[Theory of mobilization and psychogenic disorders of the gastrointestinal system].
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Gastrointestinal Diseases↗
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Antidepressant treatment outcomes of psychogenic movement disorder.
BACKGROUND: Psychogenic movement disorder (PMD) is a subtype of conversion disorder. We describe the outcomes of a series of PMD patients following antidepressant treatment. METHOD: Twenty-three outpatients with chronic PMD, diagnosed using Fahn and Williams' criteria, underwent psychiatric assessment. The patients were referred for assessment and management from January 2003 to July 2004. Fifteen agreed to be treated with antidepressants. Patients received citalopram or paroxetine; those who did not respond after 4 weeks of taking an optimal dose were switched to venlafaxine. Concurrently, 3 had supportive psychotherapy, and 1 had family intervention. Assessments included the DSM-IV-based Mini-International Neuropsychiatric Interview and scales measuring depression, anxiety, and motor and global severity. RESULTS: Eighteen patients (78%) had at least 1 Axis I diagnosis in addition to the somatoform diagnosis, and 3 (13%) had somatization disorder. Five (22%) had previous psychiatric contact. Nine (39%) had previously been treated with antidepressants, but only 4 (17%) had adequate trials. No significant differences existed in patient characteristics between treated and untreated groups. Among treated patients, Montgomery-Asberg Depression Rating Scale scores improved from baseline (p < .01). Two treated subgroups were identified: 10 patients (67%) had primary conversion disorder, of whom 8 had marked motor and global improvements with 7 complete remissions, and 5 (33%) had primary hypochondriasis, somatization disorder, or probable factitious disorder/malingering, of whom none improved. All of the patients with primary conversion disorder had a current or previous depressive or anxiety disorder compared with 40% (N = 2) of the patients with additional somatoform diagnoses. DISCUSSION: Our preliminary findings suggest that chronic PMD with primary conversion symptoms and with recent or current depression or anxiety may respond to antidepressants. Further well-designed studies, now under way, are required to confirm these findings.
Adult↗
[Combined psychological treatment of psychogenic voice disorders; a phonetic contribution to psychogenic aphonia].
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Aphonia↗
[Situational reactions manifesting themselves in behavior disorders as a form of psychogenic (reactive) disorders in children and adolescents].
The paper is related to the history, elimination, clinical expression, systematics and the clinico-nozological place of the group of situational reactions expressed in disordered behaviour of children and adolescents. These reactions are considered as associated pairs, including interconnected psychological and pathological forms. Some common criteria delineating the psychological and pathological situational reactions are presented. The paper also contains a description of the main traits of psychological and pathological reactions of protest, rejection, imitation, compensation-hypercompensation. All these reactions are considered as a special group of psychogenic (reactive) diseases.
Adolescent↗
Evaluation of clinical diagnostic criteria for psychogenic movement disorders.
Previous studies showed that there are certain features suggestive of a psychogenic disorder, and Fahn and Williams proposed criteria for psychogenic movement disorders. Data on the sensitivity and specificity of these criteria are lacking. We expanded on the Fahn and Williams criteria to create a new set of diagnostic criteria. We retrospectively reviewed 79 patients in a movement disorders specialty clinic. We applied the proposed diagnostic criteria to both cases and controls and analyzed sensitivity and specificity. The diagnostic criteria correctly identified "clinically probable" (or better) psychogenic movement disorders with a sensitivity of 83% and specificity of 100%. For "clinically possible" or greater, sensitivity was 97% and specificity was 96%. In addition, a significantly higher proportion of patients with psychogenic disease were female and reported either a family history of neurological disease or other exposure to neurological disease (P = 0.001 and 0.01, respectively). The diagnostic criteria are simple to apply and have high sensitivity and specificity for psychogenic movement disorders. Also, we report a correlation between previous exposure to a disease model and psychogenic disease.
Adult↗
Psychogenic movement disorders.
Diagnosis and treatment of psychogenic movement disorders are challenging for both neurologists and psychiatrists. Symptoms can mimic the full range of organic abnormal involuntary movements, affect gait and speech, or present as unusual undifferentiated movements. Typical clinical characteristics of these disorders are acute onset, fast progression, movement patterns incongruent with organic movement disorders, distractibility, variability, and simultaneous occurrence of various abnormal movements and dysfunctions. Avoidance of iatrogenic damage by unnecessary invasive tests or inappropriate medication, as well as use of appropriate psychiatric treatments are pivotal steps in the management of these disorders. The few clinical trials specific to psychogenic movement disorders focus on antidepressants and psychotherapy. Presence of a comorbid psychiatric diagnosis of depression or an anxiety disorder is a positive prognostic factor, whereas long-standing symptoms, insidious onset of movements, and a psychiatric diagnosis of hypochondriasis, factitious disorder, or malingering are associated with poor outcome.
Humans↗
Psychogenic movement disorders.
All varieties of movement disorders may be mimicked by a psychogenic disorder, most commonly tremor, dystonia, and myoclonus. Approximately 3% of patients seen in specialty clinics have a psychogenic movement disorder (PMD). The diagnosis of a PMD depends on not just ruling out an organic movement disorder, but moreover, recognizing features from the history and examination that are inconsistent or incongruous with an organic movement disorder. Most PMDs represent a conversion disorder, sometimes as part of a somatoform disorder; less common diagnoses include a factitious disorder or malingering. Co-morbid psychiatric illness is prevalent in patients with PMD including depression, anxiety, and personality disorders. Many PMDs remain chronic, but a multidisciplinary approach centering on psychiatric intervention can be successful. A shorter duration of symptoms and a co-existent treatable psychiatric disorder portend a better prognosis, whereas compensation and pending litigation are associated with a poorer prognosis.
Female↗
Psychogenic movement disorders: diagnosis and management.
Psychogenic movement disorders (PMDs) are best defined as hyper- or hypo-kinetic movement disorders, often associated with gait disorders, that cannot be directly attributed to a lesion or dysfunction of the nervous system and which are derived in most cases from psychological or psychiatric causes. There are a variety of PMDs including tremor, dystonia, parkinsonism, gait disorders and, even, unusual forms including paroxysmal dyskinesias. As has been recognised in the recent literature, PMDs cannot be strictly classified into clearly defined psychiatric disorders such as somatoform, dissociative or conversion disorders. In this review, we discuss the diagnosis of various PMDs (including hyper- and hypo-kinetic disorders; and current evidence for underlying comorbid disorders) and the current therapeutic approach to them. The therapy of PMDs is not well established, is very challenging to the clinician, and a better outcome can be achieved in the setting of a team approach involving movement disorders specialists, psychiatrists and therapists who specialise in cognitive-behavioural techniques. Current pharmacological and non-pharmacological approaches to treatment focus on therapy of underlying comorbid psychiatric and psychological issues, although compliance is a major concern.
Anxiety↗
Differential diagnosis and treatment of psychogenic voice disorder.
Forty consecutive patients with psychogenic voice disorder were studied prospectively to shed light on some problems of differential diagnosis met by the otolaryngologist. The females (n = 35) were on average younger than males (n = 5) (mean age 34.5 vs 51.8 years, respectively). Although an upper respiratory tract infection preceding the voice disorder was reported by no more than 25% of the patients, as many as 40% had been treated with antibiotics on one or more occasions. Other treatment and voice rest had been prescribed to a further 20% of the patients. The frequency rate of reported asthma/allergy-like symptoms (37.5) exceeded the incidence of asthma/allergy in the normal Swedish adult population. Minor laryngeal abnormalities found in 10 patients could be rejected as causative since they were inconsistent with the voice disturbance. In most of the patients (n = 27), vocal function returned to normal or improved after voice therapy combined with counselling. Vocal abnormalities remained unchanged in three patients. The patients who required multiple therapy sessions (n = 10) were older (mean age 48.8 years) and seemed to have more profound personal problems than the average. The findings suggest that psychogenic voice disorder may often be misdiagnosed as acute laryngitis or asthma/allergy. Restricted use of antibiotics and other drugs is to be recommended in the treatment of benign voice disorders.
Adult↗
[The status of psychogenic hearing disorder today].
The general symptoms of psychogenic hearing disorders are pointed out and exemplified by 16 own cases seen by the author in 1987 to 1988. Psychogenic hearing disorders imitate various constellations of findings and histories of genuine organic hearing disorders. The individual's experience and the contemporary consciousness of hearing disorders seem to enter into the individual manifestation. The 16 cases can clearly be divided into 3 groups of equal size: 1. The unilateral acute hearing loss, imitating either an acute traumatic damage or an idiopathic sudden hearing loss. This was seen almost exclusively in children. 2. The bilateral chronic hearing loss. This, too, was seen mainly in children and youths. 3. The acute bilateral recurring or progressing hearing disorder. This was seen predominantly in adults, mimicking dramatic courses ending up in bilateral profound deafness. In part of the cases the psychological background of the neurotic reaction could be explored quite easily. Knowledge of the various manifestations of psychogenic hearing disorders is important, because otherwise, as the reported cases demonstrate, misleading interpretation of findings entails costly diagnostic procedures (computerized tomography, arteriography) and expensive therapeutic measures (hospitalization, fitting of hearing aids).
Adolescent↗
[Definition of psychogenic voice disorders].
The clinical designation of the psychogenic voice disorder is discussed. "Psychogenic" is aetiologically by no means an apposite, or adjective, to organic diseases, for the occurrence of factors that can be defined as psychopathological (either primary or secondary) is always practically and clinically important--especially if these factors are of general psychosocial relevance, or of a latent depressive and neurotic nature. Hence, biographical anamnesis can be obligatory, supplying information that is essential for a therapeutic approach.
Affective Symptoms↗
Psychogenic movement disorders.
PURPOSE OF REVIEW: This review focuses on recent studies assessing clinical features and laboratory findings that may help diagnose psychogenic movement disorders, and the ongoing controversy about the relationship of these disorders with preceding peripheral injury. RECENT FINDINGS: 'Organic' movement disorders may still be misdiagnosed as psychogenic. Probably more commonly, however, psychogenic movement disorders are underdiagnosed. Most features typically associated with recognized movement disorders, including geste antagoniste or treatment-induced dyskinesias, can be seen in psychogenic movement disorder, and abnormal movements that would not normally be considered psychogenic or produced by psychological factors, such as palatal tremor, may occur on a psychogenic basis. On the other hand, psychiatric features are sometimes seen in neurologically based movement disorders. The diagnostic criteria for psychogenic movement disorders provide a degree of diagnostic certainty based on a combination of clinical and psychiatric features. Laboratory investigations can help exclude specific diagnoses, such as Parkinson's disease with (123I)beta-CIT single photon emission computed tomography, and neurophysiological methods can demonstrate characteristic features of psychogenic movement disorders, such as entrainment or suppression of psychogenic tremor with contralateral hand movements. However, some tests reported to differentiate psychogenic from neurological movement disorders may have incomplete specificity; for example, psychogenic tremor may not always be associated with complete coherence of tremor frequency. An ongoing controversy surrounds movement disorders following peripheral injuries, but recent evidence suggests that such patients should always be screened for the presence of a psychogenic movement disorder. SUMMARY: Psychogenic movement disorder continues to be a difficult diagnosis to make and is likely to be underrecognized. Clinical and laboratory features are emerging, however, that support this diagnosis. The controversy regarding posttraumatic movement disorders continues, but a diagnosis of a psychogenic movement disorder should be actively sought in such patients.
Diagnosis, Differential↗
Psychogenic voice disorders in performers: a psychodynamic model.
Psychogenic voice disorders are not infrequently encountered in the busy voice clinic. A clinician-friendly psychodynamic model and a multidisciplinary management approach are presented which have proven helpful for our voice team and our patients. In essence the formulation revolves around an "event" occurring, which may be either organic or psychological in nature. The ensuing dysphonia then leads to emotional consequences which in turn have physical consequences on the vocal tract. The situation can become reinforcing and illness behaviors develop. Elucidating this event/process to the patient improves the likelihood of a successful long-term outcome. The diagnostic and management roles of the various team members are discussed.
Adult↗
Psychogenic pain disorder in children.
The concept of psychogenic pain in children is by no means new; it has been researched for at least 3 decades. There is increasing recognition of the relationship between emotional factors and complaints of pain in the absence of organic disease. By their very nature these conditions warrant a team approach, incorporating both medical and psychological perspectives, to treatment. A study was undertaken that focused on identifying the incidence and related features of this problem at a general hospital. Over a 2-year period 46 children showed psychogenic pain disorder according to the criteria of Diagnostic and Statistical Manual of Mental Disorders. Physical examinations and basic investigations revealed no organic disease. The majority of the children (34, 73.9%) complained of abdominal pain, although limb and chest pains also featured. Marital problems between parents constituted the most common stressor, affecting 31 of the children (67.4%). Psychotherapeutic management was initiated with all the children and their families. Thirty-five (76.1%) had remission of symptoms after psychotherapy.
Adolescent↗
Evaluation and management of bilateral vocal cord immobility.
Bilateral vocal cord immobility can be life threatening for some patients. Others, who have an open glottic chink, may have a breathy dysphonia, intermittent dyspnea, and stridor. These signs and symptoms may also be found in a number of other conditions that cause weakness or paradoxical motion of the vocal cords that mimics paralysis. These other conditions include central nervous system diseases, neuromuscular disorders, laryngospasm, and psychogenic disorders. In addition, patients with cricoarytenoid joint immobility or interarytenoid scar can also have similar symptoms at presentation. It is critical to consider the differential diagnosis of an assumed bilateral vocal cord paralysis and understand the management of paradoxical movement, weakness, joint fixation, interarytenoid scar, laryngospasm, and psychogenic disorders. The treatment for bilateral immobility should proceed only after a thorough evaluation, which might include electromyography and/or examination during general anesthesia under dense anesthetic paralysis. Reconstructive procedures are the treatments of choice, and destructive procedures should be chosen only as a last resort.
Arytenoid Cartilage↗
[Psychogenic hearing disorders in childhood and adolescence].
Psychogenic hearing defects are more common than previously recognized. The disorder is characterized by typical behaviour, audiological signs and symptoms. Patients may show severe hearing losses as evaluated by pure-tone threshold audiometry but can understand usual conversation. Results of audiological examination may be conflicting and suggest a wide range of organic hearing disorders. Other characteristics are dramatic improvement of hearing following sham procedures or placebo medication. Detection of psychogenesis and etiologic factors are of utmost importance for successful therapy. Between 1988 and 1991, 21 children and adolescents (ages 5-16 years) with psychogenic hearing losses were studied. Typical signs as well as diagnostic and therapeutic tools are illustrated in renewal case histories. In-patient diagnosis and treatment are recommended, since improvement was achieved in all patients treated.
Adolescent↗
Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study.
OBJECTIVE: To assess psychiatric outcome in patients with an established diagnosis of a hyperkinetic (i.e. tremor, dystonia, myoclonus) psychogenic movement disorder. BACKGROUND: Longitudinal studies of patients with psychogenic movement disorders (PMD) have to date suffered from small sample size, lack of sample homogeneity (psychogenic movements grouped with other somatoform disorders, mixed hyper and hypokinetic movements), the absence of structured psychiatric interviews, and a failure to adequately address the extent of psychiatric co-morbidity by adopting a hierarchical approach to diagnosis. METHODS: A sample of 88 patients with documented PMD according to the criteria of Fahn and Williams were followed up on average 3.2 years (sd = 2.2; range 1-7 years) after first being assessed at a tertiary referral clinic for patients with movement disorders. The detailed psychiatric assessment included the Structured Clinical Interview for Axis (SCID-I) and Axis II (SCID-II) DSM-IV disorders which generated diagnoses with respect to major mental illness (SCID-I) and personality disorders (SCID-II) respectively. RESULTS: Of 88 subjects initially seen in clinic, three had died (one by suicide), two were in nursing homes (Alzheimers disease, terminal cancer) and three had emigrated. Of the remaining 80 subjects, 42 (52.5%) agreed to be interviewed. There were no demographic or illness-related differences between those who agreed or refused participation. At follow-up, the mean age of subjects was 48.6 (13.3) years, 62.7% were female and 75% were unemployed. An Axis I diagnosis of mental illness was made in 40 (95.3%) subjects. The PMD had remitted in four subjects, but had been replaced in two of them by a different mental disorder. Thirty-eight percent of subjects with PMD had developed additional unexplained medical symptoms at follow-up. Point and lifetime prevalence rates for other Axis I diagnoses were: major depression 19.1% and 42.9%; anxiety disorders 38.2% and 61.9%; co-morbid major depression and anxiety disorders 11.9% and 28.6%. Personality disorders were present in 45% of the sample. No subject viewed their PMD as primarily psychiatric in origin. Poor outcome with respect to the abnormal movements was associated with long duration of symptoms, insidious onset of movements and psychiatric co-morbidity on Axis I diagnoses. CONCLUSIONS: Follow-up data of patients with PMD revealed a persistence in abnormal movements in more than 90% of subjects. Prevalence rates of mental illness in excess of those found in the general population and in neurologic disorders plus an inability to acknowledge the essentially psychologic nature of their condition characterized the outcome picture and carries a poor longer term prognosis.
Female↗
Gait abnormalities in psychogenic movement disorders.
An abnormal gait is not uncommon in patients with medically unexplained neurological symptoms, including those with other psychogenic movement disorders (PMDs). Previous studies have not evaluated the gait characteristics of patients with a variety of PMDs and there are no reports comparing PMDs with and without gait disturbances. We were interested in determining how those with and without additional involvement of gait differed and how PMD patients differed from those with a pure psychogenic gait disorder (PGD) in the absence of another PMD. We investigated gait features in a large series of patients with PMD (n = 279), dividing them into two groups (Group I with a normal gait and Group II with an abnormal gait). Group I included those with PMD with a normal gait and no change in the PMD while walking (I-1), and those with a change in PMD while walking, but not affecting gait (I-2). Group II was divided into those with PMD with additional abnormal gait (II-1) and those with pure psychogenic gait disorder without other abnormal movements (II-2). Excessive slowing of movement was more common in PMD patients with an abnormal gait (Group II) compared to those without (Group I). Slowness of gait was the most common feature in patients with PMD combined with a PGD (II-1) and buckling of the knee pattern was the most common type of pure PGD (II-2), followed by astasia-abasia.
Adolescent↗