Movement disorders: Psychogenic movement disorders: what do neurologists do?

摘要

Patients with psychogenic movement disorders (PMDs) present with tremor, fixed postures of limbs (typically an inverted ankle or clenched fist; Figure 1), jerks, or other combinations of abnormal movements. Examination usually shows that the movements are internally inconsistent or incongruous with recognized neurological disorders. Traditionally, PMDs and other conversion symptoms were not considered to fall strictly within the remit of clinical neurology, but their profile is slowly rising within this speciality. These types of disorders are common, and, as neurologists are beginning to appreciate, can be intellectually challenging and rewarding to treat. In addition, functional imaging and neurophysio-logical studies of PMDs are prompting a move away from the purely psychodynamic perspective of the past 100 years to a 'multi-perspective' view of the underlying etiology and mechanisms. Much remains to be understood, however-not least the clinical realities of how patients with PMDs are diagnosed, labeled and managed.