Pathogenesis and pathophysiology of functional (psychogenic) movement disorders

Baizabal‐Carvallo, José Fidel; Hallett, Mark; Jankovic, Joseph

doi:10.1016/j.nbd.2019.02.013

Cited by 119 publications

(127 citation statements)

References 210 publications

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“…The occurrence of bodily sensations in the absence of external or objective internal stimuli encompasses disorders that have had a different taxonomy over time. Earlier terms employed to describe the phenomenon were hysteria, hypochondria, conversion disorders, somatization, somatoform, factitious disorders, or psychogenic disorders . The Diagnostic and Statistical Manual of Mental Disorders‐5 eventually categorized the phenomena under the SFD term as “somatic symptom disorder, conversion, illness anxiety disorder, factitious disorder” as well as a generic “other” category or “psychological factors affecting other medical conditions.” The last category has been likely added to finally acknowledge the presence of functional disorders in patients affected by recognizable medical disorders and is suitable for SFDs that occur in synucleinopathies.…”

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

“…The Diagnostic and Statistical Manual of Mental Disorders‐5 eventually categorized the phenomena under the SFD term as “somatic symptom disorder, conversion, illness anxiety disorder, factitious disorder” as well as a generic “other” category or “psychological factors affecting other medical conditions.” The last category has been likely added to finally acknowledge the presence of functional disorders in patients affected by recognizable medical disorders and is suitable for SFDs that occur in synucleinopathies. As symptoms may express themselves in conjunction with motor signs, movement disorder experts have debated for years whether “psychogenic” or “functional” is the most suitable term to describe them . The term “functional” eventually prevailed, to include conversion and somatic symptom disorders, and a Functional Movement Disorder Study Group was established…”

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

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Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

et al. 2019

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Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD‐dementia with Lewy bodies psychosis. We propose that PD‐dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast‐theta or pre‐alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self‐referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society

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Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

Section: Somatic Symptom and Functional Disordersmentioning

confidence: 99%

Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

et al. 2019

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“…The higher prevalence of FND in females led several medical authorities over the millennia to develop theories relating the FNDs with the uterus, reinforcing the usage of the term hysteria and giving exclusivity of this group of disorders to the female gender. It was not until the 17th century that the pathogenic theories of FNDs shifted from emphasis on the uterus to the brain and mind . This permitted the recognition that the uterus was not necessary for the development of hysteria, and therefore it may also occur in males.…”

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confidence: 99%

“…Functional movement disorders (FMDs), previously known as “psychogenic movement disorders,” are among the most frequently recognized FNDs . Despite the recognition of FMDs in males, studies comparing clinical and demographic features between genders are lacking.…”

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confidence: 99%

Gender Differences in Functional Movement Disorders

Baizabal‐Carvallo

Jankovic

2019

Movement Disord Clin Pract

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Background Background: Functional neurological disorders are generally more common in females than males, but the reason for this gender difference is not well understood. Objectives Objectives: In this study, we aim to compare the clinical and demographic features of functional movement disorders (FMDs) between males and females. Methods Methods: We examined clinical data and video-recordings of patients with FMDs evaluated at the Baylor College of Medicine Movement Disorders Clinic. Results Results: Of the 196 patients with FMDs, males represented only 30% (n = 59) of the entire cohort. Men had an older age at onset: 40.5 versus 34.1 years (P = 0.026) and an older age at evaluation: 43.8 versus 38.1 years (P = 0.041) compared to women. Functional dystonia was more frequently observed in women: 47.5 versus 20.3% (P < 0.001), but there was a trend for higher frequency of functional gait disorder in men: 44 versus 30% (P = 0.056). Females were particularly over-represented (73.7%) in children and adolescents; but the genders were equally represented in patients aged ≥50 years. ConclusionsConclusions: Female patients are over-represented in FMDs, except in individuals aged ≥50 years. Compared to female patients, males with FMDs present later in life and are less likely to have functional dystonia.

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“…Since the advent of modern psychiatry, a correlation between the experience of emotional trauma and psychogenic symptoms has been postulated . This relationship led to the original terminology of conversion disorder—the belief that stressful mood states were converted into sensorimotor neurologic processes . Despite significant criticisms and limitations of this theory, the role of stress and trauma remain important risk factors for developing functional neurological disorders .…”

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confidence: 99%

Gender as a Risk Factor for Functional Movement Disorders: The Role of Sexual Abuse

Kletenik

Sillau

Isfahani

et al. 2019

Movement Disord Clin Pract

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Background Background: The prevalence of functional movement disorders is 2 to 3 times higher in women than in men. Trauma and adverse life events are important risk factors for developing functional movement disorders. On a population level, rates of sexual abuse against women are higher when compared with the rates against men. Objectives Objectives: To determine gender differences in rates of sexual abuse in functional movement disorders compared with other neurologic disorders and evaluate if the gender prevalence is influenced by higher rates of sexual abuse against women. Methods Methods: We performed a case-control series including 199 patients with functional movement disorders (149 women) and 95 controls (60 women). We employed chi-squared test to assess gender and sexual abuse associations and Bayes formula to condition on sexual abuse. Results Results: Our analysis showed an association between sexual abuse and functional movement disorders in women (odds ratio, 4.821; 95% confidence interval, 2.089-12.070; P < 0.0001), but not men. Bayesian analysis found the functional movement disorder prevalence ratio between women and men conditional on sexual abuse to be 4.87 times the unconditioned ratio. ConclusionsConclusions: There is a statistically significant association between sexual abuse and functional movement disorders in women and a greater likelihood that women who are sexually abused will develop functional movement disorders than men who are sexually abused. Our findings suggest that the increased prevalence of functional movement disorders in women is associated, at least in part, with sexual abuse and its sequelae; however, further research is needed to explore the role of other traumatic and nontraumatic factors.Functional movement disorders (FMD) are commonly seen in neurologic practice and are characterized by abnormal control over movements, often presenting with tremor, dystonia, and gait disorders and associated nonmotor complaints with evidence of symptom incompatibility with recognized neurologic diseases. 1 The prevalence of functional movement disorders is 2 to 3 times higher in women than in men. 2 Since the advent of modern psychiatry, a correlation between the experience of emotional trauma and psychogenic symptoms has been postulated. 3 This relationship led to the original terminology of conversion disorder-the belief that stressful mood states were converted into sensorimotor neurologic processes. 1,4 Despite significant criticisms and limitations of this theory, the role of stress and trauma remain important risk factors for developing functional neurological disorders. 5 Given the higher rates of sexual abuse (SA) in women when compared with men, 6 we hypothesized that the previously reported gender association of functional movement disorders is influenced by higher rates of SA against women. MethodsTo test our hypothesis, we performed a retrospective analysis of deidentified data from 2 academic referral sites (National Institutes of Health and the University of Louisville),...

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Pathogenesis and pathophysiology of functional (psychogenic) movement disorders

Cited by 119 publications

References 210 publications

Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

Hallucinations, somatic‐functional disorders of PD‐DLB as expressions of thalamic dysfunction

Gender Differences in Functional Movement Disorders

Gender as a Risk Factor for Functional Movement Disorders: The Role of Sexual Abuse

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