Post‐Traumatic Shoulder Movement Disorders: A Challenging Differential Diagnosis Between Organic and Functional

Pandey, DM Sanjay; Nahab, Fatta B.; Aldred, Jason; Nutt, John G.; Hallett, Mark

doi:10.1002/mdc3.12016

Cited by 16 publications

(9 citation statements)

References 10 publications

(23 reference statements)

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“…There are many clues to the diagnosis on history and examination. Features like abrupt onset, variability, distractibility, possible secondary gain, and comorbid psychiatric illness favor a diagnosis of PMD . On physical examination, there may be general clues, and disappearance of the disorder on distraction is most helpful; however, the disorder also may worsen with attention.…”

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confidence: 99%

Psychogenic Movement Disorders in Adults and Children: A Clinical and Video Profile of 58 Indian Patients

Pandey

Koul

2017

Movement Disord Clin Pract

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View Supplementary Video 1 View Supplementary Video 2 Background Psychogenic movement disorders (PMDs) represent 2% to 20% of patients with movement disorders. There is a paucity of literature on PMD in children, with most existing literature relating to adults only. Methods For this detailed report of 58 patients (33 adults and 25 children) with PMD, history was assessed in the form of disease onset, duration, precipitating factors, diagnosis, and outcome. Movement phenotype was classified in terms of its appearance as tremor, dystonia, myoclonus, chorea, and others. Clinical evaluations were done to document variability, distractibility, and entrainment. Surface electromyography studies were obtained in patients with tremor. Results Seven adults and 7 children were classified with “documented” PMD, and 26 adults and 18 children were classified with “clinically established” PMD. Abrupt onset was common in adults (75.75%) and children (68%). The most common precipitating factors were family and social issues (42.42%) in adults and fear of examination (40%) and school‐related issues (24%) in children. Tremor was the most common PMD in both adults and children. The second most common PMD was hemifacial spasm in adults. Conclusion The majority of patients had abrupt onset of symptoms, and tremor was the most common form of movement disorder. The second most common PMDs were hemifacial spasm in adults and dystonia and gait abnormality in children. The most common precipitating factors in adults were related to family and social issues; whereas, in children, examination and school‐related issues were most common. Complete improvement was seen in only 405 of patients.

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Psychogenic Movement Disorders in Adults and Children: A Clinical and Video Profile of 58 Indian Patients

Pandey

Koul

2017

Movement Disord Clin Pract

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“…‘Functional’ and ‘organic’ aetiology is conceived as if attributing more ‘organic’ causality necessarily implies the attribution of less ‘functional’ causality. This is apparent in the concept of “functional overlay” 56 , 57 where a certain proportion of the total presentation is attributed to either ‘organic’ or ‘functional’ aetiology, and the wide-ranging discussion of differential diagnosis between syndromes apparently on either side of the aetiological distinction 58 – 60 . These diagnostic categories imply syndromes exist in “purely functional” or “purely organic” equivalents, presumably representing the far ends of a functional-organic spectrum.…”

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confidence: 99%

What is the functional/organic distinction actually doing in psychiatry and neurology?

et al. 2020

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The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms ‘functional’ and ‘organic’ varies considerably by context. Techniques for differentially diagnosing ‘functional’ and ‘organic’ diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of ‘zero sum’ causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note ‘functional’ and ‘organic’ have loaded social meanings, creating the potential for social disempowerment. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other in neuropsychiatric thinking. We also note that the contribution of people who experience the interaction between ‘functional’ and ‘organic’ factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

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“…This is apparent in the concept of "functional overlay" (Carter, 1967;Florence and Miller, 1985) where a certain proportion of the total presentation is attributed to either 'organic' or 'functional' aetiology, and the wide-ranging discussion of differential diagnosis between syndromes apparently on either side of the aetiological distinction (e.g. Pandey et al, 2014;Pruszewicz et al, 1991;Richter, 1991). These diagnostic categories imply syndromes exist in "purely functional" or "purely organic" equivalents, presumably representing the far ends of a functional-organic spectrum.…”

Section: Discussionmentioning

confidence: 99%

What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology?

Bell¹,

Wilkinson²,

Greco³

et al. 2020

Preprint

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The functional-organic distinction aims to distinguish symptoms, signs, and syndromes that can be explained by diagnosable biological changes, from those that cannot. The distinction is central to clinical practice and is a key organising principle in diagnostic systems. Following a pragmatist approach that examines meaning through use, we examine how the functional-organic distinction is deployed and conceptualised in psychiatry and neurology. We note that the conceptual scope of the terms 'functional' and 'organic' varies considerably by context. Techniques for differentially diagnosing 'functional' and 'organic' diverge in the strength of evidence they produce as a necessary function of the syndrome in question. Clinicians do not agree on the meaning of the terms and report using them strategically. The distinction often relies on an implied model of 'zero sum' causality and encourages classification of syndromes into discrete ‘functional’ and ‘organic’ versions. Although this clearly applies in some instances, this is often in contrast to our best scientific understanding of neuropsychiatric disorders as arising from a dynamic interaction between personal, social and neuropathological factors. We also note 'functional' and 'organic' have loaded social meanings, creating the potential for social disempowerment and epistemic injustice. Given this, we argue for a better understanding of how strategic simplification and complex scientific reality limit each other. We also note that the contribution of people who experience the interaction between 'functional' and 'organic' factors has rarely informed the validity of this distinction and the dilemmas arising from it, and we highlight this as a research priority.

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Post‐Traumatic Shoulder Movement Disorders: A Challenging Differential Diagnosis Between Organic and Functional

Cited by 16 publications

References 10 publications

Psychogenic Movement Disorders in Adults and Children: A Clinical and Video Profile of 58 Indian Patients

Psychogenic Movement Disorders in Adults and Children: A Clinical and Video Profile of 58 Indian Patients

What is the functional/organic distinction actually doing in psychiatry and neurology?

What is the Functional / Organic Distinction Actually Doing in Psychiatry and Neurology?

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