Presentation
The clinical presentation of psychogenic myoclonus is extremely rich and polymorphous and can mimic virtually all forms of cortical, subcortical or spinal myoclonus. Focal, multifocal, axial or generalized jerks can occur. [ncbi.nlm.nih.gov]
Entire Body System
- Movement Disorder
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). [ncbi.nlm.nih.gov]
- Weakness
Positive features of functional weakness on examination include Hoover’s sign, when there is weakness of hip extension which normalises with contralateral hip flexion, and thigh abductor sign, weakness of thigh abduction which normalises with contralateral [en.wikipedia.org]
It is an umbrella term for a variety of symptoms which look similar to those caused by neurological conditions such as Multiple Sclerosis (MS) or Parkinson's disease, including weakness, fatigue and seizures. [me-pedia.org]
2016 2017 2018 2019 Billable/Specific Code Applicable To Asthenia NOS Type 1 Excludes age-related weakness ( R54 ) muscle weakness ( M62.8- ) sarcopenia ( M62.84 ) senile asthenia ( R54 ) hysterical F44.4 Ataxia, ataxy, ataxic R27.0 ICD-10-CM Diagnosis [icd10data.com]
The patient with pseudoparalysis may have “give-way” weakness: abrupt or stepwise loss of strength in the tested muscle groups. In contrast, the loss of resistance is smooth in patients with organic weakness. [aafp.org]
The rehabilitation program was successful in restoring her muscle weakness and gait. Nine months after admission, she returned home with independent ADL and mild monoplegia. Eight-month follow-up revealed that she was doing well at home. [ci.nii.ac.jp]
- Chronic Fatigue Syndrome
Wessely and White state that all somatic illnesses, including Fibromyalgia, Irritable Bowel Syndrome and Chronic Fatigue Syndrome "still fall under the title of ‘unexplained’ since no consensual scientific explanation has been advanced for any of them [me-pedia.org]
Wessely and White have argued that FND may merely be an unexplained somatic illness (like fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome) rather than a psychiatric condition. [23] References [ edit ] ^ a b Carson, A. et al. [en.wikipedia.org]
Gastrointestinal
- Nausea
These include, but are not limited to Weakness Paralysis Dizziness Nausea Changes in vision Non-epileptic seizures Blackouts Tremors Fatigue Chronic pain Sensory abnormalities Bladder or bowel changes [6] Diagnostic Criteria from DSM-5 [ edit | edit source [me-pedia.org]
Additionally, cold water caloric stimulation is noxious and can induce nausea, vomiting or recovery in a noncomatose patient. [aafp.org]
- Vomiting
Additionally, cold water caloric stimulation is noxious and can induce nausea, vomiting or recovery in a noncomatose patient. [aafp.org]
Musculoskeletal
- Restless Legs Syndrome
Hyperkinetic disorders: Examples of hyperkinetic movement disorders include dystonias, Huntington disease, chorea, ballism, athetosis, Tourette syndrome, myoclonus, ataxia, restless legs syndrome or Willis-Ekbom disease and Psychogenic Movement Disorder [icliniq.com]
Face, Head & Neck
- Facial Pain
View/Print Table TABLE 3 Signs and Symptoms in 405 Patients with Psychogenic Dysfunction of the Nervous System Sign or symptom Number of patients Pain Trunk and extremities 89 Headache 61 Atypical facial pain 13 Motor symptoms Astasia/abasia 52 Monoparesis [aafp.org]
Psychiatrical
- Suggestibility
I conclude that suggestion is therefore an ethically justifiable treatment for patients with psychogenic movement disorders. (c) 2009 Movement Disorder Society. [ncbi.nlm.nih.gov]
There may be fluctuations during a neurological exam—particularly an increase of movement following attention and suggestion (an external influence on the will of the patient), and a decrease when the person is distracted. [ninds.nih.gov]
- Anxiety Disorder
The most common psychiatric illnesses associated with PMDs are depression, conversion reactions, and anxiety disorders. [ncbi.nlm.nih.gov]
Psychiatric conditions that often masquerade as psychogenic movement disorders include somatoform disorder, factitious disorder, malingering, depression and anxiety disorder. [icliniq.com]
[…] antidepressant 抗うつ薬 anxiety 不安 anxiety disorder 不安障害 auditory hallucination 幻聴 automatism 自動症 b bereavement 死別 bipolar disorder 双極性障害 blocking of thought 思考途絶 borderline personality organization 境界人格構造 bulimia nervosa 過食症、神経性大食症 c catalepsy カタレプシー catharsis [tokyo-med.ac.jp]
- Fidgeting
When chorea has a low amplitude, it can resemble restlessness or fidgeting. When chorea has a high amplitude, the child can appear to have flailing or flinging movements. Athetosis is a term used to describe the slow writhing movements of the hands. [childneurologyfoundation.org]
Neurologic
- Dystonia
There are no definitive tests to differentiate psychogenic dystonia from organic dystonia, although one has been recently reported. Similar physiological abnormalities are seen in both groups. [ncbi.nlm.nih.gov]
The dystonia onset was abrupt in 3 patients and progression resulted rapidly into fixed dystonia in 4 patients. Pain was observed in all patients. Paroxysmal dystonia was observed in one patient. [file.scirp.org]
[…] a part of the global effort to find a cure for dystonia Current Dystonia Research Investigations The Dystonia Medical Research Foundation (DMRF) prides itself on a long history of supporting and stimulating dystonia research. [dystonia-foundation.org]
- Tremor
Other features, such as paradoxical increase of tremor amplitude with mass loading, co-activation preceding tremor onset and alteration of voluntary contralateral motor performances when tremor is present, are also of interest. [ncbi.nlm.nih.gov]
- Myoclonus
Abstract Tremor and myoclonus are very common manifestations of psychogenic movement disorders (PMD). [ncbi.nlm.nih.gov]
[…] reticular myoclonus, or is 3) absent that may suggest spinal myoclonus. [e-jmd.org]
- Chorea
Chorea Chorea can be seen in normal, healthy infants until they are about 6 month of age. After this age, chorea is typically pathologic. Chorea is rarely a primary disorder. [childneurologyfoundation.org]
Among the whole group, 44% had tremor, 24% dystonia, 12% pure gait disorders, 8% parkinsonism, 6% chorea-ballism, and 4% tic disorder. PMD developed acutely in 85% of patients, and distractibility was observed in 83%. [ncbi.nlm.nih.gov]
paroxysmal movement disorders, psychogenic movement disorders, Sydenham chorea, tardive dyskinesia and tremor. [cincinnatichildrens.org]
(chronic) (gravis) (posthemiplegic) (senile) (spasmodic) G25.5 ICD-10-CM Diagnosis Code G25.5 Other chorea 2016 2017 2018 2019 Billable/Specific Code Type 1 Excludes chorea NOS with heart involvement ( I02.0 ) Huntington's chorea ( G10 ) rheumatic chorea [icd10data.com]
- Bradykinesia
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. [ncbi.nlm.nih.gov]
PMD can present as any number of neurologically based movement disorders, including tremor, myoclonus, dystonia, chorea, bradykinesia, myoclonus, tics, athetosis, ataxia, or others. Neurologists and psychologists alike are often baffled by PMD. [brainchangersusa.com]
Bradykinesia in psychogenic Parkinsonism patients is usually unaccompanied by amplitude decrement or interruptions in repetitive movements as observed in Parkinson disease ( Table 3 ). [pediatrics.imedpub.com]
Parkinsonism Features of parkinsonism include: slow movements (bradykinesia) stiffness of muscles (rigidity) decreased spontaneous movement (akinesia) postural instability a tremor that occurs when the muscles are relaxed and not in use (resting tremor [childneurologyfoundation.org]
Psychogenic parkinsonism is characterized by abrupt onset with no evolution over time, spontaneous improvements, remission with psychotherapy and inconsistent tremor or bradykinesia. 28 In one series, 29 more than 50 percent of patients with psychogenic [aafp.org]
Treatment
Recent developments in our understanding of psychogenic movement disorders have not yet led to advances in treatment. [ncbi.nlm.nih.gov]
Prognosis
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. [ncbi.nlm.nih.gov]
Prognosis The severity of psychogenic movement symptoms and prognosis varies among individuals. Prognosis is considered poor when the movement disorder continues for many years. [ninds.nih.gov]
Etiology
The term ''organic'' is used to mean ''not due to a psychogenic etiology'', and, thus the term '' non-organic '' refers to psychogenic etiology. [icliniq.com]
Subsequently, different etiologies of dystonia, tremor, myoclonus, and other movement disorders were recognized. [frontiersin.org]
For the purpose of discussion in this review, the terms “psychogenic” or “pseudoneurologic” will be used to refer to neurologic symptoms for which a psychologic etiology is suspected. [aafp.org]
After several examinations, her neurological findings were found to be at variance with an organic etiology, and a psychiatrist evaluated her symptoms as being due to hysterical conversion. [ci.nii.ac.jp]
Since that is rarely the case, even for a physical symptom that does have an organic etiology; the patient is often disappointed by the neurological examination results and may be reluctant to delve into the complicated unconscious conflicts that are [e-sciencecentral.org]
Epidemiology
This review encompasses historical and epidemiological data, clinical aspects, diagnostic criteria, treatment and prognosis of these rather challenging and often neglected patients. [ncbi.nlm.nih.gov]
Definition Abnormal movements occurring from psychiatric cause Epidemiology As many 4% of patients seen in a movement disorders center Women > men Risk factors include trauma, surgery, stressful events Pathophysiology Unknown May be similar to conversion [wiki.uiowa.edu]
The next section of the book delineates the phenomenology (descriptions) of the movements as well as the epidemiology of the disorders. These chapters were written by specialists in movement disorders. [nejm.org]
Clinical Practice and Epidemiology in Mental Health : CP & EMH. 8 : 110–119. doi : 10.2174/1745017901208010110. ISSN 1745-0179. PMC 3480686. PMID 23115576. ^ a b c Webster, Richard. [en.wikipedia.org]
Pathophysiology
As with other functional disorders, a key issue is the absence of pathophysiological understanding. There has been an influential historical emphasis on causation by emotional trauma, which is not supported by epidemiological studies. [ncbi.nlm.nih.gov]
Prevention
Understanding of the differential diagnosis, which is broad and includes many organic causes (eg, stroke), is essential to make an early and accurate diagnosis to prevent complications and initiate appropriate management. [ncbi.nlm.nih.gov]
Animal tests suggest that fasoracetam effectively prevents memory problems and reduces amnesia and forgetfulness. Eläinkokeet osoittavat, että fasoracetam ehkäisee tehokkaasti muistin ongelmia ja vähentää amnesia ja unohdettavuutta. [tr-ex.me]
They are suppressible, meaning the patient may be able to prevent an oncoming tic from happening. [bcm.edu]
A fixed foot in plantar flexion and inversion prevents weight bearing, and forces the use of an assistive device (walker or wheelchair). A magnified view of the patient’s right foot is shown on the right. d. Swivel chair sign. [clinicalmovementdisorders.biomedcentral.com]
Early recognition and prompt intervention are needed to prevent social and academic disruptions, and hence a debilitating outcome. [pediatrics.imedpub.com]