Treatment Of Psychogenic Movement Disorders Research Articles

A case of psychogenic movement disorder unresponsive to psychopharmacological treatment

Psychogenic movement disorders (PMD) are movement disorders for which an etiology cannot be found after exclusion of organic causes. These movement disorders can perfectly mimic organic movement disorders. Clinical observations, detailed medical history and neurological examination can help diagnose this condition. We present a 45 years old man with weakness in his right leg for two years which was evident especially during a walk. His physical examination showed that during initiation of walk dystonic posturing occurred for a few seconds and this caused gait disturbance. Laboratory and radiological tests for differential diagnosis did not reveal any abnormal finding. Diagnosis of PMD was made based on these results. Psychotropic medications and cognitive behavioral therapy failed to produce any response. In conclusion both diagnosis and treatment of PMD pose a great challenge for clinician. This diagnosis should be kept in mind in order to avoid adverse consequences of wrong diagnoses and unnecessary treatments.

Immediate vs. delayed treatment of psychogenic movement disorders with short term psychodynamic psychotherapy: Randomized clinical trial

ObjectiveIn subjects with psychogenic movement disorders (PMDs), we conducted a 6 month randomized, cross-over design study to assess the effect of 3 months of psychodynamic psychotherapy followed by observation by the neurologist vs. observation by the neurologist, then 3 months of psychiatric intervention. BackgroundPMDs are often disabling but no uniformly successful treatment strategies have been identified. Short term, open label psychodynamic psychotherapy has been successful in improving PMDs but whether PMDs improve equally well with neurological observation and support has not been tested. DesignFifteen patients with PMDs were randomized to immediate vs. delayed (after 3 months) weekly psychodynamic psychotherapy for 12 weeks. During the phase without psychiatric intervention, they were monitored by the treating neurologist. Patients were assessed at baseline, 3 and 6 months. Change in their movement disorder was assessed using a clinical global impression scale change (CGI-c), depression and anxiety using the Hamilton Depression Scale (HAM-D) and Beck Anxiety Inventory (Beck-A). ResultsFourteen 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. Over the six month study, PMDs, depression and anxiety were significantly improved but time was the determinant factor without an independent effect of treatment assignment. ConclusionIn this group of PMD patients, where patients were kept within the medical system and involved in a research program, PMDs as well as depression and anxiety improved, but without specific benefit time-linked to psychotherapy as opposed to neurological observation and support.

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

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.

Psychogenic Movement Disorders

This review describes the main clinical features of psychogenic (functional) movement disorders and reports recent advances in diagnosis, pathophysiology, and treatment. The terminology and definition of patients with psychogenic movement disorders remain subjects of controversy; the term "functional" has been used more frequently in the literature in recent years regarding the neurobiological substrate underpinning these disorders. Correct diagnosis of psychogenic movement disorders should rely not on the exclusion of organic disorders or the sole presence of psychological factors but on the observation or elicitation of clinical features related to the specific movement disorder (ie, a positive or inclusionary rather than exclusionary diagnosis). Sudden onset, spontaneous remissions, and variability over time or during clinical examination are useful "red flags" suggestive of a psychogenic movement disorder. Imaging studies have demonstrated impaired connectivity between limbic and motor areas involved in movement programming and hypoactivity of a brain region that compares expected data with actual sensory data occurring during voluntary movement. Treatment of psychogenic movement disorders begins with ensuring the patient's acceptance of the diagnosis during the initial debriefing and includes nonpharmacologic (cognitive-behavioral therapy, physiotherapy) and pharmacologic options. Psychogenic movement disorders represent a challenging disorder for neurologists to diagnose and treat. Recent advances have increased understanding of the neurobiological mechanism of psychogenic movement disorders. Treatment with cognitive strategies and physical rehabilitation can benefit some patients. As short duration of disease correlates with better prognosis, early diagnosis and initiation of treatment are critical.

Psychogenic Movement Disorders in Children

Psychogenic movement disorders are defined as hyperkinetic or hypokinetic movement disorders associated with underlying psychological disorders. Psychogenic movement disorders account for 1% to 9% of all neurologic diagnoses. The assessment and treatment of psychogenic movement disorders can be complex. We report patients seen over the past 5 years, diagnosed with psychogenic movement disorder. We discuss in this article some patient characteristics and some strategies that are effective in the management of this group of patients. The case examples presented in the current article demonstrate the importance of two factors, a multidisciplinary approach and engaging the family, that are essential components in the treatment of psychogenic movement disorders.

The treatment of psychogenic movement disorders with suggestion is ethically justified

Recent developments in our understanding of psychogenic movement disorders have not yet led to advances in treatment. A potentially beneficial treatment strategy is suggestion, the voluntary use by the physicians of techniques that introduce into the patient's mind a belief that he or she will be healed. Principalism, the dominant school of contemporary medical ethics, holds that the use of suggestion is not ethically justifiable because it undermines patient autonomy and degrades the doctor-patient relationship. However, evidence from a variety of sources (neuroimaging, anecdote, expert opinion, randomized controlled trials, and meta-analysis) supports the efficacy of suggestion as a treatment for psychogenic movement disorders. When issues of choice, consent, deceit, disclosure, and decision-making are analyzed from the perspective of an ethics of care, we see that suggestion may enhance patient autonomy and does not violate the trust between doctors and their patients. I conclude that suggestion is therefore an ethically justifiable treatment for patients with psychogenic movement disorders.

Psychogenic movement disorders in children: A report of 15 cases and a review of the literature

Data on psychogenic movement disorders (PMD) in children are scarce, with most existing literature relating to adults only. We report 15 cases with the aim of highlighting the clinical characteristics, risk factors, comorbidity, treatment, outcome, and prognosis of PMD in children. Only 13% of cases had onset before age 10, with the mean age at onset being 12.3 years. Females were predominantly affected (F:M = 4:1). The most common types of movement disorders seen were dystonia (47%), tremor (40%), and gait disorders (13%). Multiple hyperkinetic phenomenologies were observed in many cases. Abrupt onset and precipitation by minor injuries, and stressful life events were commonly reported. Clinical clues on examination suggesting a psychogenic origin were similar to those identified in adults. A distinct feature of PMD in children was the predominant involvement of the dominant limb. The underlying psychiatric diagnosis was conversion disorder in the majority of cases. Time from symptom onset until diagnosis of a PMD varied broadly (between 2 weeks and 5 years). Treatment with cognitive and behavioral therapy and rehabilitation by a multidisciplinary team led to improvement in most cases. However, treatment was much more effective in children with a short time from symptom onset to diagnosis and treatment.

Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders

Background PMD are disabling, but lack any generally accepted treatment strategies. Design/methods Ten patients with PMD received treatment with Psychodynamic Psychotherapy. Patients were assessed with psychiatric rating scales and the movement disorder was rated by a blinded rater with the Psychogenic Movement Disorder Rating Scale (PMDRS). Results Total mean PMDRS ( p=0.0195), total PMDRS function scores ( p=0.0142), Hamilton depression scores ( p=0.009), Beck anxiety scores ( p=0.002), and GAF ( p=0.0083) all improved with psychotherapeutic intervention. Conclusions Psychotherapy and appropriate use of adjunct psychiatric medication can be a successful intervention for PMD.