Movement Disorders May Respond to Psychotherapy

Article excerpt

SAN FRANCISCO -- Outpatient psychotherapy is effective treatment for patients with psychogenic movement disorders, Dr. Vanessa K. Hinson said at the annual meeting of the American Academy of Neurology.

Psychogenic movement disorders, classified as conversion disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), can be chronic and disabling. Yet there has been no validated form of therapy.

Dr. Hinson reported on 10 patients diagnosed with psychogenic movement disorders (PMD) by a movement disorders specialist with confirmation by a seven-physician panel viewing videotapes. Nine of the 10 completed the 12 once-weekly sessions of psychiatrist-conducted individual psychodynamic psychotherapy. Eight patients had PMD symptoms of 8 months' duration or less, while one had a 78-month history of symptoms.

At baseline, the most commonly noted movement disorders included action tremor in eight patients; myoclonus in six; dystonia in five; and bradykinesia, resting tremor, and gait disorders in four each.

PMD is often associated with other Axis-I psychiatric disorders. Indeed, seven of nine study participants had one or more comorbid psychiatric diagnoses: Five had major depressive disorder, two had personality disorder, two had posttraumatic stress disorder, one had an anxiety disorder, and one patient had bipolar disorder.

The use of antidepressant or anxiolytic was left to the psychiatrist's discretion. A selective serotonin reuptake inhibitor was added or its dosing was increased in two of nine patients, while an SSRI or benzodiazepine was discontinued in three. …