Schrag Anette, Lang Anthony E
Royal Free and University College Medical School, University College London, London, UK.
Curr Opin Neurol. 2005 Aug;18(4):399-404. doi: 10.1097/01.wco.0000170241.86819.19.
This review focuses on recent studies assessing clinical features and laboratory findings that may help diagnose psychogenic movement disorders, and the ongoing controversy about the relationship of these disorders with preceding peripheral injury.
'Organic' movement disorders may still be misdiagnosed as psychogenic. Probably more commonly, however, psychogenic movement disorders are underdiagnosed. Most features typically associated with recognized movement disorders, including geste antagoniste or treatment-induced dyskinesias, can be seen in psychogenic movement disorder, and abnormal movements that would not normally be considered psychogenic or produced by psychological factors, such as palatal tremor, may occur on a psychogenic basis. On the other hand, psychiatric features are sometimes seen in neurologically based movement disorders. The diagnostic criteria for psychogenic movement disorders provide a degree of diagnostic certainty based on a combination of clinical and psychiatric features. Laboratory investigations can help exclude specific diagnoses, such as Parkinson's disease with (123I)beta-CIT single photon emission computed tomography, and neurophysiological methods can demonstrate characteristic features of psychogenic movement disorders, such as entrainment or suppression of psychogenic tremor with contralateral hand movements. However, some tests reported to differentiate psychogenic from neurological movement disorders may have incomplete specificity; for example, psychogenic tremor may not always be associated with complete coherence of tremor frequency. An ongoing controversy surrounds movement disorders following peripheral injuries, but recent evidence suggests that such patients should always be screened for the presence of a psychogenic movement disorder.
Psychogenic movement disorder continues to be a difficult diagnosis to make and is likely to be underrecognized. Clinical and laboratory features are emerging, however, that support this diagnosis. The controversy regarding posttraumatic movement disorders continues, but a diagnosis of a psychogenic movement disorder should be actively sought in such patients.
本综述重点关注近期评估可能有助于诊断精神性运动障碍的临床特征和实验室检查结果的研究，以及关于这些障碍与先前周围神经损伤之间关系的持续争议。
“器质性”运动障碍仍可能被误诊为精神性的。然而，可能更常见的情况是精神性运动障碍被漏诊。大多数通常与公认的运动障碍相关的特征，包括拮抗动作或治疗引起的运动障碍，都可见于精神性运动障碍，而一些通常不被认为是精神性或由心理因素引起的异常运动，如腭震颤，也可能在精神性基础上出现。另一方面，基于神经学的运动障碍有时也会出现精神症状。精神性运动障碍的诊断标准基于临床和精神特征的组合提供了一定程度的诊断确定性。实验室检查有助于排除特定诊断，如使用（123I）β-CIT单光子发射计算机断层扫描诊断帕金森病，神经生理学方法可以证明精神性运动障碍的特征，如对侧手部运动时精神性震颤的同步或抑制。然而，一些据报道可区分精神性和神经学运动障碍的测试可能特异性不完全；例如，精神性震颤并不总是与震颤频率的完全一致性相关。围绕周围神经损伤后的运动障碍存在持续争议，但最近的证据表明，此类患者应始终接受精神性运动障碍的筛查。
精神性运动障碍仍然是一个难以做出的诊断，很可能未得到充分认识。然而，支持这一诊断的临床和实验室特征正在不断涌现。关于创伤后运动障碍的争议仍在继续，但在此类患者中应积极寻求精神性运动障碍的诊断。
