Macchi Zachary A, Kletenik Isaiah, Olvera Caroline, Holden Samantha K
Department of Neurology, Section of Behavioral Neurology University of Colorado Anschutz Aurora Colorado USA.
Department of Internal Medicine, Division of General Internal Medicine University of Colorado Anschutz Aurora Colorado USA.
Mov Disord Clin Pract. 2021 Apr 26;8(5):725-732. doi: 10.1002/mdc3.13226. eCollection 2021 Jul.
Functional movement disorders (FMD) are characterized by abnormal movements and motor symptoms incongruent with a known structural neurologic cause. While psychological stressors have long been considered an important risk factor for developing FMD, little is known about the impact of psychiatric comorbidities on disease manifestations or complexity.
To compare characteristics of FMD patients with co-occurring mood and trauma-related psychiatric conditions to FMD patients without psychiatric conditions.
We performed a retrospective cohort study of patients seen in the University of Colorado Health system between January 1, 2015 and December 31, 2019. Patients were included if they had a diagnosis of FMD, determined by ICD-10 coding and ≥1 phenomenology-related diagnostic code (tremor, gait disturbances, ataxia, spasms, and weakness), and at least one encounter with a neurology specialist. Fisher's exact and unpaired t-tests were used to compare demographics, healthcare utilization, and phenomenologies of patients with psychiatric conditions to those with none.
Our review identified 551 patients with a diagnosis of FMD who met inclusion criteria. Patients with psychiatric conditions (N = 417, 75.7%) had increased five-year healthcare utilization (mean emergency room encounters 9.9 vs. 3.5, = 0.0001) and more prevalent non-epileptic seizures (18.2% vs. 7.5%, = 0.001). Suicidal ideation (8.4%) and self-harm (4.1%) were only observed amongst patients with comorbid psychiatric conditions.
Patients with FMD and comorbid psychiatric conditions require more healthcare resources and have greater disease complexity than patients without psychiatric illness. This may have implications for treatment of patients without comorbid psychiatric conditions who may benefit from targeted physiotherapy alone.
功能性运动障碍（FMD）的特征是异常运动和运动症状与已知的结构性神经病因不一致。虽然心理应激源长期以来一直被认为是发生FMD的重要危险因素，但关于精神疾病共病对疾病表现或复杂性的影响知之甚少。
比较伴有情绪和创伤相关精神疾病的FMD患者与无精神疾病的FMD患者的特征。
我们对2015年1月1日至2019年12月31日在科罗拉多大学健康系统就诊的患者进行了一项回顾性队列研究。如果患者被诊断为FMD（通过ICD - 10编码和≥1个与现象学相关的诊断代码确定，如震颤、步态障碍、共济失调、痉挛和虚弱）且至少与一名神经科专家会诊过，则纳入研究。使用Fisher精确检验和非配对t检验比较有精神疾病的患者与无精神疾病的患者的人口统计学、医疗保健利用率和现象学。
我们的回顾确定了551名符合纳入标准的FMD诊断患者。有精神疾病的患者（N = 417，75.7%）五年医疗保健利用率更高（平均急诊室就诊次数9.9次对3.5次，P = 0.0001），非癫痫性发作更普遍（18.2%对7.5%，P = 0.001）。自杀意念（8.4%）和自我伤害（4.1%）仅在伴有精神疾病共病的患者中观察到。
与无精神疾病的患者相比，患有FMD和精神疾病共病的患者需要更多的医疗资源，疾病复杂性更高。这可能对那些可能仅从针对性物理治疗中获益的无精神疾病共病的患者的治疗产生影响。
