| 심인성 운동장애 |
| 김지수, 전범석, 김상윤*, 이한보**, 박성호** |
| 서울대학교 의과대학 신경과학교실, 한림대학교 의과대학 신경과학교실*, 보라매병원 신경과** |
| Psychogenic movement disorder |
| J.S. Kim, M.D., Beom S. Jeon, M.D., S.Y. Kim, M.D.*., H.B. Lee, M.D.**., S.H. Park, M.D.**. |
| Department of Neurology, College of Medicine, Seoul National University
Hallym University*, Boramae Hospital*** |
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| Abstract |
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Background & Objectives : Psychogenic movement disorders (PMDs) can present a diagnostic and therapeutic challenge to clinicians. Herein we report the clinical features of 11 patients with PMDs and would like to draw attention to this entity. Methods The diagnosis of PMDs was based on Fahn's cruterua(1994) . Only the documented and clinically established patients were included. The psychiatric diagnosis was based on DSM-IIIR and classified into conversion, somatization, factitious disorders and malingering. Results : Eleven patients were diagnosed as PMD between March 1993 and February 1996. Four were male, 7 were female. PMDs were documented in 7 patients(63.6%) and clinically established in 4(36.4%). Seven(63.6%) were conversion disorder and 4 (39.4%), malingering. The abnormal movements developed abruptly in all patients. Inconsistency was present in 9(81.8%) patients, incongruity in 7(63.6%), distractability in 7, pseudoweakness in 7 and paroxysmal nature in 4 (36.4%) , Two patients showed la belle indifference during the attacks. Tremor was present in 8 patients(72.7%), gait disturbance in 2(1 with ataxia and 1 with limping) , myoclonus in 1, chorea in 1, dystonia and startle in 1. Three patients had more than one type of movements. The types of tremor were resting in 5, postural in 1, resting and postural in 1, postural and kinetic in 1. None of the patients were diagnosed as PMD when referred. Of the 11 patients, 2 rejected the diagnosis of malingering and refused treatment. The other 9 patients received psychotherapy with good results (complete recovery in 6 and significant improvement in 3). Litigation was pending in most malingering patients. Conclusion : Tremor was the most common abnormal movement pattern in PMDs. Abrupt onset, inconsistency, incongruity, pseudoweakness were the most important clinical features that pointed to the diagnosis of PMD. They responded well to psychotherapy. None of the patients were correctly diagnosed as PMD when referred, hence precluding appropriate treatment. Malingering should be considered in patients who present with abnormal movements and have legal conflicts. Awareness of this entity is warranted. . |
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