Are Patients with Psychogenic Movement Disorders More Likely to be Healthcare Workers?

Abstract

Background: Reported risk factors for the development of a psychogenic movement disorder (PMD) include young age, female gender, history of abuse, current or past psychiatric disorder, lower levels of education and socioeconomic status, and employment as a healthcare worker. Although employment in healthcare is included in several diagnostic criteria for PMD, as well as in many case series, this association has never been validated. Methods: Using the University of Maryland Movement Disorder Database (UMMDD), we identified PMD cases, as well as patients with isolated focal dystonia as controls. An experienced movement disorder specialist diagnosed all patients, and all cases met criteria for clinically established PMD. Demographic and occupational histories were obtained from medical records and were supplemented by telephone interviews. PMD cases and controls were compared using t tests/v 2 tests.Results: Controls (n = 148) were older than PMD cases (n = 132), with an average age of 61.4 and 52.1 years, respectively (P < 0.001); there were no significant differences between groups with respect to gender, education level, and ethnicity. The proportion of healthcare workers was not significantly different between PMD cases and controls (25% of PMD cases vs. 20% of controls; P = 0.28).Conclusions: In contrast to traditional teaching, this investigation demonstrates that in our patient population, patients with a PMD were no more likely to be employed as healthcare workers than patients with isolated focal dystonia. This study calls into question the use of employment in healthcare as a reliable criterion to support the diagnosis of PMD.Psychogenic movement disorders (PMDs), also called functional movement disorders, are common and often present a diagnostic challenge.

Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case–control study

“…Employment in care-giving positions within health and social care industries amongst mFND patients is worth noting. Studies in movement disorders clinics have found no difference between mFND patients and controls (Kenney et al ., 2007; Perry et al ., 2017), although McCormack et al . (2014) report high rates of this employment.…”

Clinical Correlates of Functional Motor Disorders: An Italian Multicenter Study

“…There are no previously published data on educational level in FMDs except 2 studies performed in small cohorts (N = 42 26 and N = 30 27 ), which reported primary education levels in most of the subjects. However, in a recent study of 132 subjects, 57% of patients with FMDs had a college or higher degree 28 . This is an opposite trend compared with neurodegenerative and cardiovascular diseases, which are associated with poor education 29 .…”

“…However, in a recent study of 132 subjects, 57% of patients with FMDs had a college or higher degree. 28 This is an opposite trend compared with neurodegenerative and cardiovascular diseases, which are associated with poor education. 29 Interestingly, it was demonstrated that higher educational level is associated with lower severity of motor impairment in Parkinson's disease.…”

Predisposing Risk Factors for Functional Limb Weakness: A Case-Control Study

“…The interview questions pertained to family structure (including birth order, parental health, separation, and educational and family milestones), sexual and physical abuse during childhood as well as abuse during adult life (to complement questionnaire items), and surgical and medical comorbidity. Exposure to a model for symptoms refers to the idea that patients with FND may be more likely to have symptoms that they have seen in others (13). We therefore asked about exposure to neurological problems in family members, friends, and coworkers.…”