Volume 24, Issue 9 p. 1366-1374
Research Article

Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members

Alberto J. Espay MD, MSc

Corresponding Author

Alberto J. Espay MD, MSc

Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

University of Cincinnati, 260 Stetson St., Suite 2300, Cincinnati, OH 45267-0525Search for more papers by this author
Linda M. Goldenhar PhD

Linda M. Goldenhar PhD

Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

Search for more papers by this author
Valerie Voon MD

Valerie Voon MD

National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA

Search for more papers by this author
Anette Schrag MD, PhD

Anette Schrag MD, PhD

Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom

Search for more papers by this author
Noël Burton MA

Noël Burton MA

Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA

Search for more papers by this author
Anthony E. Lang MD, FRCPC

Anthony E. Lang MD, FRCPC

Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada

Search for more papers by this author
First published: 07 May 2009
Citations: 127

Potential conflict of interest: None reported.

The Movement Disorder Society helped distribute the survey to its members but did not participate as sponsor.

Abstract

Five hundred and nineteen members of the Movement Disorder Society completed a 22-item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non-PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non-physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non-US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non-US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society