Editors: Mark Hallett, Anthony E. Lang, Joseph Jankovic, Stanley Fahn, Peter W. Halligan, Valerie Voon, and C. Robert Cloninger
Publisher:  Cambridge University Press – 324 pages
Book Review by: Nano Khilnani

There are many reasons why patients with psychogenic movement disorders and other conversion disorders “are falling through the cracks” (meaning they have not been able to receive the correct treatment), the editors of this book point out. Here are some of the reasons:

  • Paucity of research and evidence-based reports on the mechanisms of treatment
  • Many movement disorders have a psychological basis, but patients are not referred to psychologists; much less to psychiatrists
  • There are various obstacles to accessing appropriate, competent psychiatric care

“ Such patients utilize a large fraction of healthcare resources, estimated at 16 percent of dollars in the USA,” the editors write in their Preface. This quoted portion is not quite clear to us.

Nevertheless, because many of those people with psychogenic movement disorders and other conversion disorders are not receiving the right treatment because of the reasons we cite above, we decided to provide as much information as we can on these disorders through this book.

One way to do this is to list all the 43  chapters of this book here so that those who are reading this review will be able to get all the details necessary to understand the symptoms and develop the right course of treatment for those afflicted with such disorders.

Seventy-eight specialists in brain cognition, clinical psychology, motor control, neurology, neuropsychiatry, neuroscience, neurosurgery, Parkinson’s Disease, psychiatry, psychobiology, psychology, radiology, social behavior, and related areas,  authored the chapters of this extensive study on psychogenic movement disorders and other types of disorders.

They are from all over the United States and nine other countries – Australia, Canada, Germany, Italy, the Netherlands, New Zealand, Switzerland, Turkey and the United Kingdom.

We list below the titles of the 43 chapters of this book and the four Sections around which they are organized, to provide you an overview of the contents:

  1. Section I – Clinical Issues
    1. Introduction to the psychiatry of conversion disorders
    2. Phenomenology of psychogenic movement disorders
    3. Psychogenic parkinsonism
    4. Epidemiology and clinical impact of psychogenic movement disorders
    5. The Scottish Neurological Systems Study: diagnoses, characteristics, and prognosis of 1144 new neurology outpatients with symptoms unexplained by disease
    6. Predisposition and issues of mixed etiology in psychogenic movement disorders
    7. Psychogenic movement disorders in children
    8. Childhood disorders: another perspective
    9. Clinical features and treatment outcome of conversion disorders on children and adolescents
    10. Somatoform disorders and psychogenic movement disorders
    11. Psychogenic non-epileptic seizures
    12. Hypochondriasis and its relationship to somatization
    13. Movement disorders in complex regional pain syndrome: the pain field perspective
    14. Psychogenic dystonia in psychogenic complex regional pain syndrome
    15. Latah and related syndromes
    16. Trauma and dissociation: clinical manifestations, diagnosis, epidemiology, pathogenesis and treatment
    17. Psychogenic movement disorders: illness in search of disease?
    18. Possible genetic approaches to conversion
  2. Section II – Physiology     
    1. Functional brain imaging of psychogenic paralysis during conversion and hypnosis
    2. Action control in conversion paralysis: evidence from motor imagery
    3. Imaging in psychogenic movement disorders
    4. Imaging in hysterical, hypnotically suggested, and malingered limb paralysis
    5. Functional imaging of psychogenic and feigned weakness
    6. An fMRI study of recall of causal life events in conversion disorder: preliminary evidence of increased orbitofrontal and parietal activation
    7. Cortisol, trauma, and threat vigilance in patients with psychogenic non-epileptic seizures
    8. Components of voluntary action
    9. Action selection in psychogenic movement disorders
    10. Insights from physiology: tremor and myoclonus
    11. Physiology and psychogenic dystonia
    12. Evoked potentials in the assessment of patients with suspected psychogenic sensory symptoms
    13. Characterizing and assessing the spectrum of volition in psychogenic movement disorders
  3. Section III – Assessment
    1. Rating scales for psychogenic movement disorders
    2. Quality of life in psychogenic disorders: the cause, not the effect
    3. Psychiatric testing
    4. Diagnostic considerations for the assessment of malingering within the context of psychogenic movement disorders
  4. Section IV – Treatment
    1. Prognosis in patients with psychogenic motor disorders
    2. Psychogenic movement disorders: explaining the prognosis
    3. Patterns of practice: report of the Movement Disorder Society questionnaire
    4. Psychotherapy for psychogenic movement disorders
    5. Pharmacotherapy
    6. Suggestion
    7. Treating psychogenic movement disorders with suggestion
    8. Inpatient therapy: trying to transcend pathological dissociation, dependence, disability

Appendix: Psychogenic movement disorders video legends

A meeting of physicians, psychologists, psychiatrists, and other healthcare professionals  who study and treat patients with psychogenic movement and similar ailments, conditions, and diseases was held about ten years ago in Washington DC.

This book contains much of the subject matter of the discussions and outcome of that gathering entitled Second International Conference on Psychogenic Movement Disorders and Other Conversion Disorders sponsored by the Movement Disorder Society and other organizations involved in the study and treatment of people afflicted with these disorders.

There are many incorrect assumptions and beliefs in the medical community about the cause-and-effect relationships between psychogenic movement disorders (and other disorders) on the one hand, and the existence of a psychological basis for those disorders, on the other hand.

This work sheds light on these assumptions and provides empirical evidence of what has been found so far, or not found.

 

Editors:

Mark Hallett, MD is Chief of the Human Motor Control Section in the Medical Neurology Branch of the National Institute of Neurological Disorders (NINDS) at the National Institute of Health (NIH) in Bethesda, Maryland.

Anthony E. Lang, MD, FRCPC is Professor and Director of the Division of Neurology, and Jack Clark Chair for Parkinson’s Disease Research at the University of Toronto, and Director of the Movement Disorders Center at Toronto Western Hospital, in Ontario, Canada.

Joseph Jankovic, MD is Professor of Neurology, Distinguished Chair in Movement Disorders and Director of the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine -Department of Neurology in Houston, Texas.

Stanley Fahn. MD is H. Houston Merritt Professor of Neurology and Director of the Center for Parkinson’s Disease and Other Movement Disorders at Columbia University in New York, New York.

Peter W. Halligan, DSc, FBPS, FMedSci is Professor and Dean of Strategic Futures and  Interdisciplinary Studies in the School of Psychology at Cardiff University in the United Kingdom.

Valerie Voon, MD is Clinical Research Associate in the Behavioral and Clinical Neuroscience Institute in the Department of Psychiatry at the University of Cambridge in the United Kingdom.

Robert Cloninger, MD is Wallace Renard Professor of Psychiatry and Director of the Center for Psychobiology of Personality in the Department of Psychiatry at Washington University School of Medicine in St. Louis, Missouri.