Immediate Versus Delayed Treatment of Psychogenic Movement Disorders with Short Term Psychodynamic Psychotherapy (P02.246)

Abstract

Objective: In subjects with psychogenic movement disorders (PMDs), we conducted a 6 month randomized, cross-over design to assess the effect of 3 months of psychodynamic psychotherapy initiated at study onset followed by continued observation by the neurologist vs. three months of continued observation followed by 3 months of psychiatric intervention. Background PMDs are often disabling but no uniformly successful treatment has been identified. Short term psychodynamic psychotherapy was successful in improving PMDs in 10 patients used in open label fashion (Hinson, 2006). Design/Methods: Fifteen patients with PMDs seen in a Movement Disorders clinic were randomized to immediate versus delayed (after 3 months) weekly psychodynamic psychotherapy for 12 weeks. During the phase without psychiatric intervention, they were monitored by a treating neurologist. Patients were assessed at baseline, 3 and 6 months using a clinical global impression scale change of their movement disorder (CGI-c), Hamilton depression scale (HAM-D) and Beck anxiety inventory (Beck-A). Results: Fourteen women and one man, age 42.3± 11, disease duration 63.2± 73 months, were randomized to immediate (7 patients) or delayed (8 patients) treatment. The primary diagnosis was conversion (8 patients), somatoform disorder not otherwise specified (5 patients), and somatization (2 patients). Nine patients carried the diagnosis of depression combined with anxiety in 3. Six patients had tremor, 5 myoclonus, 1 dystonia, 7 gait and 2 speech involvement. Over the six month study, PMDs, depression and anxiety, improved (CGI-c F[1,13] = 4.01, p = 0.03; Ham-D F[1,13] = 18.62, p = 0.001; Beck-A F[1,13] = 32.46, p Conclusions: In this group of PMD patients, where patients were all kept within the medical system and involved in a research program, movements, depression and anxiety improved, but there was no specific benefit from psychotherapy as opposed to observation and support. Disclosure: Dr. Kompoliti has received personal compensation for activities with Merz as a participant on a scientific advisory board. Dr. Kompoliti has received research support from Allergan, Michael J Fox Foundation, Teva Neuroscience, Addex Pharmaceuticals, Otsuka Pharmaceuticals, Inc., and Pfizer Inc. Dr. Wilson has nothing to disclose. Dr. Stebbins has received personal compensation for activities with Impax Laboratories, Inc., Ceregene, Inc., Biovail Technologies, Ltd., Santhera Pharmaceuticals, and Ingenix Pharmaceutical Services. Dr. Stebbins has received research support from the National Institutes of Health, American Cancer Society, the Michael J. Fox Foundation, and Fragile-X Foundation.