P-236 - Psychogenic neurologic disorders: what to do?

Abstract

From Hippocrates to Freud and not forgetting Charcot and Janet, psychogenic disorders have intrigued generations of neurologists and psychiatrists. The authors' aim is to present a clinical vignette of a 44-year-old female who suffered from a neurologic disorder with a psychogenic origin. A literature review about the diagnosis and management of psychogenic neurologic disorders was also made. A 44-year-old female presented to the hospital complaining of increasingly frequent tremor of the upper limbs over the past month and pronounced weight loss (19 pounds in 3 months). She was discharged with a prescription of sertraline and oxazepam. One month later, she reported worsening of the symptoms, with tremor of upper limbs, chest and head and she was hospitalized to undergo a diagnostic workup. Diagnostic testing included: brain cranial tomography and magnetic resonance imaging which were normal; laboratory tests with thyroid function, electroencephalogram, syphilis detection test and examinations of serum and urine, also normal. Neurologic examination was normal. During the hospitalization, inconsistent characteristics of the symptom were found. The patient exhibited depressed mood and she stated that her symptoms had begun after the death of her mother, with whom she lived. The patient accepted psychiatric referral and the symptoms improved after she started psychiatric treatment. Despite their psychogenic basis, neurologic disorders are generally truly disabling. The diagnosis and treatment of neurologic disorders of psychogenic origin are still a challenge in clinical practice, nowadays.