Chapter 51 - Hyperkinetic psychogenic movement disorders

Abstract

Publisher Summary This chapter focuses on the phenomenology, laboratory tests, psychiatric assessment, pathophysiology, and management of hyperkinetic psychogenic movement disorders (PMD). PMD are a heterogeneous group of disorders of movement that are thought primarily to arise from psychological disturbance. They present major difficulties for diagnosis and management and can be a source of considerable disability for affected patients. Psychogenic illness in general is very common. PMD form a small proportion of the burden of psychogenic medical problems, and in general movement disorder clinics PMD account for about 2–5% of consultations. PMDs are much commoner in females than males. Diagnostic criteria have been proposed for PMD which divide PMD into four categories: (1) documented; (2) clinically established; (3) probable; and (4) possible. Psychogenic tremor is one of the commonest PMD, accounting for at least 50% of all PMD. Psychogenic dystonia is the most challenging and controversial of the PMDs. Early positive diagnosis of a psychogenic disorder is a very important step to improve final outcome in PMD. Drug rationalization and withdrawal are important components of treatment for some patients.