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

Woolie

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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!
 
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Sidereal

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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/

A female patient, currently 12 years old, has a genetic disorder, Ehlers-Danlos Syndrome (EDS) hypermobility type 1, dysautonomia, non-epileptic seizures, chronic gastritis, mitochondrial dysfunction, asthma, vision loss, thyroid tumor and anti-cardiolipin antibodies. As a result of her EDS, the patient has had repeated dislocations of her right shoulder, as well as her right ankle. The patient first developed CRPS in her lower right extremity in 2008. In 2009, the patient developed dystonic muscle spasms in the upper extremities, which were interpreted by her physicians as evidence of a conversion disorder.
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.

In December of 2011, she underwent percutaneous pinning of the right ankle to stabilize the joint. The pins were removed 6 weeks later and the ankle joint subluxated again. In February of 2012, the patient underwent reinforcement to the right ankle with cadaver ligaments. She continued to be on low dose naltrexone during this time, except for 4 perioperative days, during which the LDN was discontinued. As per institutional protocol, LDN was stopped for 24 h before surgery. After surgery, she was given oral opioids (hydrocodone with acetaminophen) for 1 week. The oral opioids were then discontinued, and LDN treatment was resumed 24 h, after her last dose of opioid. The patient noticed a decrease in her post-operative pain, ranging from (4–6)/10, 3 weeks after resuming LDN. Skin discoloration and allodynia could not be assessed after the surgery because her leg was in a cast.

At the time of cast removal, the patient’s lower leg and ankle had a normal range of motion, indicating a remission of the leg’s fixed dystonia (Fig. 3b). The leg had a slight red color at the time of cast removal, but no allodynia. Ten months after surgery, the patient’s gait was normal.

Remarkably, the patient did not experience any spread of her CRPS, despite undergoing multiple invasive procedures, including surgery. One of the known triggers for a CRPS flare-up, or spread of CRPS symptoms, is trauma (Schwartzman et al. 2009; van Rijn et al. 2011). The patient still has a chronic shoulder dislocation, associated with her EDS. However, her CRPS symptoms have resolved completely. The patient has been maintained on LDN for 18 months. No side effects of LDN have been noted.
 

Forbin

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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.
 
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PeterPositive

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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.
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
 

chipmunk1

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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.
 

Sidereal

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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.
 

Valentijn

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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.
 

chipmunk1

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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.
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.
 

chipmunk1

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

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

A comprehensive look at the evolution of ideas on hysteria in the followers of Charcot shows that contrary to a common and artificially maintained view over the years, the modernity of several of his concepts remains remarkable, including: (1) his traumatic theory, which encompassed sexual factors nearly 20 years before Freud; (2) his evolution towards psychological and emotional issues, which opened the way for Janet and Freud, but unfortunately was largely ignored by Babinski; (3) his strong claim against Bernheim of the similarity of mental states in hypnotism and hysteria
 
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Woolie

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The patient first developed CRPS in her lower right extremity in 2008. In 2009, the patient developed dystonic muscle spasms in the upper extremities, which were interpreted by her physicians as evidence of a conversion disorder.
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!
 

lansbergen

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Woolie

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If you're interested, you can find the film on vimeo. The scene I described is at about 10 minutes into part I.
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.
 

Woolie

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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/
@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/