A Retrospective Audit of Outcomes of Treatment for Psychogenic Movement Disorders
Objective:
Approximately 7% of our movement disorder clinic referrals are diagnosed with a psychogenic movement disorder (PMD). We performed a retrospective audit of patient outcomes to evaluate our management practice.
Methods:
Patients diagnosed with PMD between Jan 03-Dec 04 were identified from patient databases. Demographics, referral source, clinical findings and treatment recommendations were ascertained from medical records. Level of diagnostic certainty (per criteria of Williams, Ford and Fahnref) was assigned retrospectively. Details of treatment received were obtained from relevant specialists, GPs and hospital medical records. Current status of the movement disorder and level of disability were ascertained from each patient’s current GP.
Results:
38 PMD patients were identified after exclusion of those with isolated paralysis, seizures or concurrent organic movement disorder. Follow up was available in 34 (89%). 7 (18%)had “documented” (proven) PMD, 8 (21%) “clinically documented”, 22 (58%) “probable” and 1 “possible”. Mean age was 41.5 (14.8-68.2 +/- 2SD), 68% were female. 66% were referred by another neurologist. 7% had unresolved litigation/ insurance issues. 39% had another concurrent psychiatric diagnosis, 42% were able to perform their usual occupation at the time of assessment. 76% had been symptomatic >6months. 24/38 (63%) had any treatment recommended, 15/35 (43%) received treatment (psychiatric, rehabilitation or both). 9/38 (24%) attended neurological follow-up. Clinical outcome was improved in 16/34 (47%). Duration of symptoms (p=0.052), psychiatric treatment (p=0.052) and any prescribed treatment (p=0.006) were independently associated with favorable outcome.
Conclusion:
Treatment of PMD may be associated with favorable outcome. We plan a prospective treatment trial.