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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 Sep 07, 2018   -  3 min read

Abstract

Abstract

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

Diagnosis and Management of Psychogenic Movement Disorders

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 a hand from a hot plate.

Semivoluntary Movements:

Semivoluntary movements are induced by an inner stimulus that is sensory in nature. For example: need to scratch an itch.

Involuntary Movements:

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

Movement disorders can be classified into two types:

Psychogenic Movement Disorders:

These are an often neglected category of movement disorders. These are caused by psychological factors, 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. The term ''organic'' is used to mean ''not due to a psychogenic etiology'', and, thus the term ''non-organic'' refers to psychogenic etiology. 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. It is imperative to explore the psychodynamics which could possibly point to the etiology in such cases.

It is intellectually intriguing that the human brain is capable of creating neurodeficits such as paralysis, sensory loss, blindness, epilepsy, from physiologic factors. A great deal of work has been done in this regard by Charcot and Freud. Till date, no investigation exists that can differentiate between an involuntary and a voluntary movement disorder.

Diagnosis of Psychogenic Movement Disorders:

A diagnosis can only be made by:

Some pointers towards the diagnosis of a psychogenic movement disorders include an abrupt onset, inconsistent and incongruous movements, bizarre gait, excessive fatigue, excessive startle response to a stimulus, spontaneous remissions, 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. These may take the form of a psychogenic tremor, psychogenic gait, psychogenic dystonia, psychogenic tics, psychogenic myoclonus and surprisingly even psychogenic parkinsonism.

Management of Psychogenic Movement Disorders:

Correct diagnosis is of vital importance. If clinicians fail to identify psychogenic movement disorders, the patient can be put unnecessarily on medications which 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 liaise with a psychiatrist for effective and appropriate management of these disorders. The diagnosis can only be made by a psychiatrist and the diagnosis dictates the further management. Wrong diagnoses can have deleterious consequences.

Evidence based treatment approaches include:

Consult a psychiatrist online to know more about psychogenic movement disorders --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

 

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Last reviewed at:
07 Sep 2018  -  3 min read

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Dr. Alok Vinod Kulkarni

Dr. Alok Vinod Kulkarni

MBBS, DPM (NIMHANS), (MD) Psychiatry

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