Psychogenic Movement Disorders (AAN 2004)

Subject: Psychogenic Movement Disorders (AAN 2004)

Date: 5/28/2004

E-MOVE reports from the American Academy of Neurology, San Francisco April 25-30, 2004. Page (A), session (S) and poster (P) numbers are from Neurology 2004;62(7), Suppl 5

1. Single-blind clinical trial for treatment of psychogenic movement disorders with psychotherapy
VK Hinson, S Weinstein, CG Goetz, B Bernard, S Leurgans
S65.004, A539

Psychotherapy and medication are effective for psychogenic movement disorders, according to this study.

Ten patients with psychogenic movement disorders (PMDs) were recruited. Diagnosis was by a movement disorder specialist and confirmed by a panel of 7 other physicians by video review. Most patients were Caucasian females with PMDs of 8 months or less duration. Action tremor, myoclonus, and dystonia were the most common movement disorders. Comorbidities included depression (5), post-traumatic stress disorder (2), personality disorder (2), anxiety disorder (1), and bipolar disorder (1).

Patients received 12 weeks of outpatient psychodynamic psychotherapy, with antidepressant or anxiolytic medication as needed in the opinion of the treating psychiatrist. Total Psychogenic Movement Disorder Rating Scale scores improved from 71.2 at baseline to 29 at 12 weeks (P<0.02). Functional impairment, anxiety, and depression scores also improved significantly.

2. Long-term outcome of psychogenic tremor
J Jankovic, M Thomas, KD Vuong
P06.115, A501

Psychogenic movement disorder was diagnosed in 4.1% (n=517) of all patients seen at a single movement disorders clinic in a 14-year period. Of these, 41% had psychogenic tremor. Telephone interviews and chart review for 127 consenting patients with PT indicated the following:
--mean age at initial evaluation was 43.7 years
--mean duration of symptoms was 4.6 years
--the most characteristic features were abrupt onset (79%), distractibility (72%), and variable amplitude and frequency (62%)
--some precipitating event (stress, trauma, illness, or iatrogenic causes) occurred in the majority of patients
--comorbidities included organic neurologic disorder (37%), depression (57%), and anxiety (31%).
--secondary gain was present in 32%
--59% of patients rated themselves “better” on last follow-up.