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Diagnostic agreement in patients with psychogenic movement disorders

Authors

  • Francesca Morgante PhD,

    1. Dipartimento di Neuroscienze, Scienze Psichiatriche ed Anestesiologiche, Università di Messina, Messina, Italy
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  • Mark J. Edwards PhD,

    1. Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, Queen Square, London, United Kingdom
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  • Alberto J. Espay PhD,

    1. University of Cincinnati Neuroscience Institute, Department of Neurology, Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
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  • Alfonso Fasano PhD,

    1. Istituto Neuromed, Pozzilli, Italy
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  • Pablo Mir PhD,

    1. Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
    2. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Barcelona, Spain
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  • Davide Martino PhD,

    Corresponding author
    1. Dipartimento di Scienze Neurologiche e Psichiatriche, Università di Bari, Bari, Italy
    2. Neuroscience and Trauma Center, Barts and The London School of Medicine and Dentistry, London, United Kingdom
    • Dipartimento di Scienze Neurologiche e Psichiatriche, Università di Bari, Piazza Giulio Cesare 11, I-70124 Bari, Italy

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  • on behalf of the DISMOV-SIN study group on psychogenic movement disorders

    1. Neuroscience and Trauma Center, Barts and The London School of Medicine and Dentistry, London, United Kingdom
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    • See Appendix for list of collaborators.


  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Background:

The reliability and applicability of published diagnostic criteria for psychogenic movement disorders (PMDs) have never been examined.

Methods:

Eight movement disorder and six general neurologists rated 14 patients diagnosed with PMD and 14 patients diagnosed with organic movement disorders. Raters provided a dichotomous judgment (i.e., psychogenic or organic) upon review of video-based movement phenomenology and a category of diagnostic certainty based on the Fahn-Williams and Shill-Gerber criteria after accessing standardized clinical information. We measured interobserver agreement on the diagnosis and clinical certainty judgment of PMD.

Results:

In both groups of raters, agreements were “fair” on the video-based dichotomous judgment, but improved to “substantial” after access to standardized clinical information. “Slight” to “poor” agreement was reached for the “probable” and “possible” categories of diagnostic certainty corresponding to both diagnostic criteria.

Conclusions:

Diagnosis according to clinical available criteria for PMD yields poor diagnostic agreement. © 2012 Movement Disorder Society

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