This represents a very small proportion (1 – 5%) of all patients with dystonia. The terminology means that the dystonia has no organic basis and is deemed to arise from a patient’s inner psychological conflicts. Although rare, it is not uncommon. A fully trained movement disorders neurologist can usually diagnose the condition. It may resemble a “true” or organic form of dystonia but certain features can help distinguish it from the latter such as:
- These types of dystonia may be accompanied by other movement disorders such as rhythmical shaking, bizarre gait, excessive slowness
- This type of dystonia improves with distraction and may spontaneously remit
- Usually abrupt onset in a patient with a long history of somatisations
- Any part of the body may be affected. But it is important to note that the dystonia has changing characteristics over time and may even fluctuate
It is important, therefore, to obtain a very thorough psychiatric assessment. Their history may reveal previous psychopathology like depression, anxiety or personality disorders. Any history of abuse or financial gain should also be sought after. Patients with psychogenic dystonia should be thoroughly investigated to exclude any organic cause such as a tumor, stroke, infection or other exogenous factors causing the disturbance. Findings that are normal will help reassure the patient.
A combination of medications plus counseling is the best approach to these patients. A referral to a psychiatrist or a counselor can help these patients face their issues and hopefully get back on track with their lives.