ADVERTISEMENT
Emotional and Mental Health Data Verified

Diagnosis and Management of Psychogenic Movement Disorders

Written by
Dr. Alok Vinod Kulkarni
and medically reviewed by iCliniq medical review team.

Published on Dec 21, 2014 and last reviewed on Jul 06, 2021   -  5 min read

Abstract

This article discusses the various types of psychogenic movement disorders, clinical pointers towards their diagnosis and effective treatment strategies.

Contents
Diagnosis and Management of Psychogenic Movement Disorders

What Are The Types Of Movements?

Movements are categorized into four classes:

Automatic Movements:

Automatic movements are learned motor acts that are performed without conscious effort. For example: opening the door while entering a room, tapping one's fingers while thinking about something.

Voluntary Movements:

Voluntary movements are planned or self-initiated. In other words, the movements are intentional and are externally triggered. For example: withdrawing the hand from a hot plate.

Semi voluntary Movements:

Semi-voluntary movements are induced by an inner stimulus that is sensory in nature. For example, a need to scratch an itch.

Involuntary Movements:

An important difference between semi-voluntary and involuntary movements is that the patient can suppress semi-voluntary movements, and involuntary movements are often non-suppressible or partially suppressible (some tremors, chorea, dystonia, stereotypies, and some tics).

Movement disorders are classified into two types:

What Are Psychogenic Movement Disorders?

These are an often neglected category of movement disorders. Psychological factors cause these, and hence they were earlier classified as functional or non-organic movement disorders. Earlier, they fell under the category of medically unexplained symptoms, and in that, a diagnosis was made only after other organic causes were ruled out. One must not assume that the term "functional" always points to a psychogenic basis. In the past, the term "functional" has been used to denote organic diseases in which a specific cause was not determined. However, much debate continues regarding these terminologies in the international forum for movement disorders.

In the recent past, there has been an upward trend in the occurrence of psychogenic movement disorders, and studies estimate that their global prevalence is around 1 to 9 % in all neurologic diagnoses. To be classified as a psychogenic movement disorder, no organic cause should be evident, and there should be an overlay of a psychiatric disorder. Therefore, it is imperative to explore psychodynamics, which could point to the etiology in such cases.

It is intellectually intriguing that the human brain is capable of creating neuro deficits such as paralysis, sensory loss, blindness, epilepsy from physiologic factors. However, no investigation exists that can differentiate between an involuntary and a voluntary movement disorder.

What Are The Causes Of Psychogenic Movement Disorders?

Diagnosis of Psychogenic Movement Disorders:

A diagnosis can only be made by:

Some pointers towards the diagnosis of psychogenic movement disorders include abrupt onset, inconsistent and incongruous movements, bizarre gait, excessive fatigue, excessive startle response to a stimulus, spontaneous remissions, the disappearance of movements with distraction, response to placebo treatment and strong suggestions, deliberate slowness of movement and multiple vague somatizations.

Psychiatric conditions that often masquerade as psychogenic movement disorders include somatoform disorder, factitious disorder, malingering, depression, and anxiety disorder.

In addition, these may take the form of psychogenic tremor, psychogenic gait, psychogenic dystonia, psychogenic tics, psychogenic myoclonus, and surprisingly even psychogenic Parkinsonism.

The diagnosis is also based on a combination of several clinical observations and recognition of typical characteristics that include:

Other characteristics include:

A blood test or any other diagnostic test cannot be done for psychogenic movement disorder. The diagnosis of a psychogenic movement disorder is a two-step process. The first step is to make a positive diagnosis that the movements are psychogenic rather than from an organic illness. The second step is to identify either a psychiatric disorder, such as depression or anxiety, or the psychodynamics that could explain the abnormal movements. It is essential to properly diagnose psychogenic movement disorder because only then can we give appropriate treatment.

Additionally, suppose the patient has been misdiagnosed with a psychogenic movement disorder. In that case, the patient may be given inappropriate treatment, such as inappropriate medication that may create harmful side effects. This will also postpone appropriate psychiatric treatment. Delaying or improper diagnosis and treatment may lead to chronic disability.

Management of Psychogenic Movement Disorders:

Correct diagnosis is of vital importance. Suppose clinicians fail to identify psychogenic movement disorders. In that case, the patient can be put unnecessarily on medications that will have debilitating side effects, like cognitive impairment, excessive dryness of the mouth, drying up of the tears, constipation, blurred vision, and difficulty in urination.

Always communicate with a psychiatrist for effective and appropriate management of these disorders. A psychiatrist can only make the diagnosis, and the diagnosis dictates further management. Wrong diagnoses can have deleterious consequences.

Evidence-based treatment approaches include:

Conclusion:

Psychogenic movement disorders are common, but diagnosing may be difficult. Visual appearance alone is usually insufficient to make a proper diagnosis, but such information is undoubtedly important. The severity of psychogenic movement abnormalities and prognosis varies among individuals. Long-term outcomes appear to be best in patients with a shorter span of symptoms. Most importantly, the patients who accept the diagnosis and work with their physicians and other healthcare professionals will help them return to their mainstream of life.

ADVERTISEMENT

Last reviewed at:
06 Jul 2021  -  5 min read

RATING

15

Tags:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers


Stress in a Broad Perspective - More Than Merely a Mental Illness!!

Article Overview: Stress is not always due to mental (psychiatric) illnesses. Physical wellness also counts for stress levels in modern life. Read Article


Dr. Muhammad M. Hanif Md.
Dr. Muhammad M. Hanif Md.
Internal Medicine Physician

What Do You Think Is Stress in Your Daily Life? Stress is not just a mental illness. It is not merely a disease of your brain and does not always mean that you have a serious psychiatric disorder. It is a multifactorial disorder including general physical wellness, issues related to chronic disease...  Read Article

I have a habit of tongue thrusting. How to stop it?

Query: Hi doctor, I have a habit of tongue thrusting. Now, I am using permanent retainers for the past four months. How to overcome it?  Read Full »

Can I take antidepressants only when needed and not continuously?

Query: Hello doctor, I have depression. But for some reason, I do not want to take antidepressants. I have been taking it for the past one year. And have stopped it. But sometimes I get very depressed. Can I take my antidepressant like Desvenlafaxine sometimes? As needed? Or maybe any other antidepressant ...  Read Full »

Popular Articles Most Popular Articles

Do you have a question on Antidepressants or Cognitive Behaviour Therapy?

Ask a Doctor Online

* guaranteed answer within 4 hours.

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.