Psychogenic Tremor

Abstract

Psychogenic movement disorders are a daily challenge for neurologists. A mistake in its recognition may have important consequences for the patients. Thus, this diagnosis must be considered very cautiously in clinical practice. Psychogenic movement disorders are not unusual, mainly tremors, and a wrong diagnosis is common. Psychogenic is an unspecific term that usually hides true mental disorders. The correct psychiatric syndrome somatoform disorders, factitious disorders, malingering, depression, anxiety and histrionic personality disorder, although the absence of ­psychiatric diagnosis does not preclude a psychogenic cause. Diagnosis may be difficult and should be made by an expert neurologist. Organic movement disorders must be excluded after a detailed neurological history, examination, and appropriate diagnostic studies. Psychogenic tremor is a diagnosis of exclusion. It can be diagnosed positively by the following neurological signs the fact that it is inconsistent (variation over time) and incongruous with the organic movement. Diagnosis is mainly clinical but several tests can be used, especially accelerometry, electromyography, and the analysis of the response to placebo or suggestion. New studies are shedding light on our knowledge of the basic underlying mechanisms of such intriguing pathology. Treatment requires a strong alliance between the medical team and patient. Psychogenic tremor should never be minimized. An early diagnosis should be reached as soon as possible and treatment must always be tried.