Psychogenic Movement Disorders
Psychogenic movement disorders (PMDs) are defined as follows: “those movement disorders which cannot be fully accounted for by any known organic syndrome and which appear as based on available clinical evidence to have significant psychological and/or psy
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Psychogenic Movement Disorders Teri R. Thomsen and Janis M. Miyasaki This chapter contains videos segment which can be found at the URL: http://www.springerimages.com/Suchowersky Video Segment Content Case 1: Psychogenic gait. Note the non-anatomic posture of the feet in extreme external rotation. Clinicians should be familiar with typical cerebellar gait (broad-based and irregular steps), parkinsonian (small steps with festination or freezing) and dystonic gait (postures will change with walking with occasional resolution of dystonic posture in feet with walking backwards). Unusual gaits should be reviewed: cock walking gait with manganese toxicity and the gait with neuroacanthocytosis. Case 2: Psychogenic tremor. Note the tremor is inconsistent in amplitude, direction and nature. Tremor is distractible with conversation and also entrains with movements performed by other parts of the body requiring concentration. This feature may not be present when psychogenic tremor is present for long periods of time. Also see Chapter 3, cases 21 and 22 and Chapter 6, cases 11 and 12.
Introduction Psychogenic movement disorders (PMDs) are defined as follows: “those movement disorders which cannot be fully accounted for by any known organic syndrome and which appear as based on available clinical evidence to have significant psychological and/or psychiatric contributants” [1] and have been variously labeled as functional, pseudoneurologic, psychosomatic, hysterical, and nonorganic [2, 3]. PMDs can be either hyperkinetic, such as myoclonus, or hypokinetic, such as parkinsonism. This chapter deals with hyperkinetic PMDs, including tremor, dystonia, myoclonus, tic, chorea/athetosis, gait disorders, and exaggerated startle reflex. T.R. Thomsen, MD, JD University of Iowa Hospital and Clinic, Neurology 2 RCP, 200 Hawkins Drive, Iowa City, IA 52242, USA J.M. Miyasaki, MD, FRCPC (*) Department of Medicine (Neurology), University of Toronto, The Movement Disorder Centre, 399 Bathurst Street, 7MCL, Toronto, ON, Canada M5T 2S8 e-mail: [email protected] O. Suchowersky and C. Comella (eds.), Hyperkinetic Movement Disorders, Current Clinical Neurology, DOI 10.1007/978-1-60327-120-2_7, © Springer Science+Business Media New York 2012
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166 Table 7.1 Prevalence of various PMDs noted in recent studies Thomas Factor et al. [2] et al. [4] Tremor (%) 50 39.8 Dystonia (%) 18 40.6 Myoclonus (%) 14 17.2 Parkinsonism (%) 7 3.2 Tic (%) 4.3 Chorea (%) 0.6 Other dyskinesia (%) 10 1.5 Gait disorder (%)
T.R. Thomsen and J.M. Miyasaki
Miyasaki et al. [1] 32.8 25 25 6.1
10.9
Williams et al. [15] 13 53 7 1.9 1.3 9 9
PMDs are a significant source of morbidity and disability in affected persons; therefore, a basic understanding of these disorders is important to allow neurologists to recognize their presentation [4]. Estimates of the prevalence of PMDs range from 1 to 25% due to differing diagnostic criteria and ascertainment methodologies [4, 5]. One study noted that among 4,470 consecutive neurological inpatients, 405 of these (9%) were found to h
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