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Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders

  • Movement Disorders (M Okun, Section Editor)
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Abstract

Published diagnostic criteria for functional (psychogenic) movement disorders (FMDs) include psychiatric symptoms and some historical variables to affect the threshold between categories of diagnostic certainty. Clinically probable and possible categories, however, do not suffice to rule in FMD or rule out complex organic movement disorders and therefore are of little practical help. In contrast, a handful of unequivocal and reliably incongruent or inconsistent clinical features in each functional movement phenotype, when present, allow a clinically definite diagnosis of FMD, regardless of any psychiatric symptom. We suggest that the use of phenotype-specific clinically definite FMD diagnostic criteria will increase inter-rater reliability and minimize false-positive diagnostic errors. This process involves the ascertainment of core (mandatory) examination features instead of supportive but insufficiently sensitive historical, psychiatric, and inconsistent examination features.

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Compliance with Ethics Guidelines

Conflict of Interest

Alberto J. Espay is supported by the K23 career development award (NIMH, 1K23MH092735) and has received grant support from CleveMed/Great Lakes Neurotechnologies and the Michael J. Fox Foundation; personal compensation as a consultant/scientific advisory board member for AbbVie, Chelsea Therapeutics, TEVA, Impax, Merz, Pfizer, Acadia, Cynapsus, Solstice Neurosciences, Eli Lilly, Lundbeck, and US WorldMeds; royalties from Lippincott Williams & Wilkins and Cambridge University Press; and honoraria from AbbVie, UCB, US WorldMeds, Lundbeck, TEVA, the American Academy of Neurology, and the Movement Disorders Society. He serves as Associate Editor of Movement Disorders, Frontiers in Movement Disorders, and Journal of Clinical Movement Disorders, and on the editorial boards of Parkinsonism and Related Disorders and The European Neurological Journal.

Anthony E. Lang has served as an advisor for AbbVie, Allon Therapeutics, Avanir Pharmaceuticals, Biogen Idec, Boerhinger Ingelheim, Ceregene, Lilly, Medtronic, Merck, Novartis, NeuroPhage Pharmaceuticals, TEVA, and UCB; received honoraria from Medtronic, TEVA, UCB, and AbbVie; received grants from Brain Canada, Canadian Institutes of Health Research, Edmond J Safra Philanthropic Foundation, Michael J. Fox Foundation, the Ontario Brain Institute, National Parkinson Foundation, Parkinson Society Canada, Tourette Syndrome Association, and W. Garfield Weston Foundation; received publishing royalties from Saunders, Wiley-Blackwell, Johns Hopkins Press, and Cambridge University Press; and has served as an expert witness in cases related to the welding industry.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Gardner Family Center for Parkinson’s Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA

    Alberto J. Espay

  2. Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease, University Health Network, University of Toronto, Toronto, Canada

    Anthony E. Lang

  3. University of Cincinnati Academic Health Center, 260 Stetson St., Suite 2300, Cincinnati, OH, 45267-0525, USA

    Alberto J. Espay

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  1. Alberto J. Espay
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Correspondence to Alberto J. Espay.

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This article is part of the Topical Collection on Movement Disorders

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Espay, A.J., Lang, A.E. Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders. Curr Neurol Neurosci Rep 15, 32 (2015). https://doi.org/10.1007/s11910-015-0556-y

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