Download PDF
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
Further Information

Publication History

Publication Date:
22 June 2006 (online)

    Permissions and Reprints

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
    CrossrefPubMedSearch in Google Scholar
  • 2 Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many?.  Lancet. 1999;  354 936-939
    CrossrefPubMedSearch in Google Scholar
  • 3 Kirmayer L J, Groleau D, Looper K J, Dao M D. Explaining medically unexplained symptoms.  Can J Psychiatry. 2004;  49 663-672
    PubMedSearch in Google 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
    PubMedSearch in Google 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
    CrossrefPubMedSearch in Google Scholar
  • 6 Reuber M, Elger C E. Psychogenic nonepileptic seizures: review and update.  Epilepsy Behav. 2003;  4 205-216
    CrossrefPubMedSearch in Google Scholar
  • 7 Thomas M, Jankovic J. Psychogenic movement disorders: diagnosis and management.  CNS Drugs. 2004;  18 437-452
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google Scholar
  • 9 Neimark G, Caroff S N, Stinnett J L. Medically unexplained physical symptoms.  Psychiatr Ann. 2005;  35 298-305
    PubMedSearch in Google Scholar
  • 10 Ford C V. The Somatizing Disorders: Illness as a Way of Life. New York; Elsevier 1983
    Search in 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
    CrossrefPubMedSearch in Google Scholar
  • 12 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC; American Psychiatric Association 1994: 445-469
    Search in 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
    CrossrefPubMedSearch in Google 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
    PubMedSearch in Google 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
    Search in 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
    PubMedSearch in Google 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
    PubMedSearch in Google Scholar
  • 18 Stinnett J L. The functional somatic symptom.  Psychiatr Clin North Am. 1987;  10 19-33
    PubMedSearch in Google Scholar
  • 19 Taylor G J. Somatization and conversion: distinct or overlapping constructs?.  J Am Acad Psychoanal Dyn Psychiatry. 2003;  31 487-508
    PubMedSearch in Google Scholar
  • 20 Barsky A J, Borus J F. Functional somatic syndromes.  Ann Intern Med. 1999;  130 910-921
    PubMedSearch in Google Scholar
  • 21 Barsky A J, Ahern D K. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial.  JAMA. 2004;  291 1464-1470
    CrossrefPubMedSearch in Google 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
    CrossrefPubMedSearch in Google 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
    Search in 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