Munchausen's Syndrome Simulating Torsion Dystonia

Batshaw, Mark L.; Wachtel, Renee C.; Deckel, A. W.; Whitehouse, Peter J.; Moses, Hamilton; Fochtman, L. J.; Eldridge, Roswell

doi:10.1056/nejm198505303122207

Cited by 42 publications

(14 citation statements)

References 9 publications

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“…A intensidade da distonia não pode ser considerada como um critério diferencial 7,18 . Os espasmos nestes pacientes podem ser extremos e desfigurantes, como evidente em ambas as pacientes.…”

Section: Discussionunclassified

“…Outro fator que influi no prognóstico é o quadro psiquiátrico de base. Desordens fictícias, como na Paciente 1, geralmente não melhoram; os sintomas só desaparecem quando o paciente estiver pronto para se livrar deles 5,18 . Os transtornos somatoformes podem responder a psicoterapia e a outras medidas, entretanto os sintomas podem voltar, mesmo que o paciente tenha consciência da origem emocional do problema 5,7 .…”

Section: Discussionunclassified

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Distonia psicogênica: relato de dois casos

Vargas¹,

Carod-Artal²,

Negro³

et al. 2000

Arq. Neuro-Psiquiatr.

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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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Section: Discussionunclassified

Distonia psicogênica: relato de dois casos

Vargas¹,

Carod-Artal²,

Negro³

et al. 2000

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

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“…For example, Batshaw et al [2,21] describe a patient who generated the symptoms of torsion dystonia so convincingly over a period of years that intrathecal steroid therapy and eventually a bilateral thalamoto my were carried out.…”

Section: Factitious Disorders In the Field Of Neurologymentioning

confidence: 99%

Factitious Disorders in the Field of Neurology and Psychiatry

Eckhardt¹

1994

Psychother Psychosom

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“…Other secondary causes of dystonia include perinatal birth injury, stroke, head injury, Parkinson's disease, Huntington's chorea (Westphal variant), brain tumour, toxins including manganese, carbon monoxide and carbon disulfide, drugs including levodopa and anti-convulsants and metabolic disorders. A rare cause that may present as dystonia is Munchausen's syndrome [23]. Among patients with a history of abnormal birth or development it may be difficult clinically to differentiate between tardive dystonia and delayed-onset dystonia resulting from perinatal injury [24] co-incidental with the use of antipsychotic drugs.…”

Section: Differential Diagnosismentioning

confidence: 99%

Tardive Dystonia

Chiu

Lee

1989

Aust N Z J Psychiatry

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Unlike tardive dyskinesia (TD) which is much better known by clinicians, tardive dystonia is a more recently recognised complication of neuroleptic use. It refers to chronic dystonia related to the use of neuroleptic drugs and may be an even more disabling condition than TD. This article reviews its epidemiology, clinical features and treatment aspects, and suggests that it should be separated from TD as a distinct entity.

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Munchausen's Syndrome Simulating Torsion Dystonia

Cited by 42 publications

References 9 publications

Distonia psicogênica: relato de dois casos

Distonia psicogênica: relato de dois casos

Factitious Disorders in the Field of Neurology and Psychiatry

Tardive Dystonia

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