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You think ME is bad - try having a "Psychogenic movement disorder"!

Discussion in 'Other Health News and Research' started by Woolie, Feb 3, 2015.

  1. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    "Psychogenic movement disorder (PMD)" is a catch-all phrase for any patient presenting with a movement disorder whose features are inconsistent with a known neurological or other movement disorder. Assuming the person is not actually faking, then the underlying mechanism is considered to be psychosomatic. That is, psychological trauma is "converted" into a physical symptom.

    Here are the Fahn and Williams (1988) criteria for diagnosis (excluding fakers). Note you need not have a co-morbid psychiatric diagnosis at all to fit any category, although such findings support the diagnosis (the most usual is depression or anxiety).

    Clinically Established Psychogenic: Inconsistent or incongruent with classical dystonia. In addition, one or all of the following is highly suggestive: other neurologic signs present that are psychogenic (self-inflicted injuries, false weakness, false sensory findings), an obvious psychiatric disturbance is present, and multiple somatizations are present.
    Probable Psychogenic: Movements are inconsistent or incongruent, but there are no supporting features OR movements are consistent with organic dystonia, but there are other psychogenic signs (as listed above), or multiple somatizations are present.
    Possible Psychogenic: An obvious emotional disturbance is present, but movements are consistent with
    organic dystonia.​

    I have now read about 15 papers, and in none of these is there any justification given for the view that these are conversion disorders (its obvious, isn't it?) and there is no dissent whatsoever from this view! Treatment: psychotherapy and psychiatric medications, of course! Prognosis: poor. Some studies note a particularly poor prognosis for those silly patients who cling to the idea that they have a real physical illness (I seem to have heard that one before!)

    Hey, and guess what? Turns out in actual fact, there's no evidence of higher rates of psychological trauma in this group than in matched controls. Plus, a recent study - link below - found that 80% of cases were precipitated by a physical illness. But did this challenge these authors' view of these disorders? Of course not! Obviously, these factors interact with psychological ones to generate the syndrome!

    http://www.researchgate.net/profile..._disorders/links/0a85e53404b5a3db27000000.pdf

    I suppose its possible there might in theory be such a thing as PMD - but the thing is, I can see no positive supporting evidence anywhere.

    We think of our 21st century selves as so "scientific". But we have a total blindspot where it comes to statements about mind-body relations. They seem to have an evidential "free ride".

    If I've learned anything from having CFS, its this!
     
    Last edited: Feb 3, 2015
  2. taniaaust1

    taniaaust1

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    Now why doesnt it at all surprise me that prognosis is poor with that treatment...
     
  3. lansbergen

    lansbergen Senior Member

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    They should watch BSE cows. Of course terminal human BSE patients were diagnosed with psychiatric diseases.
     
  4. Sidereal

    Sidereal Senior Member

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    Speaking of dystonia, last night I got so angry reading a paper about the use of low dose naltrexone for complex regional pain syndrome (CRPS), another "contested" disease.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661907/

    Right, of course! A child with multiple serious medical conditions develops a new symptom which doesn't fit the neurologist's beliefs about how the nervous system functions and gets a diagnosis of hysteria. Anyway, her "conversion disorder" was fixed by surgery and LDN.

     
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  5. Forbin

    Forbin Senior Member

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    In John Huston's 1962 film "Freud: The Secret Passion," starring Montgomery Clift as Freud, there is a scene in which young Freud is introduced to the concept of "hysteria." During a lecture, two patients are presented. One is a woman who cannot walk, the other is a man who cannot stop shaking. Through the miracle of hypnosis, the woman's paralysis is transferred to the man, and the man's shaking is transferred to the woman, thus proving that both conditions were of psychological origin.

    Whether this scene reflected something that Freud actually saw, I don't know. I do fear, however, that the film may have inspired a generation of students considering the field of psychology to think that psychogenic illness was just that simple.

    I, myself, found this scene fascinating when I first saw it. It seemed to represent a triumph of science over the mysteries of illness. It even briefly inspired me to consider a career in psychology... but then I turned 11.


    If you're interested, you can find the film on vimeo. The scene I described is at about 10 minutes into part I.
     
    Last edited: Feb 4, 2015
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  6. PeterPositive

    PeterPositive Senior Member

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    There is good historical evidence that Freud made up and falsified data to prove his theories... and yet he is recognized as the father of modern psychology/psychoanalysis... Fortunately most of his theories are no longer fashionable, although they have permeated decades of popular culture and their echo is still present in movies and literature. Much less is known about his "unorthodox" ways (to use an euphemism) of gathering clinical data and his antipathy to external and scientific scrutiny of his work and theories.

    http://www.workersliberty.org/node/6472
     
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  7. chipmunk1

    chipmunk1 Senior Member

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    the irony is that dystonia was still considered psychogenic in the seventies. now it is no longer but if you have a case of dystonia that doesn't closely resemble a textbook case or you have some "mood abnormalities" or "anxiety" beware. you might get a psychogenic movement disorder diagnosis.
     
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  8. Sidereal

    Sidereal Senior Member

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    Freud spent time as a young man in the Salpêtrière hospital in Paris where Charcot's florid public presentations of young female patients with "hysteria" influenced him and the subsequent birth of psychoanalysis.
     
  9. Valentijn

    Valentijn WE ARE KINA

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    I have a mitochondrial missense mutation which is known to cause adult onset dystonia. Every European who has haplogroup H1b1 has it, though it certainly doesn't always result in dystonia.

    I've got plenty of maternal relatives with the same mutation who don't have obvious dystonia, though most have other health issue: FM, neuropathic pain, food intolerances (most of us), thyroid problems, Downs' Syndrome, and an inborn deficiency of something resulting in developmental delays when it went untreated.
     
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  10. chipmunk1

    chipmunk1 Senior Member

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    psychoanalysis the term was borrowed from a french physician calling it analyse psychologique. most of the foundation of Freud's earlier theories were inspired by his experiences in Paris while visiting the famous neurologist Charcot.

    Charcot's reputation was largely based on his studies on hysteria. Interestingly he did not believe that hysteria could only occur in females but described cases of male hysteria as well. He did believe however that hysteria would be limited to the lower social classes.

    Back in Vienna and after several years of study Freud began to realise that Charcot's theories were unlikely to be correct. He solved the problem by shifting his theories and focus to the unconscious and invented the Oedipus Complex making it impossible to prove or disprove his theories.
     
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  11. alex3619

    alex3619 Senior Member

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    At the French Saltipierre, where Charcot the teacher of Freud put on shows, he used actors to portrey hysterics. Actors. Many of these were healthy staff members. It was a presentation to impress, not science.
     
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  12. chipmunk1

    chipmunk1 Senior Member

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    Charcot was controversial even back then. Some his lectures remind one of stage hypnosis shows.

    http://www.ncbi.nlm.nih.gov/pubmed/20938153

     
    Last edited: Feb 4, 2015
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  13. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    I didn't know, this, @Iansbergen! I'll be looking that up now.
     
  14. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    Extraordinary! It seemed that delayed progress on her treatment for two years. IN fact, even worse, the new treatment does not seem to have been in response to the "conversion disorder" at all!
     
  15. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    This might be a good place to collect information and studies where psychogenic/psychosomatic/somatoform explanations have been invoked. I'm thinking of writing a paper.

    We might even change the thread title to reflect that?
     
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  16. lansbergen

    lansbergen Senior Member

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    There was a paper about it. I had it but can not find it now. Must have been mid nineties.
     
  17. lansbergen

    lansbergen Senior Member

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    This paper mentions they were reffered to a psychiatrist.
    http://biochem.stanford.edu/biochem230/lectures2008/Prions/Will_color.pdf

    The one I remember named the spychiatric diagnoses.
     
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  18. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    Wow!

    I read somewhere that after Charcot's discovery of MS, Freud, his pupil, decided to reinterpret some of Charcot's original cases as having hysteria.... thereby setting the clock back on advancement of MS research by around 50 years.
     
  19. Woolie

    Woolie Gone now, hope to see you all again soon somewhere

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    @Sidereal, you might be interested in this article too, which touches on CRPS, and contains some outrageous quotes from pediatricians who believe in somatoform illnesses.

    http://blogs.scientificamerican.com...8/have-pain-are-you-crazy-rare-diseases-pt-2/
     
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  20. Sidereal

    Sidereal Senior Member

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