CNS Drugs

, Volume 18, Issue 7, pp 437–452

Psychogenic Movement Disorders

Diagnosis and Management
Therapy in Practice

Abstract

Psychogenic movement disorders (PMDs) are best defined as hyper- or hypo-kinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in most cases from psychological or psychiatric causes. There are a variety of PMDs including tremor, dystonia, parkinsonism, gait disorders and, even, unusual forms including paroxysmal dyskinesias. As has been recognised in the recent literature, PMDs cannot be strictly classified into clearly defined psychiatric disorders such as somatoform, dissociative or conversion disorders

In this review, we discuss the diagnosis of various PMDs (including hyper- and hypo-kinetic disorders; and current evidence for underlying comorbid disorders) and the current therapeutic approach to them. The therapy of PMDs is not well established, is very challenging to the clinician, and a better outcome can be achieved in the setting of a team approach involving movement disorders specialists, psychiatrists and therapists who specialise in cognitive-behavioural techniques. Current pharmacological and non-pharmacological approaches to treatment focus on therapy of underlying comorbid psychiatric and psychological issues, although compliance is a major concern

References

  1. 1.
    Lewis A. “Psychogenic”: a word and its mutations. Psychol Med 1972; 2: 209–15PubMedCrossRefGoogle Scholar
  2. 2.
    Stone J, Zeman A, Sharpe M. Functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2002; 73: 241–5PubMedCrossRefGoogle Scholar
  3. 3.
    Charcot JM. Clinical lectures on diseases of the nervous system. London: The New Sydenham Society, 1877–89Google Scholar
  4. 4.
    Gowers WR. A manual of diseases of the nervous system. Hafner: Darion, 1893. Reprinted 1970Google Scholar
  5. 5.
    Head HH. The diagnosis of hysteria. BMJ 1922; 1: 827–9PubMedCrossRefGoogle Scholar
  6. 6.
    Marsden CD. Hysteria-a neurologist’s view. Psychol Med 1986; 16: 277–88PubMedCrossRefGoogle Scholar
  7. 7.
    Trimble MR. Neuropsychiatry. Chichester (NY): John Wiley & Sons, 1981: 79–87Google Scholar
  8. 8.
    Lempert T, Diettrich M, Huppert D, et al. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 1990; 82: 335–40PubMedCrossRefGoogle Scholar
  9. 9.
    Factor SA, Podskalny GD, Molho ES. Psychogenic movement disorders: frequency, clinical profile and characteristics. J Neurol Neurosurg Psychiatry 1995; 59: 409–12CrossRefGoogle Scholar
  10. 10.
    Slater E. Diagnosis of ‘hysteria’. BMJ 1965; 1: 1395–9PubMedCrossRefGoogle Scholar
  11. 11.
    Whitlock FA. The aetiolgy of hysteria. Acta Psychiatr Scand 1967; 43: 144–62PubMedCrossRefGoogle Scholar
  12. 12.
    Merskey H, Buhrich NA. Hysteria and organic brain disease. Br J Med Psychol 1975; 48: 359–66PubMedCrossRefGoogle Scholar
  13. 13.
    Ranawaya R, Riley D, Lang AE. Psychogenic dyskinesias in patients with organic movement disorders. Mov Disord 1990; 5: 127–33PubMedCrossRefGoogle Scholar
  14. 14.
    Krumholz A, Niedermeyer E. Psychogenic seizures: a clinical study with follow up data. Neurology 1983; 33: 498–502PubMedCrossRefGoogle Scholar
  15. 15.
    Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol 1995; 65: 231–57PubMedGoogle Scholar
  16. 16.
    Zeigler FJ, Imboden JB, Meyer E. Contemporary conversion reactions: a clinical study. Am J Psychiatry 1960; 116: 901–10Google Scholar
  17. 17.
    Servan-Schreiber D, Kolb R, Tabas G. Mental health: the somatizing patient. Prim Care 1999; 26: 226–42CrossRefGoogle Scholar
  18. 18.
    Barsky AJ, Wyshak G, Klerman GL. Psychiatric co-morbidity in DSM-III-R hypochondriasis. Arch Gen Psychiatry 1992; 49: 101–8PubMedCrossRefGoogle Scholar
  19. 19.
    Wise MG, Ford CV. Factitious disorders. Prim Care 1999; 26: 315–26PubMedCrossRefGoogle Scholar
  20. 20.
    Turner J, Reid S. Muchausen’s syndrome. Lancet 2002; 359: 346–9PubMedCrossRefGoogle Scholar
  21. 21.
    Meadow R. Munchausen syndrome by proxy: the hinterland of child abuse. Lancet 1977; II: 343–5CrossRefGoogle Scholar
  22. 22.
    Feinstein A, Stergiopoulos V, Lang AE. Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol 2001; 14: 169–76PubMedGoogle Scholar
  23. 23.
    Vuilleumier P, Chicherio C, Assal F, et al. Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain 2001; 124: 1077–90PubMedCrossRefGoogle Scholar
  24. 24.
    Purtell JJ, Robins E, Cohen ME. Observations in clinical aspects of hysteria: a quantitative study of 50 hysteria patients and 150 control subjects. JAMA 1951; 146: 902–9CrossRefGoogle Scholar
  25. 25.
    Ron M. Explaining the unexplained: understanding hysteria. Brain 2001; 124: 1065–6PubMedCrossRefGoogle Scholar
  26. 26.
    Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol 1988; 50: 431–55PubMedGoogle Scholar
  27. 27.
    Marjama J, Troster AI, Koller WC. Psychogenic movement disorders. Neurol Clin 1995; 13: 283–97PubMedGoogle Scholar
  28. 28.
    Kurlan R, Brin MF, Fahn S. Movement disorder in reflex sympathetic dystrophy: a case proven to be psychogenic by surveillance video monitoring. Mov Disord 1997; 12: 243–5PubMedCrossRefGoogle Scholar
  29. 29.
    Walters AS, McHale D, Sage JI, et al. A blinded study of the suppressibility of involuntary movements in Huntington’s chorea, tardive dyskinesia, and L-Dopa-induced chorea. Clin Neuropharmacol 1990; 13: 236–40PubMedCrossRefGoogle Scholar
  30. 30.
    Lang AE. Psychogenic dystonia: a review of 18 cases. Can J Neurol Sci 1995; 22: 136–43PubMedGoogle Scholar
  31. 31.
    Koller WC, Lang AE, Vetere-Overfield B, et al. Psychogenic tremors. Neurology 1989; 39: 1094–9PubMedCrossRefGoogle Scholar
  32. 32.
    Deuschl G, Koster B, Lucking C, et al. Diagnostic and patho-physiological aspects of psychogenic tremors. Mov Disord 1998; 13: 294–302PubMedCrossRefGoogle Scholar
  33. 33.
    Kim YJ, Anthony S, Pakiam I, et al. Historical and clinical features of psychogenic tremor: a review of 70 cases. Can J Neurol Sci 1999; 26: 190–5PubMedGoogle Scholar
  34. 34.
    Blakeley J, Jankovic J. Secondary paroxysmal dyskinesias. Mov Disord 2002; 17: 726–34PubMedCrossRefGoogle Scholar
  35. 35.
    Bressman SB, Fahn S, Burke RE. Paroxysmal non-kinesigenic dystonia. Adv Neurol 1988; 50: 403–13PubMedGoogle Scholar
  36. 36.
    Lang AE, Koller WC, Fahn S. Psychogenic Parkinsonism. Arch Neurol 1995; 52: 802–10PubMedCrossRefGoogle Scholar
  37. 37.
    Knapp PC. Astasia-abasia, with report of a case of paroxysmal trepidant abasia, associated with paralysis agitans. J Nerv Ment Dis 1891; 17: 673–703CrossRefGoogle Scholar
  38. 38.
    Spiller WG. Akinesia algera. Arch Neurol Psych 1933; 30: 842–84CrossRefGoogle Scholar
  39. 39.
    Southard EE. Shell-shock and other neuropsychiatrie problems. Boston: WM Leonard, 1919Google Scholar
  40. 40.
    Oppenheim H. Diseases of the nervous system. 1st ed. Philadelphia: JB Lippincott, 1900: 803Google Scholar
  41. 41.
    Keane JR. Hysterical gait disorders: 60 cases. Neurology 1989; 39: 586–9PubMedCrossRefGoogle Scholar
  42. 42.
    Lempert T, Brandt T, Dietrich M, et al. How to identify psychogenic disorders of stance and gait: a video study in 37 patients. J Neurol 1991; 238: 140–6PubMedCrossRefGoogle Scholar
  43. 43.
    Hayes MW, Graham S, Heldorf P, et al. A video review of the diagnosis of psychogenic gait: appendix and commentary. Mov Disord 1999; 14: 914–21PubMedCrossRefGoogle Scholar
  44. 44.
    Tan EK, Jankovic J. Psychogenic hemifacial spasm. J Neuropsychiatry Clin Neurosci 2001; 13: 380–4PubMedCrossRefGoogle Scholar
  45. 45.
    Leonard R, Kendall K. Differentiation of spasmodic and psychogenic dysphonias with phonoscopic evaluation. Laryngoscope 1999; 109: 295–300PubMedCrossRefGoogle Scholar
  46. 46.
    Monday K, Jankovic J. Psychogenic myoclonus. Neurology 1993; 43: 349–52PubMedCrossRefGoogle Scholar
  47. 47.
    Eldridge R, Riklan M, Cooper IS. The limited role of psychotherapy in torsion dystonia. experience with 44 cases. JAMA 1969; 210: 705–8Google Scholar
  48. 48.
    Marsden CD, Harrison MJG. Idiopathic torsion dystonia. Brain 1974; 97: 793–810PubMedCrossRefGoogle Scholar
  49. 49.
    Cooper LS, Cullinan T, Riklan M. The natural history of dystonia. Adv Neurol 1976; 14: 157–69PubMedGoogle Scholar
  50. 50.
    Lesser RP, Fahn S. Dystonia: a disorder often misdiagnosed as a conversion reaction. Am J Psychiatry 1978; 153: 349–452Google Scholar
  51. 51.
    Ferraz HB, Andrade AF. Symptomatic dystonia: clinical profile of 46 Brazilian patients. Can J Neurol Sci 1992; 19: 504–7PubMedGoogle Scholar
  52. 52.
    Jayne D, Lees AJ, Stern GM. Remission in spasmodic torticollis. J Neurol Neurosurg Psychiatry 1984; 47: 1236–7PubMedCrossRefGoogle Scholar
  53. 53.
    Friedman A, Fahn S. Spontaneous remissions in spasmodic torticollis. Neurology 1986; 36: 398–400PubMedCrossRefGoogle Scholar
  54. 54.
    Neng T, Yi C, Xiu-Bao Z, et al. Acute infectious torticollis. Neurology 1983; 33: 1344–6CrossRefGoogle Scholar
  55. 55.
    Blakeley J, Jankovic J. Secondary causes of paroxysmal dyskinesia. Adv Neurol 2002; 89: 401–20PubMedGoogle Scholar
  56. 56.
    Fletcher NA, Harding AE, Marsden CD. A case controlled study of idopathic torsion dystonia. Mov Disord 1991; 6: 304–9PubMedCrossRefGoogle Scholar
  57. 57.
    Jankovic J, Van Der Linden C. Dystonia and tremor induced by peripheral trauma: predisposing factors. J Neurol Neurosurg Psychiatry 1988; 51: 1512–9PubMedCrossRefGoogle Scholar
  58. 58.
    Jankovic J. Can peripheral trauma induce dystonia and other movement disorders? Yes! Mov Disord 2001; 16: 7–12CrossRefGoogle Scholar
  59. 59.
    Jankovic J. Post-traumatic movement disorders: central and peripheral mechanisms. Neurology 1994; 44: 2008–14Google Scholar
  60. 60.
    Bhatia KP, Bhatt MH, Marsden CD. The causalgia-dystonia syndrome. Brain 1993; 116: 843–51PubMedCrossRefGoogle Scholar
  61. 61.
    Schwartzman RJ, Kerrigan J. The movement disorder of reflex sympathetic dystrophy. Neurology 1990; 40: 57–61PubMedCrossRefGoogle Scholar
  62. 62.
    Lang AE, Fahn S. Movement Disorder of RSD [letter to the editor]. Neurology 1990; 40: 1476CrossRefGoogle Scholar
  63. 63.
    Gower WR. Diseases of the nervous system. Philadelphia: Blackston,Son & Co, 1888Google Scholar
  64. 64.
    Campbell J. The shortest paper. Neurology 1979; 29: 1633PubMedCrossRefGoogle Scholar
  65. 65.
    Walters AS, Hening W. Noise-induced psychogenic tremor associated with post traumatic stress disorder. Mov Disord 1992; 7: 333–8PubMedCrossRefGoogle Scholar
  66. 66.
    O’Sulleabhain PE, Matsumoto J. Time-frequency analysis of tremors. Brain 1998; 121: 2127–34CrossRefGoogle Scholar
  67. 67.
    Thompson PD, Colebatch JG, Brown P, et al. Voluntary stimulus-sensitive jerks and jumps mimicking myoclonus or pathological startle syndromes. Mov Disord 1992; 7: 257–62PubMedCrossRefGoogle Scholar
  68. 68.
    Brown P, Thompson PD. Electrophysiological aids to jerks, spasms and tremor. Mov Disord 2001; 16: 595–9PubMedCrossRefGoogle Scholar
  69. 69.
    Garza JA, Louis ED, Ford B. Long-term outcome of psychogenic movement disorders. Neurology 2001; 56: A120Google Scholar
  70. 70.
    Thomas M, Jankovic J. Long term prognosis of patients with psychogenic movement disorders [abstract]. Neurology 2002; 58: A483Google Scholar
  71. 71.
    Reuber M, Pukrop R, Bauer J, et al. Outcome in psychogenic non epileptic seizures: 1 to 10 year follow up in 164 patients. Ann Neurol 2003; 53: 305–11PubMedCrossRefGoogle Scholar
  72. 72.
    Stone J, Sharpe M, Rothwell P, et al. The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2003; 74: 591–6PubMedCrossRefGoogle Scholar
  73. 73.
    Remick RA. Diagnosis and management of depression in primary care: a clinical update and review. CMAJ 2002; 167: 1253–60PubMedGoogle Scholar
  74. 74.
    Joffe R, Sokolov S, Streiner D. Antidepressant treatment of depression: a meta-analysis. Can J Psychiatry 1996; 41: 613–6PubMedGoogle Scholar
  75. 75.
    Moller HJ, Fuger J, Kasper S. Efficacy of new generation antidepressants: metaanalysis of imipramine-controlled studies. Pharmacopsychiatry 1994; 27: 215–23PubMedCrossRefGoogle Scholar
  76. 76.
    Brawman-Mintzer O. Pharmacologic treatment of generalized anxiety disorder. Psychiatr Clin North Am 2001; 24: 119–37PubMedCrossRefGoogle Scholar
  77. 77.
    Barsky AJ. The patient with hypochondriasis. N Engl J Med 2001; 345: 1395–9PubMedCrossRefGoogle Scholar
  78. 78.
    Reich P, Gottfried LA. Factitious disorders in a teaching hospital. Ann Intern Med 1983; 99: 240–7PubMedGoogle Scholar
  79. 79.
    Clark DM, Salkovskis PM, Hackmann A, et al. Two psychological treatments for hypochondriasis: a randomized controlled trial. Br J Psychiatry 1998; 173: 218–25PubMedCrossRefGoogle Scholar
  80. 80.
    Kroenke K, Swindle R. Cognitive behavioral therapy for soma-tization and symptom syndromes: a critical review of controlled clinical trials. Psychother Psychosom 2000; 69: 205–15PubMedCrossRefGoogle Scholar
  81. 81.
    Critchley HD, Melmed RN, Featherstone E, et al. Brain activity during biofeedback relaxation: a functional neuroimaging investigation. Brain 2001; 124: 1003–12PubMedCrossRefGoogle Scholar
  82. 82.
    Brown RJ, Trimble MR. Dissociative psychopathology, non-epileptic seizures, and neurology. J Neurol Neurosurg Psychiatry 2000; 69: 285–91PubMedCrossRefGoogle Scholar
  83. 83.
    Mailis-Gagnon A, Giannoylis I, Downar J, et al. Altered central somatosensory processing in chronic pain patients with “hysterical” anesthesia. Neurology 2003; 60: 1501–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Department of Neurology, Parkinson’s Disease Center and Movement Disorders ClinicBaylor College of MedicineHoustonUSA

Personalised recommendations