Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members
Identifieur interne : 000806 ( Istex/Corpus ); précédent : 000805; suivant : 000807Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members
Auteurs : Alberto J. Espay ; Linda M. Goldenhar ; Valerie Voon ; Anette Schrag ; Noël Burton ; Anthony E. LangSource :
- Movement Disorders [ 0885-3185 ] ; 2009-07-15.
English descriptors
Abstract
Five hundred and nineteen members of the Movement Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society
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DOI: 10.1002/mds.22618
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Goldenhar</name><affiliation><mods:affiliation>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</mods:affiliation></affiliation></author><author><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name><affiliation><mods:affiliation>National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA</mods:affiliation></affiliation></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name><affiliation><mods:affiliation>Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><affiliation><mods:affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. 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Espay</name><affiliation><mods:affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</mods:affiliation></affiliation></author><author><name sortKey="Goldenhar, Linda M" sort="Goldenhar, Linda M" uniqKey="Goldenhar L" first="Linda M." last="Goldenhar">Linda M. 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Lang</name><affiliation><mods:affiliation>Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="sub">Official Journal of the Movement Disorder Society</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2009-07-15">2009-07-15</date><biblScope unit="vol">24</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1366">1366</biblScope><biblScope unit="page" to="1374">1374</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">F108535107E57841D52E934EC51EE3634A219269</idno><idno type="DOI">10.1002/mds.22618</idno><idno type="ArticleID">MDS22618</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>medically unexplained symptoms</term><term>psychogenic movement disorders</term><term>survey</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Five hundred and nineteen members of the Movement Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Alberto J. Espay MD, MSc</name><affiliations><json:string>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</json:string></affiliations></json:item><json:item><name>Linda M. Goldenhar PhD</name><affiliations><json:string>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</json:string></affiliations></json:item><json:item><name>Valerie Voon MD</name><affiliations><json:string>National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA</json:string></affiliations></json:item><json:item><name>Anette Schrag MD, PhD</name><affiliations><json:string>Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Noël Burton MA</name><affiliations><json:string>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</json:string></affiliations></json:item><json:item><name>Anthony E. Lang MD, FRCPC</name><affiliations><json:string>Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>psychogenic movement disorders</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>medically unexplained symptoms</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>survey</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Five hundred and nineteen members of the Movement Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society</abstract><qualityIndicators><score>7.244</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 810 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1851</abstractCharCount><pdfWordCount>4244</pdfWordCount><pdfCharCount>29323</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>261</abstractWordCount></qualityIndicators><title>Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members</title><genre><json:string>Serial 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international survey of movement disorder society members</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><availability><p>Wiley Subscription Services, Inc., A Wiley Company</p></availability><date>2009</date></publicationStmt><notesStmt><note type="content">*Potential conflict of interest: None reported.</note><note type="content">*The Movement Disorder Society helped distribute the survey to its members but did not participate as sponsor.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members</title><author><persName><forename type="first">Alberto J.</forename><surname>Espay</surname><roleName type="degree">MD, MSc</roleName></persName><note type="correspondence"><p>Correspondence: University of Cincinnati, 260 Stetson St., Suite 2300, Cincinnati, OH 45267‐0525</p></note><affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation></author><author><persName><forename type="first">Linda M.</forename><surname>Goldenhar</surname><roleName type="degree">PhD</roleName></persName><affiliation>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation></author><author><persName><forename type="first">Valerie</forename><surname>Voon</surname><roleName type="degree">MD</roleName></persName><affiliation>National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA</affiliation></author><author><persName><forename type="first">Anette</forename><surname>Schrag</surname><roleName type="degree">MD, PhD</roleName></persName><affiliation>Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom</affiliation></author><author><persName><forename type="first">Noël</forename><surname>Burton</surname><roleName type="degree">MA</roleName></persName><affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation></author><author><persName><forename type="first">Anthony E.</forename><surname>Lang</surname><roleName type="degree">MD, FRCPC</roleName></persName><affiliation>Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada</affiliation></author></analytic><monogr><title level="j">Movement Disorders</title><title level="j" type="sub">Official Journal of the Movement Disorder Society</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="pISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><idno type="DOI">10.1002/(ISSN)1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2009-07-15"></date><biblScope unit="vol">24</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1366">1366</biblScope><biblScope unit="page" to="1374">1374</biblScope></imprint></monogr><idno type="istex">F108535107E57841D52E934EC51EE3634A219269</idno><idno type="DOI">10.1002/mds.22618</idno><idno type="ArticleID">MDS22618</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Five hundred and nineteen members of the Movement Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>psychogenic movement disorders</term></item><item><term>medically unexplained symptoms</term></item><item><term>survey</term></item></list></keywords></textClass><textClass><keywords scheme="Journal Subject"><list><head>Article category</head><item><term>Research Article</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-11-06">Received</change><change when="2009-03-25">Registration</change><change when="2009-07-15">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/F108535107E57841D52E934EC51EE3634A219269/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Wiley Subscription Services, Inc., A Wiley Company</publisherName><publisherLoc>Hoboken</publisherLoc></publisherInfo><doi registered="yes">10.1002/(ISSN)1531-8257</doi><issn type="print">0885-3185</issn><issn type="electronic">1531-8257</issn><idGroup><id type="product" value="MDS"></id></idGroup><titleGroup><title type="main" xml:lang="en" sort="MOVEMENT DISORDERS">Movement Disorders</title><title type="subtitle">Official Journal of the Movement Disorder Society</title><title type="short">Mov. 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href="file:MDS.MDS22618.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="2"></count><count type="tableTotal" number="4"></count><count type="referenceTotal" number="22"></count><count type="wordTotal" number="6249"></count></countGroup><titleGroup><title type="main" xml:lang="en">Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members<link href="#fn1"></link> <link href="#fn2"></link></title><title type="short" xml:lang="en">Psychogenic Movement Disorders</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Alberto J.</givenNames><familyName>Espay</familyName><degrees>MD, MSc</degrees></personName><contactDetails><email>alberto.espay@uc.edu</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af2"><personName><givenNames>Linda M.</givenNames><familyName>Goldenhar</familyName><degrees>PhD</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af3"><personName><givenNames>Valerie</givenNames><familyName>Voon</familyName><degrees>MD</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af4"><personName><givenNames>Anette</givenNames><familyName>Schrag</familyName><degrees>MD, PhD</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Noël</givenNames><familyName>Burton</familyName><degrees>MA</degrees></personName></creator><creator xml:id="au6" creatorRole="author" affiliationRef="#af5"><personName><givenNames>Anthony E.</givenNames><familyName>Lang</familyName><degrees>MD, FRCPC</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA</unparsedAffiliation></affiliation><affiliation xml:id="af4" countryCode="GB" type="organization"><unparsedAffiliation>Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom</unparsedAffiliation></affiliation><affiliation xml:id="af5" countryCode="CA" type="organization"><unparsedAffiliation>Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en" type="author"><keyword xml:id="kwd1">psychogenic movement disorders</keyword><keyword xml:id="kwd2">medically unexplained symptoms</keyword><keyword xml:id="kwd3">survey</keyword></keywordGroup><supportingInformation><p> Additional Supporting Information may be found in the online version of this article. </p><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds22618:MDS_22618_sm_SuppFig1"></mediaResource><caption>Findings believed "essential or absolutely necessary" for a clinically definite diagnosis of PMD.</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds22618:MDS_22618_sm_SuppTable1"></mediaResource><caption>Supporting Table 1. Knowledge gaps and related research questions.</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds22618:MDS_22618_sm_SuppTable2"></mediaResource><caption>Supporting Table 2. Movement Disorders Society Member Survey. Expert opinions and clinical practices related to patients with psychogenic movement disorders.</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds22618:MDS_22618_sm_SuppTable3"></mediaResource><caption>Supporting Table 3. Limitations to being able to manage patients with PMD.</caption></supportingInfoItem><supportingInfoItem><mediaResource alt="supporting information" href="urn-x:wiley:08853185:media:mds22618:MDS_22618_sm_SuppTable4"></mediaResource><caption>Supporting Table 4. Open‐ended responses ("Are there any other issues that you believe are important in the diagnosis and treatment of PMDs that have not been addressed?")</caption></supportingInfoItem></supportingInformation><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Five hundred and nineteen members of the <i>Movement</i> Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Potential conflict of interest: None reported.</p></note><note xml:id="fn2"><p>The <i>Movement</i> Disorder Society helped distribute the survey to its members but did not participate as sponsor.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><!--Version 0.6 générée le 4-12-2015--><mods version="3.6"><titleInfo lang="en"><title>Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Psychogenic Movement Disorders</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Opinions and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: An international survey of movement disorder society members</title></titleInfo><name type="personal"><namePart type="given">Alberto J.</namePart><namePart type="family">Espay</namePart><namePart type="termsOfAddress">MD, MSc</namePart><affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation><description>Correspondence: University of Cincinnati, 260 Stetson St., Suite 2300, Cincinnati, OH 45267‐0525</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Linda M.</namePart><namePart type="family">Goldenhar</namePart><namePart type="termsOfAddress">PhD</namePart><affiliation>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Valerie</namePart><namePart type="family">Voon</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anette</namePart><namePart type="family">Schrag</namePart><namePart type="termsOfAddress">MD, PhD</namePart><affiliation>Department of Clinical Neurosciences, Royal Free and University College Medical School, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Noël</namePart><namePart type="family">Burton</namePart><namePart type="termsOfAddress">MA</namePart><affiliation>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony E.</namePart><namePart type="family">Lang</namePart><namePart type="termsOfAddress">MD, FRCPC</namePart><affiliation>Movement Disorders Division, Division of Neurology, University of Toronto, Toronto, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre authority="originalCategForm">article</genre><originInfo><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><place><placeTerm type="text">Hoboken</placeTerm></place><dateIssued encoding="w3cdtf">2009-07-15</dateIssued><dateCaptured encoding="w3cdtf">2008-11-06</dateCaptured><dateValid encoding="w3cdtf">2009-03-25</dateValid><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">2</extent><extent unit="tables">4</extent><extent unit="references">22</extent><extent unit="words">6249</extent></physicalDescription><abstract lang="en">Five hundred and nineteen members of the Movement Disorder Society completed a 22‐item questionnaire probing diagnostic and management issues in psychogenic movement disorders (PMD). When patients showed definite evidence of PMD with no other unexplained clinical features, approximately 20% said they informed patients of the diagnosis and requested no further neurological testing. The 51% who reported conducting standard neurological investigations to rule out organic causes before presenting the diagnosis to such patients had fewer years of fellowship training and fewer PMD patients seen per month. A non‐PMD diagnosis was correlated with patients' normal social or personal functioning, little or no employment disruption, lack of non‐physiologic findings, and lack of psychiatric history. Ongoing litigation was more predictive of the PMD diagnosis for US compared to non‐US respondents. Two thirds of respondents, more commonly younger and academic clinician researchers, refer PMD patients to a psychiatrist or mental health specialist while also providing personal follow up. Physician reimbursement, insurability of PMD patients, and ongoing litigation interfered with managing PMD patients to a greater extent in the US compared to non‐US countries. Acceptance of the diagnosis by the patient and identification and management of psychological stressors and concurrent psychiatric disorders were considered most important for predicting a favorable prognosis. These findings suggest that expert opinions and practices related to diagnosing and managing PMD patients differ among movement disorders neurologists. Some of the discrepancies may be accounted for by factors such as training, type of practice, volume of patients, and country of practice, but may also reflect absence of practice guidelines. © 2009 Movement Disorder Society</abstract><note type="content">*Potential conflict of interest: None reported.</note><note type="content">*The Movement Disorder Society helped distribute the survey to its members but did not participate as sponsor.</note><subject lang="en"><genre>Keywords</genre><topic>psychogenic movement disorders</topic><topic>medically unexplained symptoms</topic><topic>survey</topic></subject><relatedItem type="host"><titleInfo><title>Movement Disorders</title><subTitle>Official Journal of the Movement Disorder Society</subTitle></titleInfo><titleInfo type="abbreviated"><title>Mov. Disord.</title></titleInfo><note type="content"> Additional Supporting Information may be found in the online version of this article.Supporting Info Item: Findings believed "essential or absolutely necessary" for a clinically definite diagnosis of PMD. - Supporting Table 1. Knowledge gaps and related research questions. - Supporting Table 2. Movement Disorders Society Member Survey. Expert opinions and clinical practices related to patients with psychogenic movement disorders. - Supporting Table 3. Limitations to being able to manage patients with PMD. - Supporting Table 4. Open‐ended responses ("Are there any other issues that you believe are important in the diagnosis and treatment of PMDs that have not been addressed?") - </note><subject><genre>article category</genre><topic>Research Article</topic></subject><identifier type="ISSN">0885-3185</identifier><identifier type="eISSN">1531-8257</identifier><identifier type="DOI">10.1002/(ISSN)1531-8257</identifier><identifier type="PublisherID">MDS</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>24</number></detail><detail type="issue"><caption>no.</caption><number>9</number></detail><extent unit="pages"><start>1366</start><end>1374</end><total>9</total></extent></part></relatedItem><identifier type="istex">F108535107E57841D52E934EC51EE3634A219269</identifier><identifier type="DOI">10.1002/mds.22618</identifier><identifier type="ArticleID">MDS22618</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2009 Movement Disorder Society</accessCondition><recordInfo><recordOrigin>Wiley Subscription Services, Inc., A Wiley Company</recordOrigin><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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