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PubMed1989

Speech therapy for psychogenic voice disorder: a survey of current practice and training.

A survey of speech therapists in the United Kingdom showed that they usually undertook the treatment of psychogenic voice disorders. Their pre-qualification education had provided advice that was usually reflected accurately in the experience they gained in practice, though during their education about a third had lacked any opportunity to treat or observe psychogenic voice disorders. The appropriate duration of treatment appears to be in doubt. At present, speech therapists acquire many of the psychological skills required for treatment after qualification. There is a substantial need for post-qualification courses, although more practical instruction on psychological treatment might advantageously be incorporated in initial education.

Humans↗
PubMed2004

Psychogenic movement disorders in children.

A common problem in neurology is the existence of disorders that present with neurologic symptoms but do not have an identifiable neurologic basis. These disorders are often thought to have a psychologic basis. Abnormal movements are among the most frequent symptoms in psychogenic neurologic disorders. Although these disorders have not been studied extensively in children, clinical experience in our busy pediatric movement disorders clinic and many case reports support their existence in this age group. Elements of history, physical examination, and therapeutic intervention must be combined to construct a clear diagnosis of a psychogenic movement disorder. This article reviews the diagnosis and treatment of these disorders and includes two illustrative cases. Review of the current literature reveals a need for prospective trials to provide a solid foundation for better diagnosis and treatment of these disorders.

Adolescent↗
PubMed1991

[Organization of self-help groups for patients with psychogenic eating disorders].

The author pays attention to the organization of self-help groups of women suffering from anorexia nervosa and bulimia and illustrates them on several examples of self-help groups in the USA, Austria and Czechoslovakia. Great attention is paid to the BASH programme (Bulimia Anorexia Self-help) in St. Louis in the USA, one of the first self-help groups developing within the framework of a therapeutic and research institution for patients with psychogenic eating disorders. In the conclusion of the review the author presents his own experience with the organization of a MAB (mental anorexia--bulimia club) founded in 1989 at the Psychiatric Clinic of the Faculty of General Medicine, Charles University in Prague, attached to the Unit of specialized care of patients with psychogenic eating disorders. He emphasizes the necessity of differentiated and long-term therapeutic action on patients with psychogenic eating disorders where self-help groups hold an irreplaceable place. Attention is drawn to the fact that in addition to detection, emotional and social rehabilitation in the treatment of patients with preclinical symptoms a very important place is held by self-help groups which have a specific therapeutic influence and importance.

Anorexia Nervosa↗
PubMed1995

Psychogenic movement disorders.

The diagnosis of PMDs is by no means a simple task. Organic movement disorders are more often misdiagnosed as psychogenic rather than the reverse. The degree to which psychological factors underlie movement disorders may range from being the exclusive cause to being a reaction to the movement disorder. The most common psychiatric illnesses associated with PMDs are depression, conversion reactions, and anxiety disorders. Although the diagnosis of psychogenicity may seem elusive, the definitions and diagnostic criteria of PMDs outlined in this article serve as useful guidelines for obtaining a more accurate diagnosis. The emphasis on a multidisciplinary approach with a strong alliance of neurologist and psychologist or psychiatrist is essential to assure proper diagnoses and treatment.

Adult↗
PubMed2005

Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders.

BACKGROUND: PMD are disabling, but lack any generally accepted treatment strategies. DESIGN/METHODS: Ten patients with PMD received treatment with Psychodynamic Psychotherapy. Patients were assessed with psychiatric rating scales and the movement disorder was rated by a blinded rater with the Psychogenic Movement Disorder Rating Scale (PMDRS). RESULTS: Total mean PMDRS (p = 0.0195), total PMDRS function scores (p = 0.0142), Hamilton depression scores (p = 0.009), Beck anxiety scores (p = 0.002), and GAF (p = 0.0083) all improved with psychotherapeutic intervention. CONCLUSIONS: Psychotherapy and appropriate use of adjunct psychiatric medication can be a successful intervention for PMD.

Adolescent↗
PubMed1995

Psychological processes in psychogenic voice disorder.

Using Freud's hysterical conversion model as a basis for reviewing the psychological features in psychogenic voice disorder, this paper describes research findings which show that individuals with this condition are not usually suffering from severe psychopathology but tend to be women who are experiencing high levels of stress (commonly associated with interpersonal relationship conflicts, low self-esteem, the burden of responsibility and feelings of powerlessness), and have above-average musculoskeletal tension as well as difficulties in voicing their feelings or views. The review indicates that the psychoanalytic interpretation of psychogenic voice loss continues to have relevance. However, it is suggested that in most cases Freud's hysterical conversion model should be reformulated, reducing the core focus to unconscious conflicts, repression, denial and secondary gains, in order to emphasise the psychosocial causes and maintenance of intrapsychic conflict and physical dysfunction. It is also suggested that a reformulated psychoanalytic interpretation of psychogenic voice loss has a lot in common with a cognitive-behavioural conceptual model. A psychoanalytic approach may be valuable when focused on early trauma and repressed experiences or feelings, whereas cognitive-behavioural treatment strategies, such as stress management and assertiveness training, appear to be particularly relevant in this condition. The paper concludes by briefly considering some areas of future research.

Affect↗
PubMed1998

Etiology and treatment of psychogenic voice disorder: results of a follow-up study of thirty patients.

It is generally accepted that psychogenic voice disorder (PVD) is a result of psychosocial stress; however, systematic studies of etiological factors in this condition are few. Furthermore, although immediate effects of therapy are estimated to be good, relapses are frequent, and the long-term effects of therapy are not known. The present prospective and longitudinal study on 30 patients was thus focused on possible etiological factors, the course of therapy, and the long-term results of therapy for PVD. The results indicate that interpersonal conflicts related to family and work are of basic importance in precipitating this condition. PVD is interpreted as a specific disorder of verbal emotional expression. Our therapy model in which vocal exercises are performed, together with training of communicative skills, seems rewarding. Relapses were not reported in 88% of the patients during the followup period of 1.9-8.4 years after therapy.

Adolescent↗
PubMed1986

[Psychogenic movement disorders in the mental handicapped. Differential diagnosis and therapy. Case report].

The problems involved in treating psychogenic movement disorders in mentally retarded persons are pointed out. A psychoanalytic approach is doomed to failure because of the mental handicap. The authors report positive therapeutic results with a 17-year-old girl who had a severe hysterical movement disorder including sudden falls and a grotesque gait. Successful behavior therapy with this patient supports the hypothesis that conditioning was the chief factor in the maintenance of the symptoms and indicates that even severe mental retardation does not necessarily imply that there will be resistance to extinction. The individuals of greatest significance to the patient should, in the author's view, play an important part in the treatment program.

Adolescent↗
PubMed2003

Late delayed postradiation spinal myoclonus or psychogenic movement disorder?

We describe a patient with intermittent, at times rhythmic trunk flexion movements. Neurophysiological assessment excluded a psychogenic movement disorder. The segmental spinal myoclonus occurred 6 years after radiation therapy of the brain and entire spinal cord, and we suggest this patient to be the first case of a late-delayed sequela of spinal cord irradiation presenting as segmental spinal myoclonus.

Adult↗
PubMed2005

Rating scale for psychogenic movement disorders: scale development and clinimetric testing.

We developed and tested the clinimetric properties of a scale for psychogenic movement disorders (PMDs). PMDs are disabling but lack any generally accepted treatment strategies. To develop treatments, means of assessing disease severity must be provided. No scale to assess PMDs existed. The PMD scale developed here rates 10 phenomena (rest tremor, action tremor, dystonia, chorea, bradykinesia, myoclonus, tics, athetosis, ballism, cerebellar incoordination), 2 functions (gait, speech), and 14 body regions. To study interrater agreement, three movement disorder neurologists independently rated 88 videotapes of PMD patients. Data analysis was performed using a kappa coefficient of agreement, Kendall's coefficient of concordance, Spearman correlations, and intraclass correlation coefficients. Validity and scale responsiveness were tested as well. All phenomena and speech and gait dysfunction occurred in the patient sample. A wide range of affected body regions, severity, and incapacitation was captured. Ratings showed excellent interrater reliability for presence or absence of each phenomenon (kappa range, 0.63 to 0.86). Kendall's concordance coefficients for phenomenology, function, and total PMD scores were 0.92, 0.93, and 0.91. Spearman correlations between raters ranged from 0.86 to 0.90. The scale was responsive to changes that occurred as a result of a neuropsychiatric intervention. The PMD scale adequately captures the complex movements of PMDs and can be used to assess PMDs and test the efficacy of intervention strategies.

Adolescent↗
PubMed1987

Controlled study of alexithymic characteristics in patients with psychogenic pain disorder.

Alexithymic characteristics were examined in a sample of 30 patients fulfilling the DSM-III criteria for psychogenic pain disorder using an interviewer-rated scale (Beth Israel Hospital Psychosomatic Questionnaire), a self-rated scale (Toronto Alexithymia Scale) and a projective technique (Thematic Apperception Test). The findings were compared with a control group of healthy subjects matched on sociodemographic variables. Pain patients were found to be more alexithymic in contrast to the control group as evidenced by the interviewer-rated and self-rated scales. The correlations among the three measures were in the expected direction.

Adolescent↗
PubMed1991

Headache: pattern and features as experienced in a neurology clinic in Tanzania.

Patients with recurrent headaches accounted for 319 (20.6%) of all new referrals to the neurology clinic over a two-year period. Of these, 47 (34%) had migraine, 38 (27%) psychogenic disorders (non-migrainous) and 18 (13%) post traumatic headache. Others included 16 (11%) vascular-muscular contraction, 11 (8%) muscular contraction and 9 (7%) were miscellaneous. Recurrent headache was found commonly in young patients of both sexes. However, migraine was more common in females. Common migraine was about 4 times as frequent as classical migraine. Headache due to psychogenic disorders was part of a symptom complex of anxiety states in 17% and 8% neurotic depression. Over two thirds of patients experienced severe headaches. This was common in the younger age group. Whereas a half of the patients experienced warning symptoms, over two thirds had precipitating factors. About a third of patients with migraine and psychogenic disorders associated witchcraft with their headaches while a half of those with psychogenic disorders expressed fear of having a brain tumour.

Adolescent↗
PubMed2005

Transcultural comparison of psychogenic movement disorders.

Prompted by the lack of cross-cultural comparative data, and because a better understanding in the different clinical presentations of psychogenic movement disorders (PMDs) is relevant to neurological assessment and interventions, we compared the phenomenology, anatomical distribution, and functional impairment of PMDs in the United States and Spain. Consecutive patients diagnosed with PMD by a movement disorder specialist from one US site and from eight Spanish university centers were included in the study. The two groups were similar in their movement types, anatomical distribution, and functional impairment. PMDs were more prevalent in women than in men and were most common in upper and lower extremities. Gait and speech dysfunctions were distributed similarly in both countries. We found action tremor to be the most frequent PMD in both countries.

Adult↗
PubMed2005

[Generalized compartment syndrome after excessive drinking. A rare complication of psychological disorders?].

Psychogenic polydipsia can lead to compartment syndromes, which is too infrequently considered in psychiatric patients who binge-drink on hypotonic fluids. If masked by the leading clinical presentation of cerebral edema, compartment syndromes of the extremities may be diagnosed too late or remain undetected. Based on a literature review and case report, we discuss additional factors and the specific features of diagnosis and treatment.

Adult↗
PubMed2006

Psychogenic tremor: long-term outcome.

INTRODUCTION: Psychogenic disorders, also referred to as somatoform, conversion, somatization, hysteria, and medically unexplained symptoms, are among the most challenging disorders to diagnose and treat. Psychogenic movement disorders are increasingly encountered in specialized clinics, and represent approximately 15% of all patients evaluated in the Baylor College of Medicine Movement Disorders Clinic. OBJECTIVE: To characterize psychogenic tremor and provide data on prognosis and long-term outcome in a large group of patients with psychogenic tremor followed in a movement disorders clinic. METHODS: Patients evaluated at the Baylor College of Medicine Movement Disorders Clinic in Houston, Texas, between 1990 and 2003 with the diagnosis of psychogenic movement disorder (PMD), who consented to be interviewed, were administered a structured questionnaire designed to assess current motor and psychological function. RESULTS: psychogenic tremor is the most common PMD, accounting for 4.1% of all patients evaluated in our clinic. We were able to obtain clinical information on a total of 228 of 517 (44.1%) patients with PMD, followed for a mean of 3.4+/-2.8 years. Among the 127 patients diagnosed with psychogenic tremor, 92 (72.4%) were female, the mean age at initial evaluation was 43.7+/-14.1 years, and the mean duration of symptoms was 4.6+/-7.6 years. The following clinical features were considered to be characteristic of psychogenic tremor: abrupt onset (78.7%), distractibility (72.4%), variable amplitude and frequency (62.2%), intermittent occurrence (35.4%), inconsistent movement (29.9%), and variable direction (17.3%). Assessment of long-term outcome showed that 56.6% of patients reported improvement in their tremor. Factors predictable of a favorable outcome were elimination of stressors and patient's perception of effective treatment by the physician. CONCLUSION: This largest longitudinal study of patients with psychogenic tremor provides data on the clinical characteristics and natural history of this most common PMD. The accurate diagnosis of psychogenic tremor is based not only on exclusion of other causes but is also dependent on positive clinical criteria, the presence of which should avoid unnecessary investigation. The prognosis of psychogenic tremor may be improved with appropriate behavioral and pharmacologic management.

Adolescent↗
PubMed2003

Psychogenic voice disorders and traumatic stress experience: a discussion paper with two case reports.

Psychogenic dysphonia refers to loss of voice where there is insufficient structural or neurological pathology to account for the nature and severity of the dysphonia, and where loss of volitional control over phonation seems to be related to psychological processes such as anxiety, depression, conversion reaction, or personality disorder. Such dysphonias may often develop post-viral infection with laryngitis, and generally in close proximity to emotionally or psychologically taxing experiences, where "conflict over speaking out" is an issue. In more rare instances, severe and persistent psychogenic dysphonia may develop under innocuous or unrelated circumstances, but over time, it may be traced back to traumatic stress experiences that occurred many months or years prior to the onset of the voice disorder. In such cases, the qualitative nature of the traumatic experience may be reflected in the way the psychogenic voice disorder presents. The possible relationship between psychogenic dysphonia and earlier traumatic stress experience is discussed, and the reportedly low prevalence of conversion reaction (4% to 5%) as the basis for psychogenic dysphonia is challenged. Two cases are presented to illustrate the issues raised: the first, a young woman who was sexually assaulted and chose to "keep her secret," and the second, a 52-year-old woman who developed a psychogenic dysphonia following a second, modified thyroplasty for a unilateral vocal fold paresis.

Adult↗
PubMed2004

[A psychoneurophysiological evaluation of non-specific cerebral systems in patients with permanent autonomic disorders of psychogenic etiology during therapy].

Fifteen patients with permanent vegetative disorders combined with a pronounced anxiety were examined before and after treatment by the Nott drug. The clinical-and-neurological technique, psychometric evaluation of cognitive functions and the neurophysiological method of acoustic cognitive induced potentials P300 were made use of. Before treatment, pronounced vegetative anxiety-related and cognitive disorders were observed in patients. A reliably decreased amplitude of the P300 peak was noted in patients versus healthy subjects while registering the cognitive induced potentials. After treatment, there was a reliably decreased severity of vegetative, anxious and cognitive disorders in patients; the P300 amplitude went up reliably. Supposedly, the changed P300 amplitude, as observed in patients with permanent vegetative disorders; denotes the malfunction in non-specific limbic-reticular brain structures. A growing P300-peak amplitude combined with the arrest of psychovegetative and anxious disorders and with an improvement of cognitive functions in patients due to therapy are indicative of a lower degree of the functional disintegration in the non-specific limbic-reticular brain structures. Finally, the method of endogenous induced P300 potentials can be used as a diagnostic tool in the objective evaluation of a condition of non-specific brain systems in patients with the psychovegetative syndrome; it can also be an objective criterion in the efficiency assessment of a conducted therapy.

Adult↗