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Semin Neurol 2006; 26(3): 283-288
DOI: 10.1055/s-2006-945521
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Evaluation and Diagnosis of Psychogenic Disorders in Neurological Patients

Karen E. Anderson1
  • 1Movement Disorders Division, Department of Neurology, and Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Publication History

Publication Date:
22 June 2006 (online)

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ABSTRACT

Patients with psychogenic neurological symptoms present a diagnostic challenge. There are certain elements in a history that are indicative of a psychogenic condition. These include sudden onset of symptoms, highly emotional events at the time of symptom onset, paroxysmal nature of symptoms, and migrating or changing complaints. Likewise, some findings on examination are more often seen in psychogenic cases than in organic disorders. Multiple symptoms that do not correspond to any identifiable neuroanatomical abnormality, distractibility, entrainment, and false weakness or sensory complaints, are all possible clues that a condition is emotional rather than organic. However, none of these features is an absolute indication of psychogenicity and each must be taken in the context of the complete clinical picture.

KEYWORDS

Psychogenic - conversion disorder - somatoform disorder - functional symptoms

REFERENCES

  • 1 Carson A J, Ringbauer B, Stone J et al.. Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics.  J Neurol Neurosurg Psychiatry. 2000;  68 207-210
    CrossrefPubMedGoogle Scholar
  • 2 Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many?.  Lancet. 1999;  354 936-939
    CrossrefPubMedGoogle Scholar
  • 3 Kirmayer L J, Groleau D, Looper K J, Dao M D. Explaining medically unexplained symptoms.  Can J Psychiatry. 2004;  49 663-672
    PubMedGoogle Scholar
  • 4 Fink P, Sorensen L, Engberg M et al.. Somatization in primary care: prevalence, health care utilization, and general practitioner recognition.  Psychosomatics. 1999;  40 330-338
    PubMedGoogle Scholar
  • 5 de Waal M W, Arnold I A, Eekhof J A, van Hemert A M. Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders.  Br J Psychiatry. 2004;  184 470-476
    CrossrefPubMedGoogle Scholar
  • 6 Reuber M, Elger C E. Psychogenic nonepileptic seizures: review and update.  Epilepsy Behav. 2003;  4 205-216
    CrossrefPubMedGoogle Scholar
  • 7 Thomas M, Jankovic J. Psychogenic movement disorders: diagnosis and management.  CNS Drugs. 2004;  18 437-452
    CrossrefPubMedGoogle Scholar
  • 8 Smith Jr G R, Monson R A, Ray D C. Patients with multiple unexplained symptoms: their characteristics, functional health, and health care utilization.  Arch Intern Med. 1986;  146 69-72
    PubMedGoogle Scholar
  • 9 Neimark G, Caroff S N, Stinnett J L. Medically unexplained physical symptoms.  Psychiatr Ann. 2005;  35 298-305
    PubMedGoogle Scholar
  • 10 Ford C V. The Somatizing Disorders: Illness as a Way of Life. New York; Elsevier 1983
    Google Scholar
  • 11 Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis.  J Neurol Neurosurg Psychiatry. 2005;  76(suppl l) i2-i12
    CrossrefPubMedGoogle Scholar
  • 12 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC; American Psychiatric Association 1994: 445-469
    Google Scholar
  • 13 Reuber M, Mitchell A J, Howlett S J, Crimlisk H L, Grunewald R A. Functional symptoms in neurology: questions and answers.  J Neurol Neurosurg Psychiatry. 2005;  76 307-314
    CrossrefPubMedGoogle Scholar
  • 14 Williams C, House A O. Heavy hospital case notes: a simple case finding method for psychiatric problems.  Ir J Psychol Med. 1999;  16 123-126
    PubMedGoogle Scholar
  • 15 Williams D T, Ford B, Fahn S. Treatment issues in psychogenic-neuropsychiatric movement disorders. In: Anderson KE, Weiner WJ, Lang AE Advances in Neurology. Vol. 96: Behavioral Neurology of Movement Disorders. 2nd ed. Philadelphia; Lippincott Williams & Wilkins 2005: 350-363
    Google Scholar
  • 16 Williams D T, Ford B, Fahn S. Phenomenology and psychopathology of related to psychogenic movement disorders.  Adv Neurol. 1995;  65 231-257
    PubMedGoogle Scholar
  • 17 O'Malley P G, Jackson J L, Santro J et al.. Antidepressant therapy for unexplained symptoms and symptom syndromes.  J Fam Pract. 1999;  48 980-990
    PubMedGoogle Scholar
  • 18 Stinnett J L. The functional somatic symptom.  Psychiatr Clin North Am. 1987;  10 19-33
    PubMedGoogle Scholar
  • 19 Taylor G J. Somatization and conversion: distinct or overlapping constructs?.  J Am Acad Psychoanal Dyn Psychiatry. 2003;  31 487-508
    PubMedGoogle Scholar
  • 20 Barsky A J, Borus J F. Functional somatic syndromes.  Ann Intern Med. 1999;  130 910-921
    PubMedGoogle Scholar
  • 21 Barsky A J, Ahern D K. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial.  JAMA. 2004;  291 1464-1470
    CrossrefPubMedGoogle Scholar
  • 22 Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials.  Psychother Psychosom. 2000;  69 205-215
    CrossrefPubMedGoogle Scholar
  • 23 Haligan P, Bass C, Marshall J C. Contemporary Approaches to the Science of Hysteria: Clinical and Theoretical Perspectives. Oxford; Oxford University Press 2001
    Google Scholar

Karen E AndersonM.D. 

Movement Disorders Division, Department of Neurology, N4W46, University of Maryland Medical Center

22 South Greene Street, Baltimore, MD 21201

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