Hinson Vanessa K, Haren W Blake
Department of Neurosciences, Murray Center for Research on Parkinson's Disease and Related Disorders, Medical University of South Carolina, Charleston Memorial Hospital, Charleston, SC 29425, USA.
Lancet Neurol. 2006 Aug;5(8):695-700. doi: 10.1016/S1474-4422(06)70523-3.
Diagnosis and treatment of psychogenic movement disorders are challenging for both neurologists and psychiatrists. Symptoms can mimic the full range of organic abnormal involuntary movements, affect gait and speech, or present as unusual undifferentiated movements. Typical clinical characteristics of these disorders are acute onset, fast progression, movement patterns incongruent with organic movement disorders, distractibility, variability, and simultaneous occurrence of various abnormal movements and dysfunctions. Avoidance of iatrogenic damage by unnecessary invasive tests or inappropriate medication, as well as use of appropriate psychiatric treatments are pivotal steps in the management of these disorders. The few clinical trials specific to psychogenic movement disorders focus on antidepressants and psychotherapy. Presence of a comorbid psychiatric diagnosis of depression or an anxiety disorder is a positive prognostic factor, whereas long-standing symptoms, insidious onset of movements, and a psychiatric diagnosis of hypochondriasis, factitious disorder, or malingering are associated with poor outcome.
心因性运动障碍的诊断和治疗对神经科医生和精神科医生来说都具有挑战性。其症状可模仿各种器质性异常不自主运动，影响步态和言语，或表现为异常的未分化运动。这些障碍的典型临床特征包括急性起病、进展迅速、运动模式与器质性运动障碍不一致、易分散注意力、多变性以及同时出现各种异常运动和功能障碍。避免因不必要的侵入性检查或不适当用药造成医源性损害，以及采用适当的精神科治疗方法，是管理这些障碍的关键步骤。少数针对心因性运动障碍的临床试验聚焦于抗抑郁药和心理治疗。合并存在抑郁或焦虑症的精神科诊断是一个积极的预后因素，而症状持续时间长、运动隐匿起病以及疑病症、做作性障碍或诈病的精神科诊断则与不良预后相关。
