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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 Nov 23, 2022   -  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.

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Frequently Asked Questions


1.

What Are Various Psychogenic Symptoms?

Most psychogenic symptoms are involuntary that are done without being initiated by the individual. For example, pain is a common psychogenic symptom due to any injury or illness. Psychogenic pain is a type of chronic pain and is usually not caused by clinical pathology.

2.

How to Control Psychogenic Tremors?

Botulinum toxin injections can be used to control the psychogenic tremor. Surgery and physical therapy may provide relief from tremors. Maintaining a proper diet and lifestyle can help the person control psychogenic tremors.

3.

What Is an Example of Psychogenic Pain?

Psychogenic pain is pain that occurs due to any injury or illness. Some psychogenic pain includes muscle pain, headache, stomach pain, and back pain. Psychogenic pain may impact physical as well as mental health.

4.

Can the Disorder Related to Movement Be Cured?

In most cases, the movement disorder cannot be cured. The movement disorder treatment helps relieve the pain and minimize the symptoms. However, some movement disorders can be progressive or severe and cannot be cured.

5.

What Are the Three Common Movement Disorders?

The common movement disorder involves Parkinson's disease (which refers to a progressive brain disorder that causes tremors, stiffness, and loss of balance), ataxia (refers to poor muscle control that causes clumsy voluntary movements), and tic disorder (refers to repetitive, involuntary movement).

6.

How to Stop Involuntary Movements?

Involuntary movement can be treated by deep brain stimulation, medication, or behavioral therapy. In some cases, uncontrolled movement in one or more body parts may subside easily. However, involuntary movement cannot be controlled in other cases and worsens over time.

7.

Can Stress Lead To Involuntary Movement?

The stress hormone released in the body is triggered by the brain, often leading to involuntary muscle movement. Stress can lead to soreness or tightness in the muscle. Also, it has a negative impact on the health of a person.

8.

What Leads to Uncontrolled Movements?

Uncontrolled or involuntary movements is the body movement that an individual cannot control. The most common causes of uncontrolled movements are stroke, brain injury, tumors, drug use, seizure disease, and untreated syphilis.

9.

What Leads to Uncontrolled Muscle Movement?

Uncontrolled muscle movement includes brain damage, infection, medication side effects, chronic disease, and lack of oxygen in the brain. Muscle spasms can be dangerous and become disruptive in some cases. Certain medications can decrease the frequency and severity of uncontrolled muscle movement.

10.

Is Walking Involuntary or Voluntary?

Walking is a voluntary movement. Voluntary movements are the movements produced by the involvement of thoughts of an individual. Both the brain and spinal cord are involved, which coordinate to generate necessary movements.

11.

What Is the Common Involuntary Movement Disorder?

Examples of common involuntary movement disorders include loss of muscle tone, sudden jerking, and tremors (uncontrolled repetitive movement). Involuntary movement involves the unintended or uncontrolled movement of the body governed without thought.
 
Movement disorder causes include tumors, drug use, brain injury, untreated syphilis, and seizure disorder.

12.

Why Does the Body Have Involuntary Jerks?

Myoclonus is the term used for jerking or involuntary muscle twitching. The onset of involuntary jerks is sudden. It is not a disease but a condition associated with certain diseases.

13.

How to Treat Movement Disorder?

Treatment of movement disorders includes the medications such as Diazepam, Clonazepam, Tizanidine, and Baclofen. In addition, physical therapy involving specific muscle exercises can help reduce the severity of symptoms.

14.

How Can a Person Stop Hands From Shaking?

Involuntary shaking of hands can occur due to tremors (repetitive, involuntary movements). Essential tremors cause rhythmic and involuntary shaking. The treatment option for shaky hands involves anxiety disorder,anti-seizure medications, and beta blockers.

15.

Can Anxiety Lead To Psychogenic Tremor?

Whenever the person feels anxious, the muscles may become tensored as anxiety targets the body to react in response to environmental dangers. As a result, the muscles may tremble, twitch, or shakes. Tremors caused by anxiety are known as psychogenic tremors.

Last reviewed at:
23 Nov 2022  -  5 min read

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