Distonia psicogênica: relato de dois casos

Abstract

RESUMO -Desordens de movimento raramente podem ser devidas a distúrbios psiquiátricos. A distonia psicogênica caracteriza-se pela inconsistência dos achados, presença de fatores precipitantes, manifestar-se inicialmente nos membros inferiores, associar-se a dor, a outros movimentos anormais incaracterísticos e a somatizações múltiplas. Descrevemos duas pacientes com diagnóstico de distonia psicogênica clinicamente estabelecida. Paciente 1, feminina, apresentou episódio súbito de perda de força dos quatro membros, evoluiu com distonia nos pés, laterocolo alternante, tremor generalizado, irregular, e hipertonia dos membros inferiores que desapareciam a distração; a avaliação psicológica evidenciou depressão, hipocondria, transtorno obsessivo. Paciente 2, feminina, há nove anos começou a ter tremor irregular nos membros inferiores, que desaparecia com a distração, e distonia no pé esquerdo associada a dor; progressivamente perdeu a marcha; a avaliação psicológica revelou comportamento infantilizado, com baixa tolerância a frustração, impulsividade e auto-agressão. Os exames complementares de ambas não mostraram alterações e a resposta ao tratamento farmacológico foi nula. Distonia raramente é de origem psicogênica. A inconstância e a incongruência com o quadro clássico, associadas a outras somatizações ou a distúrbios psiquiátricos, sugerem o diagnóstico. PALAVRAS-CHAVE: distonia, desordem de movimento psicogênica, distúrbio somatoforme. Psychogenic dystonia: report of two casesABSTRACT -Movement disorders have rarely been the result of psychiatric disturbances. Psychogenic dystonia is caracterized by inconsistent findings, a known precipitant factor, onset in legs, pain , multiple somatizations and incongruent association with other movement disorders. We report two patients with clinically established psychogenic dystonia. Patient 1: a female that presented sudden loss of strength in her four limbs; she developed feet dystonia, alternant laterocollis, generalized and irregular tremor, and limb hypertonia that disappeared with distraction; psychological examination showed severe depression, hypochondria and obsessive disorder. Patient 2: a female that presented with irregular limb tremors that disappeared with distraction and left foot dystonia nine years ago; she gradually lost her walk capacity; she complained pain in lumbar area and in her left limb, psychological examination showed infantile behaviour, low frustration tolerance, impulsivity and self-aggression. Their complementary exams showed no alterations and they had no reponse to specific pharmacological treatment. Dystonia is rarely psychogenic, but this etiology is suggested when clinical characteristics are inconsistent and incongrous with a classical disorder. It shoud be part of differential diagnosis when appears in association with other somatization or psychiatric disorders.KEY WORDS: dystonia, psychogenic movement disorders, somatoform disorders. Distonia é um distúrbio de movimento caracterizado por contrações musculares relativamente lentas, su...

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Walking and examining the patient before running to the imaging tests

“…Antonio Pedro Vargas and colleagues 8 have shown the clinical characteristics of two patients with psychogenic gait abnormalities and the difficult differential diagnosis; Roberta de Melo Roiz and colleagues 9 have shown, using kinematics data, that in 12 patients with Parkinson's disease (compared to 15 controls) there was a lower stride velocity, shorter stride length and slower hip joint kinematics; and Eliane Mayumi Kato-Narita and colleagues 10 have shown that in 48 patients with mild and moderate Alzheimer's disease (AD) (compared to 40 normal subjects) there was a decline of balance asso-ciated to the occurrence of falls, but interestingly the loss of functional capacity was associated with the disease's progression but not with a higher occurrence of falls. Péricles Maranhão-Filho and colleagues 4,5 are to be commended for bringing back the fundamental issue of the neurologic examination and for explaining in details how to perform and correctly interpret a modern and elegant evaluation of stance and gait.…”