Psychogenic movement disorders: frequency, clinical profile, and characteristics.

Abstract

Of 842 consecutive patients with movement disorders seen over a 71 month period, 28 (3.3%) were diagnosed as having a documented or clinically established psychogenic movement disorder. Tremor was most common (50%) followed by dystonia, myoclonus, and parkinsonism. Clinical descriptions of various types are reviewed. Clinical characteristics common in these patients included distractability (86%), abrupt onset (54%), and selective disabilities (39%). Distractability seems to be most important in tremor and least important in dystonia. Other diagnostic clues included entrainment of tremor to the frequency of repetitive movements of another limb, fatigue of tremor, stimulus sensitivity, and previous history of psychogenic illness. On examination, 71% had other psychogenic features. Over 60% had a clear history of a precipitating event and secondary gain and 50% had a psychiatric diagnosis (usually depression). Twenty five per cent of patients presented with combined psychogenic movement disorder and organic movement disorder; 35% resolved and this subgroup had a shorter duration of disease than those who are unresolved. Psychogenic movement disorder represents an uncommon diagnosis among patients with movement disorders. The ability to make a diagnosis rests on the presence of a multitude of clinical clues and therapeutic action should be taken as early as possible.

The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm

“…In a series of 131 patients with PMD, blepharospasm or other facial movements accounted for only 0.3% (4/152) of all types of psychogenic movements 5 ; in other series of PMD, 2%-7% of the cases had blepharospasm and facial movements. 6,7 In our series, 22% of all blepharospasm patients in a tertiary botulinum toxin clinic had atypical features and were clinically suspected to have a psychogenic movement disorder. However, the level of diagnostic certainty was only possible or probable psychogenic in 7 out of 9 patients.…”

“…[5][6][7] In our clinical practice, we often observe patients with atypical features to their blepharospasm, such as a relatively young age and acute onset, constant eye closure, unusual aggravating or relieving factors, or unusual (sometimes immediate) response to botulinum toxin injections. Although one would expect such features to be more typical for PB, establishing a final diagnosis is sometimes difficult on clinical grounds alone.…”

Historical and Clinical Features of Psychogenic Tremor: a Review of 70 Cases

“…As in other series of psychogenic movement disorders, 2,6 cases of psychogenic tremor that reach the attention of a specialty movement disorders clinic may have a protracted course and an uncertain or poor prognosis. We observed recurrence of psychogenic tremor in one of ten patients during the follow-up period and in three patients by history.…”

Functional Movement Disorders: Updated Overview

“…FMD can take the shape of known movement disorders, tremor being a most common presentation followed by dystonia, myoclonus, and ataxia [48]. Tics have been reported, along with other possible but less common movement disorders such as psychogenic Parkinsonism, psychogenic facial movements, some ocular manifestations, and palatal tremor.…”