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Published on: November 21, 2013
Psychogenic movement disorders
Mark Hallett1, William J Weiner, Katie Kompoliti
1Human Motor Control Section, NINDS, NIH, Bethesda, MD 20892-1428, USA. hallettm@ninds.nih.gov
Abstract:
Psychogenic movement disorders are common, but the diagnosis may be difficult. Visual appearance alone is typically not sufficient to make a diagnosis, but such information is certainly important. That a movement is bizarre can be helpful, but still must be considered thoughtfully since organic movement disorders can have endless variety. The diagnosis should rest on positive findings such as paroxysmal nature, maximum severity at or near onset, variability of tremor direction, frequency and amplitude, entrainment of tremor, distractability and suggestibility, and wildly swaying gait and balance problems with no falling. Psychogenic parkinsonism often poses a problem because of the relatively high frequency of overlap of psychogenic and organic disease. In regard to psychogenic parkinsonism, there are special features to look for. There might be tremor with kinetic movement as well as rest and posture, and finger tremor might be absent. With sequential movements, the sequence effect is typically lacking. Extreme slowness and grunting with great effort may be seen. Improvement in arm swing while running, a feature of organic parkinsonism, may not be seen.
Insights
Diagnosing psychogenic movement disorders requires careful observation beyond mere appearance. Key indicators include sudden onset, variability, and responsiveness to distraction, differentiating them from organic conditions.
Area of Science:
- Neurology
- Psychiatry
Background:
- Psychogenic movement disorders (PMDs) are frequently encountered but challenging to diagnose.
- Visual inspection alone is insufficient, though movement characteristics are crucial.
Purpose of the Study:
- To outline diagnostic criteria for PMDs, emphasizing positive findings.
- To detail specific features distinguishing psychogenic parkinsonism from organic forms.
Main Methods:
- Review of clinical presentation and diagnostic features of PMDs.
- Comparison of characteristic symptoms in psychogenic versus organic movement disorders.
Main Results:
- Positive diagnostic signs for PMDs include paroxysmal episodes, maximal severity at onset, variable tremor, entrainment, distractibility, and gait instability without falls.
- Psychogenic parkinsonism may present with kinetic and postural tremor, absent finger tremor, lack of sequential movement effects, extreme slowness, grunting, and absence of improved arm swing during running.
Conclusions:
- Diagnosis of PMDs relies on a constellation of specific positive findings rather than solely on bizarre appearance.
- Differentiating psychogenic parkinsonism requires attention to unique features that diverge from typical organic parkinsonism.
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