Abstract
Psychogenic tremor is the most common form (55%) of all psychogenic movement disorders. Almost 75% of presenting patients are female. Onset is often abrupt. Preceding events include work related injuries and other accidents. Important clinical characteristic include variability of direction, amplitude and frequency. A positive entrainment test, presence of the co-contraction sign, absence of finger tremor and slowness of voluntary movements are suggestive of psychogenic origin. Co-morbidity with psychiatric disorders is common and includes somatoform disorders (35%), such as pain, diffuse sensory loss, conversion disorders and depression (14%). One fifth (21%) of patients are involved in litigation or compensation issues. Diagnosis is based on history, clinical signs and investigations. A multimodal approach including neuropsychiatric evaluation and psychotherapy should be offered. Prognosis, however, is relatively poor particularly if the condition has persisted for over a year and in the long-term up to 80-0% of patients continue to have abnormal movements.
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American Psychiatric Association (1995) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), International Version with ICD-10 Codes, Washington DC, pp 457-87
Brown P, Thompson PD (2001) Electrophysiological Aids to the Diagnosis Of Psychogenic Jerks, Spasms, and Tremor. Mov Disord 16(4):595-99
Campbell J (1979) The shortest paper. Neurology 29:1633
Crimlisk HL, Bhatia KP, Cope H, David A, Marsden CD, Ron MA (1998) Slater revisited: 6 year follow-up study of patients with medically unexplained motor symptoms. BMJ 316:582-86
Deuschl G, Köster B, Lücking CH, Scheidt C (1998) Diagnostic and Pathophysiological Aspects of Psychogenic Tremors. Mov Disord 13:294-02
Deuschl G, Raethjen J, Kopper F, Govindan RB (2005) The diagnosis and physiology of psychogenic tremor. In: Hallett M, Fahn S, Jankovic J, Lang AE, Clninger CR, Yodofsky SC (eds) Psychogenic Movement Disorders, Lipponcott Williams and Wilkins, Philadelphia, pp 265-73
Elble RJ, Koller WC (1990) Unusual forms of tremor. In: Elble RJ, Koller WC (eds) Tremor, The Johns Hopkins University Press, Baltimore, pp 154-57
Factor SA, Podskalny GD, Molho ES (1995) Psychogenic movement disorders: Frequency, clinical profile and characteristics. J Neurol Neurosurg Psychiatry 59:406-12
Fahn S, Williams PJ (1988) Psychogenic dystonia. Adv Neurol 50:431-55
Fahn S (1994) Psychogenic movement disorders. In: Marsden CD, Fahn S (eds) Movement Disorders 3. Buttenw Heinem, Oxford, pp 359-72
Feinstein A, Stergiopoulos V, Fine J, Lang AE (2001) Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol 14(3):169-76
Ford B, Williams DT, Fahn S (1995) Treatment of psychogenic movement disorders. In: Kurlan R (ed) Treatment of Movement Disorders, JP Lippincott, pp 475-85
Gowers (1888) Diseases of the Nervous System. Philadelphia : Blackston, Son and Co
Jankovic J, Thomas M. Psychogenic tremor and shaking. (2005) In Hallett M, Fahn S, Jankovic J, Lang AE, Clninger CR, Yodofsky SC (eds) Psychogenic Movement Disorders, Lipponcott Williams and Wilkins, Philadelphia, pp 42-7
Kim YJ, Pakiam ASI, Lang AE (1999) Historical and Clinical Features of Psychogenic Tremor: Review of 70 cases. Can J Neurol Sci 26:190-95
Koller WC, Biary NM (1989) Volitional control of involuntary movements. Mov Disord 4(2):153-56
Koller WC, Lang AE, Vetre-Overfield B, Findley L, Cleeves L, Factor S, Singer C, Weiner W (1989) Psychogenic tremors. Neurology 39:1094-099
Koller WC, Marjama-Lyons J, Troster AJ (2002) Psychogenic movement disorders. In: Jankovic JJ, Tolosa E (eds) Parkinson's Disease and Movement Disorders. Lippincott, Philadelphia, pp 546-52
Lang AE, Koller WC, Fahn S (1995) Psychogenic Parkinsonism. Arch Neurol 52:802-10
McAuley J, Rothwell JC (2004) Identification of psychogenic, dystonic, and other organic tremors by a coherence entrainment test. Mov Disord; 19(3):253-7
Miyasaki JI, Sa DS, Galvez-Jimenez N, Lang AE (2003) Psychogenic Movement Disorders. Can J Neurol Sci 30:Suppl. 1-S94-S100
Monday K, Jankovic J (1993) Psychogenic myoclonus. Neurology 43:349-52
Morgan JC, Mir P, Mahapatra RK, Bhatia KP, Sethi KD (2004) Psychogenic parkinsonism: Clinical features of a large case series. Mov Disord 19:Suppl 9 S345–S346
Raethjen J, Kopper F, Govindan RB, Volkmann J, Deuschl G (2004) Two different pathogenetic mechanisms in psychogenic tremor. Neurology 63(5):812-
Ranawaya R, Riley D, Lang A (1990) Psychogenic Dyskinesias in Patients with Organic Movement Disorders. Mov Disord 5:127-33
Sa DS, Galvez-Jimenez N, Lang AE (2004) Psychogenic movement disorders. In: Watts R, Koller WC (eds) Movement Disorders, Neurologic Principles and Practice (Second Edition), McGraw Hill, pp 891-14
Schneider SA, Bhatia KP (2005) The Use of Amytal/Benzodiazepine Interview in Psychogenic Movement Disorders. In: Hallett M, Yudofsky SC, Lang AE, Jankovic J, Fahn S, Cloninger RC (eds) Psychogenic Movement Disorders. Lippincott Williams and Wilkins, Philadelphia, Baltimore, New York, London, Buenos Aires, Hong Kong, Sydney, Tokyo, pp 249-55
Tolosa E, Coehlo M, Gallardo M (2003) DAT Imaging in Drug –Induced and Psychogenic Parkinsonism. Mov Disord 18: Suppl 7 S28–S33
Whone AL, Watts RL, Stoessl AJ, Davis M, Reske S, Nahmias C, Lang AE, Rascol O, Ribeiro MJ, Remy P, Poewe WH, Hauser RA, Brooks DJ, for the REAL-PET Study Group (2003) Slower Progression of Parkinson's Disease with Ropinirole versus Levodopa: The REAL-PET Study. Ann Neurol 54:93-01
Zeuner KE, Shoge RO, Goldstein SR, Dambrosia JM, Hallet M (2003). Accelerometry to distinguish psychogenic from essential or parkinsonian tremor. Neurology 61:584-50
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Bhatia, K.P., Schneider, S.A. Psychogenic tremor and related disorders. J Neurol 254, 569–574 (2007). https://doi.org/10.1007/s00415-006-0348-z
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DOI: https://doi.org/10.1007/s00415-006-0348-z