Neuropsychiatric phenotypes in functional movement disorder.

Autor:	Gilmour GS; Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada., Langer LK; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada., Lang AE; Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, ON, Canada.; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada., MacGillivray L; Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.; Centre for Mental Health, University Health Network, Toronto, ON, Canada.; Department of Psychiatry, University of Toronto, Toronto, ON, Canada., Lidstone SC; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.; Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
Jazyk:	angličtina
Zdroj:	CNS spectrums [CNS Spectr] 2023 Dec; Vol. 28 (6), pp. 747-755. Date of Electronic Publication: 2023 Jul 10.
DOI:	10.1017/S1092852923002353
Abstrakt:	Objective: Functional movement disorder (FMD), the motor-dominant subtype of functional neurological disorder, is a complex neuropsychiatric condition. Patients with FMD also manifest non-motor symptoms. Given that patients with FMD are diagnosed based on motor phenotype, the contribution of non-motor features to the neuropsychiatric syndrome is not well characterized. The objective of this hypothesis-generating study was to explore potential novel, neuropsychiatric FMD phenotypes by combining movement disorder presentations with non-motor comorbidities including somatic symptoms, psychiatric diagnoses, and psychological traits. Methods: This retrospective chart review evaluated 158 consecutive patients with a diagnosis of FMD who underwent deep phenotyping across neurological and psychiatric domains. Demographic, clinical, and self-report features were analyzed. A data-driven approach using cluster analysis was performed to detect patterns when combining the movement disorder presentation with somatic symptoms, psychiatric diagnoses, and psychological factors. These new neuropsychiatric FMD phenotypes were then tested using logistic regression models. Results: Distinct neuropsychiatric FMD phenotypes emerged when stratifying by episodic vs. constant motor symptoms. Episodic FMD was associated with hyperkinetic movements, hyperarousal, anxiety, and history of trauma. In contrast, constant FMD was associated with weakness, gait disorders, fixed dystonia, activity avoidance, and low self-agency. Pain, fatigue, somatic preoccupation, and health anxiety were common across all phenotypes. Conclusion: This study found patterns spanning the neurological-psychiatric interface that indicate that FMD is part of a broader neuropsychiatric syndrome. Adopting a transdisciplinary view of illness reveals readily identifiable clinical factors that are relevant for the development and maintenance of FMD.
Databáze:	MEDLINE
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