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Psychogenic Movement Disorders

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Movement Disorder Emergencies

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Psychogenic conditions are a diagnostic and treatment challenge for ­physicians of all specialties. Psychogenic literally means “generated from the psyche” and is frequently used in neurological literature as a blanket term to encompass a variety of psychiatric conditions that mimic neurological symptoms including conversion disorder, malingering, factitious disorder, and others. While commonly used, the term “psychogenic” has a number of limitations and these are discussed in the text.

In this chapter we review the literature on psychogenic movement disorders, focusing on both those with a loss of motor function (i.e., weakness) and those with a “gain” of abnormal motor function (i.e., psychogenic tremor, dystonia, myoclonus, parkinsonism, tics, etc.). Some have characterized psychogenic disorders as a diagnosis of exclusion but we discuss why this is not the current paradigm and give particular emphasis on the positive and negative findings that help to make the diagnosis. We also review the limited evidence regarding the pathophysiology and treatment of these disorders and conclude with practical tips regarding the care of these patients.

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References

  1. Factor SA, Podskalny GD, Molho ES. Psychogenic movement disorders: frequency, clinical profile, and characteristics. J Neurol Neurosurg Psychiatry. 1995;59:406–12.

    Article  PubMed  CAS  Google Scholar 

  2. Marsden CDD. Hysteria—a neurologist’s view. Psychol Med. 1986;16:277–88.

    Article  PubMed  CAS  Google Scholar 

  3. Lempert T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand. 1990;82:335–40.

    Article  PubMed  CAS  Google Scholar 

  4. Portera-Cailliau C. Movement disorders fellowship training program at Columbia University Medical Center in 2001–2002. Mov Disord. 2006;21:479–85.

    Article  PubMed  Google Scholar 

  5. Carson AJJ. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J Neurol Neurosurg Psychiatry. 2000;68:207–10.

    Article  PubMed  CAS  Google Scholar 

  6. Anderson KE, Gruber-Baldini AL, Vaughan CG, et al. Impact of psychogenic movement ­disorders versus Parkinson’s on disability, quality of life, and psychopathology. Mov Disord. 2007;22:2204–9.

    Article  PubMed  Google Scholar 

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4, text revth ed. Washington, DC: American Psychiatric Association; 2000.

    Google Scholar 

  8. Stone J. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010;133:1537–51.

    Article  PubMed  Google Scholar 

  9. White A. The use of thiopentone in the treatment of non-organic locomotor disorders. J Psychosom Res. 1988;32:249–53.

    Article  PubMed  CAS  Google Scholar 

  10. Walters AS, Boudwin J, Wright D, Jones K. Three hysterical movement disorders. Psychol Rep. 1988;62:979–85.

    Article  PubMed  CAS  Google Scholar 

  11. Voon V. Emotional stimuli and motor conversion disorder. Brain. 2010;133:1526–36.

    Article  PubMed  Google Scholar 

  12. Lewis A. ‘Psychogenic’: a word and its mutations. Psychol Med. 1972;2:209–15.

    Article  PubMed  CAS  Google Scholar 

  13. Jankovic J, Madhavi T. Psychogenic tremor and shaking. In: Hallett M, Fahn S, Jankovic J, Lang A, Cloninger CR, Yudofsky S, editors. Psychogenic movement disorders: neurology and neuropsychiatry. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 42–7.

    Google Scholar 

  14. Mace C. All in the mind? The history of hysterical conversion as a clinical concept. In: Halligan PW, Bass C, Marshall JC, editors. Contemporary approaches to the study of hysteria: clinical and theoretical perspectives. Oxford: Oxford University Press; 2001. p. 1–11.

    Google Scholar 

  15. Spence SA. Hysterical paralyses as disorders of action. Cogn Neuropsychiatry. 1999;4:|203–26.

    Article  PubMed  CAS  Google Scholar 

  16. Burgmer M, Konrad C, Jansen A, et al. Abnormal brain activation during movement observation in patients with conversion paralysis. Neuroimage. 2006;29:1336–43.

    Article  PubMed  Google Scholar 

  17. Marshall JC, Halligan PW, Fink GR, Wade DT, Frackowiak RS. The functional anatomy of a hysterical paralysis. Cognition. 1997;64:B1–8.

    Article  PubMed  CAS  Google Scholar 

  18. Stone J, Zeman A, Simonotto E, et al. FMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med. 2007;69:961–9.

    Article  PubMed  Google Scholar 

  19. Tiihonen J, Kuikka J, Viinamaki H, Lehtonen J, Partanen J. Altered cerebral blood flow during hysterical paresthesia. Biol Psychiatry. 1995;37:134–5.

    Article  PubMed  CAS  Google Scholar 

  20. Vuilleumier P, Chicherio C, Assal F, Schwartz S, Slosman D, Landis T. Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain. 2001;124:1077–90.

    Article  PubMed  CAS  Google Scholar 

  21. Kanaan RA, Craig TK, Wessely SC, David AS. Imaging repressed memories in motor conversion disorder. Psychosom Med. 2007;69:202–5.

    Article  PubMed  Google Scholar 

  22. de Lange FP, Roelofs K, Toni I. Increased self-monitoring during imagined movements in conversion paralysis. Neuropsychologia. 2007;45:2051–8.

    Article  PubMed  Google Scholar 

  23. Cojan Y, Waber L, Carruzzo A, Vuilleumier P. Motor inhibition in hysterical conversion paralysis. Neuroimage. 2009;47:1026–37.

    Article  PubMed  Google Scholar 

  24. de Lange FP, Toni I, Roelofs K. Altered connectivity between prefrontal and sensorimotor cortex in conversion paralysis. Neuropsychologia. 2010;48:1782–8.

    Article  PubMed  Google Scholar 

  25. Voon V, Brezing C, Gallea C, et al. Emotional stimuli and motor conversion disorder. Brain. 2010;133:1526–36.

    Article  PubMed  Google Scholar 

  26. Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallett M. The involuntary nature of conversion disorder. Neurology. 2010;74:223–8.

    Article  PubMed  CAS  Google Scholar 

  27. Yazici KM, Kostakoglu L. Cerebral blood flow changes in patients with conversion disorder. Psychiatry Res. 1998;83:163–8.

    Article  PubMed  CAS  Google Scholar 

  28. Schneider D, Haberfeld E, Fahn S. Treating the patient, not the scan: two patients with psychogenic parkinsonism in spite of abnormal pet scans. Mov Disord. 2011;26:S345.

    Google Scholar 

  29. Williams DR. Psychogenic palatal tremor. Mov Disord. 2004;19:333–5.

    Article  PubMed  Google Scholar 

  30. Pirio Richardson S, Mari Z, Matsuhashi M, Hallett M. Psychogenic palatal tremor. Mov Disord. 2006;21:274–6.

    Article  PubMed  Google Scholar 

  31. Fahn S, Jankovic J. Principles and practice of movement disorders. Philadelphia: Churchill Livingstone; 2007. p. 597–611.

    Google Scholar 

  32. Bramstedt KA, Ford PJ. Protecting human subjects in neurosurgical trials: the challenge of psychogenic dystonia. Contemp Clin Trials. 2006;27:161–4.

    Article  PubMed  Google Scholar 

  33. Aybek S, Kanaan RA, David AS. The neuropsychiatry of conversion disorder. Curr Opin Psychiatry. 2008;21:275–80.

    Article  PubMed  Google Scholar 

  34. Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and “hysteria”. BMJ. 2005;331:989.

    Article  PubMed  Google Scholar 

  35. Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431–55.

    PubMed  CAS  Google Scholar 

  36. Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol. 2009;22:430–6.

    Article  PubMed  Google Scholar 

  37. Williams DT, Harding KJ. Somatoform disorders. In: Katie K, Leo Verhagen M, editors. Encyclopedia of movement disorders. Oxford: Academic; 2010. p. 121–7.

    Chapter  Google Scholar 

  38. Gould R, Miller BL, Goldberg MA, Benson DF. The validity of hysterical signs and symptoms. J Nerv Ment Dis. 1986;174:593–7.

    Article  PubMed  CAS  Google Scholar 

  39. Tan EK. Psychogenic tics: diagnostic value of the placebo test. J Child Neurol. 2004;19:976–7.

    Article  PubMed  Google Scholar 

  40. Ellenstein A, Kranick S, Hallett M. An update on psychogenic movement disorders. Curr Neurol Neurosci Rep. 2011;11:396–403.

    Article  PubMed  Google Scholar 

  41. Lim EC, Ong BK, Seet RC. Is there a place for placebo in management of psychogenic movement disorders? Ann Acad Med Singapore. 2007;36:208–10.

    PubMed  Google Scholar 

  42. Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol. 1995;65:231–57.

    PubMed  CAS  Google Scholar 

  43. Kim YJ, Pakiam AS, Lang AE. Historical and clinical features of psychogenic tremor: a review of 70 cases. Can J Neurol Sci. 1999;26:190–5.

    PubMed  CAS  Google Scholar 

  44. Piboolnurak P, Rothey N, Ahmed A, et al. Psychogenic tremor disorders identified using tree-based statistical algorithms and quantitative tremor analysis. Mov Disord. 2005;20:1543–9.

    Article  PubMed  Google Scholar 

  45. Kenney C, Diamond A, Mejia N, Davidson A, Hunter C, Jankovic J. Distinguishing psychogenic and essential tremor. J Neurol Sci. 2007;263:94–9.

    Article  PubMed  Google Scholar 

  46. Bhatia KP, Schneider SA. Psychogenic tremor and related disorders. J Neurol. 2007;254:569–74.

    Article  PubMed  Google Scholar 

  47. Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci. 2010;17(8):959–65.

    Article  PubMed  Google Scholar 

  48. Lang AE. Psychogenic dystonia: a review of 18 cases. Can J Neurol Sci. 1995;22:136–43.

    PubMed  CAS  Google Scholar 

  49. Munts AG. How psychogenic is dystonia? Views from past to present. Brain. 2010;133:1552–64.

    Article  PubMed  Google Scholar 

  50. Fahn S. Role of anesthesia in the diagnosis of treatment of psychogenic movement disorders. In: Hallett M, Fahn S, Jankovic J, Lang A, Cloninger CR, Yudofsky S, editors. Psychogenic movement disorders: neurology and neuropsychiatry. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 256–61.

    Google Scholar 

  51. Espay AJ, Morgante F, Purzner J, Gunraj CA, Lang AE, Chen R. Cortical and spinal abnormalities in psychogenic dystonia. Ann Neurol. 2006;59(5):825–34.

    Article  PubMed  CAS  Google Scholar 

  52. Quartarone A, Rizzo V, Terranova C, et al. Abnormal sensorimotor plasticity in organic but not in psychogenic dystonia. Brain. 2009;132:2871–7.

    Article  PubMed  CAS  Google Scholar 

  53. Kobayashi K, Lang AE, Hallett M, Lenz FA. Thalamic neuronal and EMG activity in psychogenic dystonia compared with organic dystonia. Mov Disord. 2011;26:1348–52.

    Article  PubMed  Google Scholar 

  54. Schwingenschuh P, Katschnig P, Edwards MJ, et al. The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm. Neurology. 2011;76:610–4.

    Article  PubMed  CAS  Google Scholar 

  55. Lempert T, Brandt T, Dieterich M, Huppert D. How to identify psychogenic disorders of stance and gait: a video study in 37 patients. J Neurol. 1991;238:140–6.

    Article  PubMed  CAS  Google Scholar 

  56. Hayes MW, Graham S, Heldorf P, de Moore G, Morris JG. A video review of the diagnosis of psychogenic gait: appendix and commentary. Mov Disord. 1999;14:914–21.

    Article  PubMed  CAS  Google Scholar 

  57. Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord. 2007;22:395–9.

    Article  PubMed  Google Scholar 

  58. Lang AE, Koller WC, Fahn S. Psychogenic parkinsonism. Arch Neurol. 1995;52:802–10.

    Article  PubMed  CAS  Google Scholar 

  59. Booij J, Speelman JD, Horstink MW, Wolters EC. The clinical benefit of imaging striatal dopamine transporters with [123I]FP-CIT SPET in differentiating patients with presynaptic parkinsonism from those with other forms of parkinsonism. Eur J Nucl Med. 2001;28:266–72.

    Article  PubMed  CAS  Google Scholar 

  60. Benaderette S, ZanottiFregonara P, Apartis E, et al. Psychogenic parkinsonism: a combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy. Mov Disord. 2006;21:310–7.

    Article  PubMed  Google Scholar 

  61. Gaig C, Marti MJ, Tolosa E, et al. 123I-Ioflupane SPECT in the diagnosis of suspected psychogenic parkinsonism. Mov Disord. 2006;21:1994–8.

    Article  PubMed  Google Scholar 

  62. Felicio AC, Godeiro-Junior C, Moriyama TS, et al. Degenerative parkinsonism in patients with psychogenic parkinsonism: a dopamine transporter imaging study. Clin Neurol Neurosurg. 2010;112:282–5.

    Article  PubMed  Google Scholar 

  63. Morgan JC, Sethi KD. Psychogenic parkinsonism. In: Hallett M, Fahn S, Jankovic J, Lang A, Cloninger CR, Yudofsky S, editors. Psychogenic movement disorders: neurology and neuropsychiatry. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 62–8.

    Google Scholar 

  64. Kurlan R, Deeley C, Como PG. Psychogenic movement disorder (pseudo-tics) in a patient with Tourette’s syndrome. J Neuropsychiatry Clin Neurosci. 1992;4:347–8.

    PubMed  CAS  Google Scholar 

  65. Dooley JM, Stokes A, Gordon KE. Pseudo-tics in Tourette syndrome. J Child Neurol. 1994;9:50–1.

    Article  PubMed  CAS  Google Scholar 

  66. Chouinard S, Ford B. Adult onset tic disorders. J Neurol Neurosurg Psychiatry. 2000;68:738–43.

    Article  PubMed  CAS  Google Scholar 

  67. Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA. 1908;LI:746–7.

    Article  Google Scholar 

  68. Koehler PJ, Okun MS. Important observations prior to the description of the Hoover sign. Neurology. 2004;63:1693–7.

    Article  PubMed  CAS  Google Scholar 

  69. Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb. J Neurol Neurosurg Psychiatry. 2004;75:121–5.

    PubMed  CAS  Google Scholar 

  70. Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. Brain. 2010;133:1537–51.

    Article  PubMed  Google Scholar 

  71. Ziv I, Djaldetti R, Zoldan Y, Avraham M, Melamed E. Diagnosis of “non-organic” limb paresis by a novel objective motor assessment: the quantitative Hoover’s test. J Neurol. 1998;245:797–802.

    Article  PubMed  CAS  Google Scholar 

  72. Mace CJ, Trimble MR. Ten-year prognosis of conversion disorder. Br J Psychiatry. 1996;169:282–8.

    Article  PubMed  CAS  Google Scholar 

  73. Stone J, Sharpe M, Rothwell PM, Warlow CP. The 12-year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry. 2003;74:591–6.

    Article  PubMed  CAS  Google Scholar 

  74. Jankovic J, Vuong KD, Thomas M. Psychogenic tremor: long-term outcome. CNS Spectr. 2006;11:501–8.

    PubMed  Google Scholar 

  75. Munhoz RP, Zavala JA, Becker N, Teive HA. Cross-cultural influences on psychogenic movement disorders—a comparative review with a Brazilian series of 83 cases. Clin Neurol Neurosurg. 2011;113:115–8.

    Article  PubMed  Google Scholar 

  76. Binzer M, Kullgren G. Motor conversion disorder: a prospective 2- to 5-year follow-up study. Psychosomatics. 1998;39:519–27.

    Article  PubMed  CAS  Google Scholar 

  77. Feinstein A, Stergiopoulos V, Fine J, Lang AE. Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol. 2001;14:169–76.

    PubMed  CAS  Google Scholar 

  78. Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorders. J Clin Psychiatry. 2005;66:1529–34.

    Article  PubMed  CAS  Google Scholar 

  79. Rampello L, Raffaele R, Nicoletti G, Le Pira F, Malaguarnera M, Drago F. Hysterical neurosis of the conversion type: therapeutic activity of neuroleptics with different hyperprolactinemic potency. Neuropsychobiology. 1996;33:186–8.

    Article  PubMed  CAS  Google Scholar 

  80. Wald J, Taylor S, Scamvougeras A. Cognitive behavioural and neuropsychiatric treatment of post-traumatic conversion disorder: a case study. Cogn Behav Ther. 2004;33:12–20.

    Article  PubMed  Google Scholar 

  81. LaFrance Jr WC, Friedman JH. Cognitive behavioral therapy for psychogenic movement disorders. Mov Disord. 2009;24:1856–7.

    Article  PubMed  Google Scholar 

  82. MacKinnon JL. Physical therapy treatment of a patient with a conversion reaction: a case report. Phys Ther. 1984;64:1687–8.

    PubMed  CAS  Google Scholar 

  83. Withrington RH, Wynn Parry CB. Rehabilitation of conversion paralysis. J Bone Joint Surg Br. 1985;67:635–7.

    PubMed  CAS  Google Scholar 

  84. Teasell RW, Shapiro AP. Strategic-behavioral intervention in the treatment of chronic nonorganic motor disorders. Am J Phys Med Rehabil. 1994;73:44–50.

    PubMed  CAS  Google Scholar 

  85. Speed J. Behavioral management of conversion disorder: retrospective study. Arch Phys Med Rehabil. 1996;77:147–54.

    Article  PubMed  CAS  Google Scholar 

  86. Gooch JL, Wolcott R, Speed J. Behavioral management of conversion disorder in children. Arch Phys Med Rehabil. 1997;78:264–8.

    Article  PubMed  CAS  Google Scholar 

  87. Watanabe TK, O’Dell MW, Togliatti TJ. Diagnosis and rehabilitation strategies for patients with hysterical hemiparesis: a report of four cases. Arch Phys Med Rehabil. 1998;79:709–14.

    Article  PubMed  CAS  Google Scholar 

  88. Heruti RJ, Levy A, Adunski A, Ohry A. Conversion motor paralysis disorder: overview and rehabilitation model. Spinal Cord. 2002;40:327–34.

    Article  PubMed  CAS  Google Scholar 

  89. Calvert P, Jureidini J. Restrained rehabilitation: an approach to children and adolescents with unexplained signs and symptoms. Arch Dis Child. 2003;88:399–402.

    Article  PubMed  CAS  Google Scholar 

  90. Oh DW, Yoo EY, Yi CH, Kwon OY. Case report: physiotherapy strategies for a patient with conversion disorder presenting abnormal gait. Physiother Res Int. 2005;10:164–8.

    Article  PubMed  Google Scholar 

  91. Ness D. Physical therapy management for conversion disorder: case series. J Neurol Phys Ther. 2007;31:30–9.

    PubMed  Google Scholar 

  92. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn. 2003;51:29–50.

    Article  PubMed  Google Scholar 

  93. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R. A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom. 2002;71:66–76.

    Article  PubMed  Google Scholar 

  94. Poole NA, Wuerz A, Agrawal N. Abreaction for conversion disorder: systematic review with meta-analysis. Br J Psychiatry. 2010;197:91–5.

    Article  PubMed  Google Scholar 

  95. Schonfeldt-Lecuona C, Connemann BJ, Spitzer M, Herwig U. Transcranial magnetic stimulation in the reversal of motor conversion disorder. Psychother Psychosom. 2003;72:286–8.

    Article  PubMed  Google Scholar 

  96. Schonfeldt-Lecuona C, Connemann BJ, Viviani R, Spitzer M, Herwig U. Transcranial magnetic stimulation in motor conversion disorder: a short case series. J Clin Neurophysiol. 2006;23:472–5.

    PubMed  Google Scholar 

  97. Chastan N, Parain D, Verin E, Weber J, Faure MA, Marie JP. Psychogenic aphonia: spectacular recovery after motor cortex transcranial magnetic stimulation. J Neurol Neurosurg Psychiatry. 2009;80:94.

    Article  PubMed  CAS  Google Scholar 

  98. Chastan N, Parain D. Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation. Mov Disord. 2010;25:1501–4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Robert Wood Johnson Medical School, 125 Paterson Street, Suite 6200, New Brunswick, NJ, 08901, USA

    Daniel Schneider M.D., M.A.

  2. Department of Psychiatry, Columbia University Medical Center, New York, NY, USA

    Daniel T. Williams M.D.

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  1. Daniel Schneider M.D., M.A.
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Correspondence to Daniel Schneider M.D., M.A. .

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  1. , Neurology, Columbia University Medical Center, West 168th St. Suite 310 710, New York, 10032, USA

    Steven J. Frucht

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Schneider, D., Williams, D.T. (2013). Psychogenic Movement Disorders. In: Frucht, S. (eds) Movement Disorder Emergencies. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-835-5_21

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