Functional (psychogenic) movement disorders

Abstract

Purpose of review This review provides an overview of recent developments in diagnosis, pathophysiology, neuroimaging and management of functional (psychogenic) movement disorders (FMD) and highlights the current controversy on classification of somatoform disorders in the new DSM-5. Recent findings There has been increasing interest in recent years to study the underlying pathophysiology of FMDs, which has resulted in a broadened disease model, taking neurobiologic and psychosocial factors equally into account. In this context, the term “psychogenic” has been replaced by “functional” movement disorders by many authors in the field to express the changing focus towards a multifactorial disease model. The need for establishing a positive diagnosis of FMD as opposed to providing a diagnosis of exclusion is increasingly recognized and reflected by the introduction of “laboratory-supported” diagnostic criteria of FMD. Important advances have been made through behavioral, electrophysiological and neuroimaging studies although the fundamental etiology of FMD remains poorly understood. Of particular interest have been several reports on abnormal sensorimotor features and cortical inhibition in both organic and functional dystonia, highlighting possible shared traits of both conditions. In terms of treatment, recent studies have reported benefit from both psychiatric and physical therapy based interventions. Summary Increasing efforts have been made towards better understanding and treatment of FMD, and the disease model has been broadened to include neurobiologic and psychosocial factors. Laboratory-based diagnostic criteria have been established for many FMDs to support the clinical diagnosis. To determine the most effective management strategies for FMD, a closer collaboration between neurologists and psychiatrists and intensified research efforts with prospective treatment trials are needed.

Randomised feasibility study of physiotherapy for patients with functional motor symptoms

“…A larger proportion of the intervention group rated their symptoms as improved (72%) compared to the control group (18%), while 32% of the control group felt their symptoms had worsened over the follow-up period, compared to 3% in the intervention group. The effect size of the intervention is consistent with those of similar published studies in FMS, including our cohort study of 47 patients during the development phase of the 5-day programme;8 a 5-day physiotherapy and occupational therapy-based intervention;26 and a randomised delayed-start trial of a 3-week inpatient physical-based rehabilitation programme 5. The improvement reported in the current study occurred in a sample of patients with characteristics usually associated with a poor prognosis.…”

Treatment of Myoclonus

“…A psychiatrist should consider treatment of any psychiatric disease that is present, such as anxiety and/or depression. Both physical therapy-based and cognitive behavioral therapies have been reported to be useful [80]. The clinician should keep in mind that each of these cases tends to be unique, so individualized diagnosis and treatment options are common.…”

Functional (psychogenic) movement disorders – Clinical presentations

“…Functional (or psychogenic) movement disorders are those thought to be due to a psychological cause, although in fact the full pathophysiology is not really known [1–4]. Most patients, by DSM-5 terminology, are mainly categorized as Conversion Disorder, or Functional Neurological Symptom Disorder, under the general category of Somatic Symptom and Related Disorders.…”