Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace: a cas
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JOURNAL OF MEDICAL
CASE REPORTS
CASE REPORT
Open Access
Severe psychogenic tremor of both wrists in a 13-year-old girl treated successfully with a customized wrist brace: a case report Elisabeth Sauerhoefer*, Caroline Schafflhuber and Oliver Kratz
Abstract Introduction: Psychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed. Case presentation: A 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl’s parents’ conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%). Two weeks after she was discharged from hospital, the tremor had completely disappeared. Conclusion: After careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.
Introduction Dissociative disorder is characterized by the partial or complete lack of the normally integrated functions of memories about the past, identity, perception of the environment, and control of physical movements. Diagnostic criteria include lack of a medical condition which would explain the typical characteristics of this syndrome and a conclusive temporal relation between the onset of dissociative symptoms and stressful events, problems or needs of the patient. The International Classification of Diseases (ICD-10, chapter F: mental and behavioral disorders) lists in section F 44: dissociative disorders with impaired consciousness (amnesia, fugue, stupor, trance); dissociative motor disorders (paralysis, astasia, abasia, ataxia, dysarthria, aphonia, shaking, tremor); dissociative convulsion; and dissociative anesthesia/sensory loss.
* Correspondence: [email protected] Department of Child and Adolescent Mental Health, University of Erlangen, 91054 Erlangen, Germany
Due to a lack of systematic studies, no accurate prediction regarding the rate of dissociative disorder during childhood and adolescence can be made. According to population-based prevalence studies using structured clinical interviews, lifetime prevalence of dissociative disorder is estimated to be between 2-7% [1,2] in North America.
Case presentation One week prior to her first visit to our
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