Psychogenic disorders and persistent disability?

Psychogenic motor disorders may be frequently encountered in “organic” neurology, especially in the world of movement disorders.  This group of disorders needs to be distinguished from malingering as the patients really feel that they have a functional deficits even though neurology can not explain the site and origins of deficits.  Indeed, transcranial magnetic stimulation studies have documented  abnormalities of cortical function, suggesting a potential organic component to these vexing disorders.

In the February issue of JNNP, Alan Carsons’ group report an interesting systemic review  on the prognosis of psychogenic, or functional, disorders.  Not surprisingly, this  field of neurology is in need of more   and better controlled studies.  The findings, however, are important underscoring  the persistent physical burden on patients classified to be “functional”.  As such, hiding such patients in closets, as fearful English neurology registrars of the 1930s and 1940s embarked upon to prevent the ire of their more senior colleagues, or galvanic stimulation, will simply not work.  The authors are correct to highlight the need for more studies in order to develop better risk factor paradigms so as to enable more efficacious treatment.





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