Opinions and Clinical Practices Related to Diagnosing and Managing Patients with Psychogenic Movement Disorders: An International Survey of Movement Disorder Society Members
Identifieur interne : 000D74 ( PascalFrancis/Checkpoint ); précédent : 000D73; suivant : 000D75Opinions 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 [États-Unis] ; Linda M. Goldenhar [États-Unis] ; Valerie Voon [États-Unis] ; Anette Schrag [Royaume-Uni] ; Noël Burton [États-Unis] ; Anthony E. Lang [Canada]Source :
- Movement disorders [ 0885-3185 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
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.
Affiliations:
- Canada, Royaume-Uni, États-Unis
- Angleterre, Grand Londres, Maryland, Ohio, Ontario
- Londres, Toronto
- Université de Toronto
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Goldenhar</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Office of Medical Education Evaluation and Research, University of Cincinnati College of Medicine</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name><affiliation wicri:level="2"><inist:fA14 i1="03"><s1>National Institute of Neurological Disorders and Stroke, National Institutes of Health</s1><s2>Bethesda, Maryland</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Clinical Neurosciences, Royal Free and University College Medical School</s1><s2>London</s2><s3>GBR</s3><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><affiliation wicri:level="2"><inist:fA14 i1="01"><s1>Movement Disorders Center, Department of Neurology, University of Cincinnati College of Medicine</s1><s2>Cincinnati, Ohio</s2><s3>USA</s3><sZ>1 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Ohio</region></placeName></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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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. 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Espay</name></region><name sortKey="Burton, Noel" sort="Burton, Noel" uniqKey="Burton N" first="Noël" last="Burton">Noël Burton</name><name sortKey="Goldenhar, Linda M" sort="Goldenhar, Linda M" uniqKey="Goldenhar L" first="Linda M." last="Goldenhar">Linda M. Goldenhar</name><name sortKey="Voon, Valerie" sort="Voon, Valerie" uniqKey="Voon V" first="Valerie" last="Voon">Valerie Voon</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Schrag, Anette" sort="Schrag, Anette" uniqKey="Schrag A" first="Anette" last="Schrag">Anette Schrag</name></region></country><country name="Canada"><region name="Ontario"><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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