2nd International Conference on Psychogenic Movement Disorders and Other Conversion Disorders
April 2-4, 2009
The Second International Conference on Psychogenic Movement Disorders and Other Conversion Disorders was sponsored by The Movement Disorder Society, National Institute of Neurological Disorders and Stroke, National Institute of Mental Health, and unrestricted educational grants from Lunbeck, Allergan and Ceregene. Psychogenic movement disorders are common in a movement disorder practice, but even movement disorder specialists have significant problems dealing with these patients. There are difficulties in making a definitive diagnosis, in getting a full understanding of the patient, particularly of possible psychiatric co-morbidities, and in communicating the diagnosis. There are problems in referring these patients to psychiatrists who may not understand psychogenic movement disorders. The patients may not accept the diagnosis and continue to doctor shop. The conference was attended by both neurologists and psychiatrists, hoping to reach a better understanding of this condition and hoping to improve communication between the specialties. The conference was a successful enterprise in all regards.
The conference began with a detailed analysis of the disorder. There were discussions of conversion, somatization, factitious disorder, malingering, dissocation and hypochondriasis. It became rapidly clear that the development of these disorders is multifactorial. An acute psychological stress may be a trigger, but there must be an appropriate substrate, and that is likely to be complicated. Factors include genetic, anxiety, depression, a history of childhood physical or mental abuse, and the current social situation. A biopsychosocial model emerged, and it will likely be necessary to understand and treat many different aspects of a patient. The basic physiology was discussed, with recent neuroimaging studies and clinical neurophysiological investigations. Methods for diagnosis and rating were also discussed. Therapy in many cases will need to be multifactorial, with consideration of the biopsychosocial model. Pharmacotherapy may well be helpful to deal with factors such as underlying depression or anxiety. Psychiatric therapy, perhaps delivered by a clinical psychologist, would appear obligatory, and cognitive behavioral therapy seems most promising now. A new website with downloadable patient pamphlets has just been developed by Dr. J. Stone of Edinburgh, www.neurosymptoms.org. A book for doctors was generated by the first international meeting, and a second one is planned from this meeting.
Photo: the organizing committee of the meeting, from the left, Peter Halligan, Joseph Jankovic, Stan Fahn, Anthony Lang, Mark Hallett, Robert Cloninger, Valerie Voon. (Photo credit: Mark Hallett)