Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Mov Disord. 2011 Aug 15;26(10):1844-50. doi: 10.1002/mds.23830. Epub 2011 Jun 28.
Psychogenic movement disorder is defined as abnormal movements unrelated to a medical cause and presumed related to underlying psychological factors. Although psychological factors are of both clinical and pathophysiological relevance, very few studies to date have systematically assessed their role in psychogenic movement disorder. We sought to assess the role of previous life stress using validated quantitative measures in patients with psychogenic movement disorder compared with age- and sex-matched healthy volunteers as well as a convenience sample of patients with focal hand dystonia. Sixty-four patients with psychogenic movement disorder (72% female; mean age, 45.2 years [standard deviation, 15.2 years]), 38 healthy volunteers (74% female; mean age, 49 years [standard deviation, 13.7 years]), and 39 patients with focal hand dystonia (37% female; mean age, 48.7 years [standard deviation, 11.7 years]) were evaluated using a standardized psychological interview as well as validated quantitative scales to assess trauma and previous stressors, depression, anxiety, and personality traits. Patients with psychogenic movement disorder reported higher rates of childhood trauma, specifically greater emotional abuse and physical neglect, greater fear associated with traumatic events, and a greater number of traumatic episodes compared with healthy volunteers and patients with focal hand dystonia controlled for depressive symptoms and sex (Bonferroni corrected P < .005). There were no differences in categorical psychiatric diagnoses or scores on childhood physical or sexual abuse subscales, personality traits, or the dissociative experience scale. Our findings highlight a biopsychosocial approach toward the pathophysiology of psychogenic movement disorder, although the association with psychological issues is much less prominent than expected compared with the nonepileptic seizure population. A careful psychological assessment is indicated to optimize therapeutic modalities.
心因性运动障碍定义为与医学原因无关的异常运动，被认为与潜在的心理因素有关。尽管心理因素具有临床和病理生理学意义，但迄今为止，很少有研究系统评估其在心因性运动障碍中的作用。我们试图使用经过验证的定量测量方法评估心因性运动障碍患者的既往生活应激作用，将其与年龄和性别匹配的健康志愿者以及局灶性手部运动障碍的便利样本患者进行比较。64 例心因性运动障碍患者（72%为女性；平均年龄 45.2 岁[标准差 15.2 岁]）、38 名健康志愿者（74%为女性；平均年龄 49 岁[标准差 13.7 岁]）和 39 名局灶性手部运动障碍患者（37%为女性；平均年龄 48.7 岁[标准差 11.7 岁]）接受了标准化心理访谈以及经过验证的定量量表评估，以评估创伤和既往应激源、抑郁、焦虑和人格特征。与健康志愿者和局灶性手部运动障碍患者（控制抑郁症状和性别）相比，心因性运动障碍患者报告了更高的童年创伤发生率，特别是更多的情感虐待和身体忽视、与创伤事件相关的更大恐惧以及更多的创伤事件。在分类精神病诊断或儿童期身体或性虐待子量表、人格特征或分离体验量表上，两组之间没有差异。我们的研究结果强调了心因性运动障碍病理生理学的生物心理社会方法，尽管与非癫痫性发作人群相比，心理问题的相关性远不如预期的那么突出。需要进行仔细的心理评估，以优化治疗方式。
