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Diagnostic agreement in patients with psychogenic movement disorders
Francesca Morgante1, Mark J Edwards, Alberto J Espay
1Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Messina, Italy.
Background:
The reliability and applicability of published diagnostic criteria for psychogenic movement disorders (PMDs) have never been examined.
Methods:
Eight movement disorder and six general neurologists rated 14 patients diagnosed with PMD and 14 patients diagnosed with organic movement disorders. Raters provided a dichotomous judgment (i.e., psychogenic or organic) upon review of video-based movement phenomenology and a category of diagnostic certainty based on the Fahn-Williams and Shill-Gerber criteria after accessing standardized clinical information. We measured interobserver agreement on the diagnosis and clinical certainty judgment of PMD.
Results:
In both groups of raters, agreements were "fair" on the video-based dichotomous judgment, but improved to "substantial" after access to standardized clinical information. "Slight" to "poor" agreement was reached for the "probable" and "possible" categories of diagnostic certainty corresponding to both diagnostic criteria.
Conclusions:
Diagnosis according to clinical available criteria for PMD yields poor diagnostic agreement.
Insights
Diagnostic criteria for psychogenic movement disorders (PMDs) show poor reliability among neurologists. Agreement improved with clinical information but remained low for certainty categories, indicating challenges in diagnosing PMDs.
Area of Science:
- Neurology
- Movement Disorders
- Diagnostic Reliability
Background:
- Published diagnostic criteria for psychogenic movement disorders (PMDs) lack validation.
- Assessing the reliability and applicability of current PMD diagnostic criteria is crucial.
Purpose of the Study:
- To evaluate the interobserver agreement on diagnosing psychogenic movement disorders (PMDs) using established criteria.
- To determine the reliability of diagnostic certainty categories in PMD assessment.
Main Methods:
- Neurologists reviewed video phenomenology and clinical data of patients with PMD and organic movement disorders.
- Raters provided dichotomous judgments (psychogenic vs. organic) and diagnostic certainty levels.
- Interobserver agreement was measured for diagnosis and certainty using Fahn-Williams and Shill-Gerber criteria.
Main Results:
- Initial video-based judgments showed "fair" agreement.
- Agreement improved to "substantial" after accessing standardized clinical information.
- Diagnostic certainty categories ("probable," "possible") exhibited "slight" to "poor" agreement.
Conclusions:
- Current clinical criteria for diagnosing PMDs result in poor diagnostic agreement.
- Reliability issues persist, particularly concerning diagnostic certainty levels.
- Further refinement of diagnostic criteria for PMDs is warranted.
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