Psychogenic disorders in neurology: frequency and clinical spectrum

Lempert, T.; Dieterich, Marianne; Huppert, Doreen; Brandt, Thomas

doi:10.1111/j.1600-0404.1990.tb03312.x

Cited by 167 publications

(81 citation statements)

References 35 publications

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“…Both PNES and PMD are commonly seen in clinical practice (up to 20% of outpatients 1,2 ), but their precise prevalence and incidence are unknown. The only population-based study available yielded an incidence of PNES of 1.4 per 100,000, with highest age-specific incidence (3.4 per 100,000) in the 15-24 years age group.…”

Section: Epidemiology and Demographicsmentioning

confidence: 99%

Psychogenic nonepileptic seizures and movement disorders

et al. 2016

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Purpose of review: Neurologic symptoms due to a psychogenic cause are frequently seen in clinical practice. Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are among the most common psychogenic neurologic disorders. PNES and PMD are usually investigated and managed separately by different neurology subspecialists. We review the main epidemiologic and clinical features of both PNES and PMD, aiming to highlight their similarities and differences and to see whether a common framework for these disorders exists. Recent findings:Data from the literature show that there is a profound overlap between PNES and PMD, which would argue for a larger unifying pathophysiology with variable phenotypic manifestations. Summary: Collaborative and integrated research among epileptologists, movement disorders experts, psychiatrists, psychologists, and physiotherapists may increase our collective knowledge about the pathophysiologic mechanisms of PNES and PMD and therefore improve outcomes for these patients. Neurol Clin Pract 2016;6:138-149 N eurologic symptoms due to a functional or psychogenic cause are common in clinical practice, accounting for up to 16% of patients presenting to neurology outpatient clinics, depending on the clinical definitions and methodology used for case ascertainment.1,2 The yearly costs of patients with medically unexplained symptoms in the United States have been estimated at approximately $256 billion per year.3 Despite their prevalence and associated economic and social burden, appropriate treatments for these disorders are an unmet need. This may reflect the absence of research interest and lack of discourse between neurology and psychiatry regarding these patients. Notably, although approximately 50% of the patients with somatoform disorders are identified by neurologists at the time of first contact, only 1.5% are referred to a psychiatrist or a psychologist.

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Section: Epidemiology and Demographicsmentioning

confidence: 99%

Psychogenic nonepileptic seizures and movement disorders

et al. 2016

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“…This was measured using the Patient Health Questionnaire checklist of the 15 commonest physical symptoms presenting to primary care (excluding upper respiratory tract infections) and with the sexual and menstrual items removed to leave 13 items (Kroenke et al 2002). In order to see if the inclusion of neurological symptoms made a difference we created a longer symptom score by supplementing these items with nine symptoms common in neurology patients judged to have symptoms unexplained by disease (Lempert et al 1990) to make a 22-item scale. The total number of symptoms endorsed on each scale was calculated for each patient.…”

Section: Completed By Patientsmentioning

confidence: 99%

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

et al. 2009

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Background. Patients whose symptoms are ' unexplained by disease ' often have a poor symptomatic outcome after specialist consultation, but we know little about which patient factors predict this. We therefore aimed to determine predictors of poor subjective outcome for new neurology out-patients with symptoms unexplained by disease 1 year after the initial consultation.Method. The Scottish Neurological Symptom Study was a 1-year prospective cohort study of patients referred to secondary care National Health Service neurology clinics in Scotland (UK). Patients were included if the neurologist rated their symptoms as ' not at all ' or only ' somewhat explained ' by organic disease. Patient-rated change in health was rated on a five-point Clinical Global Improvement (CGI) scale (' much better ' to ' much worse ') 1 year later.Results. The 12-month outcome data were available on 716 of 1144 patients (63 %). Poor outcome on the CGI (' unchanged ', ' worse ' or ' much worse ') was reported by 482 (67 %) out of 716 patients. The only strong independent baseline predictors were patients' beliefs [expectation of non-recovery (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.40-2.96), non-attribution of symptoms to psychological factors (OR 2.22, 95 % CI 1.51-3.26)] and the receipt of illness-related financial benefits (OR 2.30,. Together, these factors predicted 13 % of the variance in outcome.Conclusions. Of the patients, two-thirds had a poor outcome at 1 year. Illness beliefs and financial benefits are more useful in predicting poor outcome than the number of symptoms, disability and distress.

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“…Intervention at the earliest time may improve the outcome for treatment interventions and facilitate a return to normal activity for the patient [25]. The potential impact on the patient and family is illustrated by data showing that 82% of adults stop working for some period of time due to their symptoms and hospitalization in children have been reported for as long as 110 days [24,26]. As with all therapeutic interventions, active involvement of the patient and family is mandatory at all steps along the treatment path.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient responded well to biofeedback and cognitive behavioral therapy (CBT); therefore pharmacological intervention was not needed. CBT is the mainstay treatment of children with somatoform disorders [23,24]. A better prognosis can be expected in patients who have had a shorter duration, sudden onset, an early identifiable stressor, lack of comorbid psychiatric disorders, and good premorbid functioning.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Postoperative Conversion Disorder in an Adolescent Following Arthroscopic Meniscectomy

et al. 2017

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Conversion disorder (CD), also known as a functional neurological symptom disorder, is a somatoform disorder involving an unconscious, involuntary process in which psychosocial needs, conflicts, and internal stresses are expressed as somatic symptoms without an anatomical or physiological explanation. The signs and symptoms are involuntary and appear with no underlying physical cause. Various triggers and psychologic stresses may result in the sudden clinical manifestations of the disorder. We present a 14-year-old adolescent who developed a CD following anesthetic care for a partial lateral meniscectomy. Previous reports of postoperative CDs are reviewed, etiologic considerations during the postoperative period are discussed, and management options are presented.

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Psychogenic disorders in neurology: frequency and clinical spectrum

Cited by 167 publications

References 35 publications

Psychogenic nonepileptic seizures and movement disorders

Psychogenic nonepileptic seizures and movement disorders

Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome

Diagnosis and Management of Postoperative Conversion Disorder in an Adolescent Following Arthroscopic Meniscectomy

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