Antidepressant Treatment Outcomes of Psychogenic Movement Disorder
J Clin Psychiatry 2005;66(12):1529-1534
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Psychogenic movement
disorder (PMD) is a subtype of conversion disorder.
We describe the outcomes of a series of PMD
patients following antidepressant treatment.
Method: Twenty-three outpatients
with chronic PMD, diagnosed using Fahn and Williams' criteria, underwent psychiatric
assessment. The patients were referred for assessment
and management from January 2003 to July 2004. Fifteen agreed to be treated with
antidepressants. Patients received citalopram or paroxetine;
those who did not respond after 4 weeks of taking
an optimal dose were switched to venlafaxine. Concurrently, 3 had supportive psychotherapy, and
1 had family intervention. Assessments included the DSM-IV-based Mini-International
Neuropsychiatric Interview and scales measuring
depression, anxiety, and motor and global severity.
Results: Eighteen patients (78%) had at least
1 Axis I diagnosis in addition to the somatoform diagnosis, and 3 (13%) had somatization
disorder. Five (22%) had previous psychiatric
contact. Nine (39%) had previously been treated with
antidepressants, but only 4 (17%) had adequate
trials. No significant differences existed in patient
characteristics between treated and untreated
groups. Among treated patients, Montgomery-Asberg Depression Rating Scale scores improved
from baseline (p < .01). Two treated subgroups
were identified: 10 patients (67%) had primary
conversion disorder, of whom 8 had marked motor
and global improvements with 7 complete
remissions, and 5 (33%) had primary hypochondriasis,
somatization disorder, or probable factitious
disorder/malingering, of whom none improved. All of
the patients with primary conversion disorder had
a current or previous depressive or anxiety
disorder compared with 40% (N = 2) of the patients
with additional somatoform diagnoses.
Discussion: Our preliminary findings
suggest that chronic PMD with primary conversion
symptoms and with recent or current depression or anxiety may respond to antidepressants.
Further well-designed studies, now under way, are
required to confirm these findings.