title: Immediate vs. delayed treatment of psychogenic movement disorders with short term psychodynamic psychotherapy: randomized clinical trial.
abstract: OBJECTIVE
  In subjects with psychogenic movement disorders (PMDs), we conducted a 6 month randomized, cross-over design study to assess the effect of 3 months of psychodynamic psychotherapy followed by observation by the neurologist vs. observation by the neurologist, then 3 months of psychiatric intervention.
  
  
  BACKGROUND
  PMDs are often disabling but no uniformly successful treatment strategies have been identified. Short term, open label psychodynamic psychotherapy has been successful in improving PMDs but whether PMDs improve equally well with neurological observation and support has not been tested.
  
  
  METHODS
  Fifteen patients with PMDs were randomized to immediate vs. delayed (after 3 months) weekly psychodynamic psychotherapy for 12 weeks. During the phase without psychiatric intervention, they were monitored by the treating neurologist. Patients were assessed at baseline, 3 and 6 months. Change in their movement disorder was assessed using a clinical global impression scale change (CGI-c), depression and anxiety using the Hamilton Depression Scale (HAM-D) and Beck Anxiety Inventory (Beck-A).
  
  
  RESULTS
  Fourteen women and one man, age 42.3 ± 11, disease duration 63.2 ± 73 months, were randomized to immediate (7 patients) or delayed (8 patients) treatment. Over the six month study, PMDs, depression and anxiety were significantly improved but time was the determinant factor without an independent effect of treatment assignment.
  
  
  CONCLUSIONS
  In this group of PMD patients, where patients were kept within the medical system and involved in a research program, PMDs as well as depression and anxiety improved, but without specific benefit time-linked to psychotherapy as opposed to neurological observation and support.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA. Electronic address: kkompoli@rush.edu.
authors.forename: Katie
authors.initials: K
authors.lastname: Kompoliti
authors.affiliation: Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Burgess
authors.initials: B
authors.lastname: Wilson
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Stebbins
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Bernard
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hinson
mesh_terms: D000328:Adult; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000523:psychology / Q000628:therapy*; D011614:Psychotherapy, Brief; D064889:Psychotherapy, Psychodynamic; D013001:Somatoform Disorders / Q000523:psychology / Q000628:therapy*
keywords: Conversion; Somatization; Somatoform