated with this condition.

Main Methods:

• Clinical observation and diagnostic evaluation based on patient history, specific clinical signs (e.g., entrainment test, co-contraction sign), and investigations.
• Review of comorbidities including somatoform and depressive disorders.
• Assessment of factors influencing prognosis, such as duration of symptoms and litigation involvement.

Main Results:

• Key clinical features include variability in tremor (direction, amplitude, frequency), absence of finger tremor, and slowness of voluntary movements.
• High rates of psychiatric comorbidities (somatoform disorders 35%, depression 14%) and involvement in litigation (21%) are noted.
• Prognosis is generally poor, with 80-90% of patients experiencing persistent abnormal movements long-term, especially if the condition lasts over a year.

Conclusions:

• Psychogenic tremor is a distinct entity requiring a multimodal diagnostic and treatment approach.
• Neuropsychiatric evaluation and psychotherapy are recommended, though long-term outcomes are often unfavorable.
• Early diagnosis and intervention may be crucial, but persistent symptoms are common.