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Psychogenic Disease

Psychogenic disease (or psychogenic illness) is a name given to physical illnesses that are believed to arise from emotional or mental stressors, or from psychological or psychiatric disorders.[1] It is most commonly applied to illnesses where a physical abnormality or other biomarker has not yet been identified. In the absence of such "biological" evidence of an underlying disease process, it is often assumed that the illness must have a psychological cause, even if the patient shows no indications of being under stress or of having a psychological or psychiatric disorder. Symptoms of psychogenic diseases can be just as severe as symptoms of other organic diseases, but they have a psychiatric cause. One out of every six patients who seek neurological help have a psychogenic disease.

Diagnosis

Psychogenic Disease can be extremely hard to diagnose. After all other organic diseases have been ruled out, neurologists will often employ alternative tests to try to diagnose the disease. One large symptom that can help differentiate a psychogenic disease examine how the disease presented itself, the route of the disease, and how it manifests itself. For example, individuals with psychogenic movement disorders often don't show symptoms if they are distracted, whereas this is not true when there is an organic cause. This can be extremely useful when diagnosing the disease.

Examples

Examples of diseases that are believed by many to be psychogenic include psychogenic seizures, psychogenic polydipsia, psychogenic tremor and psychogenic pain, and psychogenic movement disorders. Psychogenic Movement Disorders include psychogenic tremors, dystonia, myoclonus, parkinsonism, tics, paroxysmal dyskinesia, and gait disorders.

There are problems with the assumption that all medically unexplained illness must have a psychological cause. It always remains possible that genetic, biochemical, electrophysiological or other abnormalities may be present which we do not have the technology or background to identify.[2][3]

The term psychogenic disease is often used in a similar way to psychosomatic disease. However, the term "psychogenic" usually implies that psychological factors played a key causal role in the development of the illness. The term "psychosomatic" is often used in a broader way to describe illnesses with a known medical cause where psychological factors may nonetheless play a role (e.g., asthma can be exacerbated by anxiety).

See also Functional symptom Mass psychogenic illness Psychogenic amnesia Psychogenic pain Psychological trauma Psychoneuroimmunology Psychosomatic medicine References

Lim, E. C H; Seet, R. C S (1 February 2007). "What is the place for placebo in the management of psychogenic disease?". Journal of the Royal Society of Medicine. 100 (2): 60–61. doi:10.1258/jrsm.100.2.60. PMC 1790983. PMID 17277261.
Conversion Disorders at eMedicine
Sykes, Richard (2010). "Medically Unexplained Symptoms and the Siren "Psychogenic Inference"". Philosophy, Psychiatry, & Psychology. 17 (4): 289–299. doi:10.1353/ppp.2010.0034.

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Psychogenic Disease Study

A study conducted at University College of London and University of Cambridge, revealed that individuals with psychogenic disease actually showed different brain activity than individuals with organic disease. The study specifically looked at psychogenic and organic dystonia, which cause uncomfortable muscle contractions. Each dystonia was specialized to the individual's legs. In the group with an organic cause, researchers discovered a mutation in the DYT1 gene as the root of their dystonia. However, the psychogenic group revealed no physical cause in the body, even after extensive research. The researchers then conducted PET scans of the participants brains, which revealed significant differences in the brain function between the two groups. Individuals with the organic cause had a striatum that was less active, as well as an overactive motor cortex, while the psychogenic group showed the exact opposite. Additionally, the brain function in the psychogenic group was altered throughout the entire time, not just when trying to move their legs. It had been previously thought that there was a link between problems in the prefrontal cortex of the brain and psychogenic diseases. After examining the brain scans, they discovered that both groups showed irregular activity in the front region due to their dystonia, and therefore, it cannot linked to psychogenic disorders.

Psychogenic Movement Disorders

Psychogenic Movement Disorders are a subset of psychogenic disease that affect an individual's movement. It can include random uncontrollable movements, including spasms, shakes, jitters, in the face, neck, body, arms, and legs. These movements can impair one's walking and balance, as well as their ability to speak clearly. Because they are a type of psychogenic disease, they are caused by stress, anxiety, of another type of psychological condition. As a result, they cannot be diagnosed with routine tests such as blood work, MRI's or other types of imaging. The severity of the disease greatly varies between individuals, and can worsen in some cases. These movement disorders can be confused with other more common disorders, however neurologist should be able to tell difference between the two. Psychogenic Movement disorders can be further broken down into more categories.

Psychogenic Tremors

Psychogenic Tremors are the most common of all types of psychogenic movement disorders, as they appear in about half of the cases. These tremors resemble tremors of other diseases, and can happen when a person is moving or sedentary. They can be individual events that happen one at a time, or they can be separate events that happen in different body parts at the same time. Each tremor differs from one another, and can be different in motion, speed, or direction. Depending on the severity of the condition, some individuals may be able to control the tremor by focusing on something else, which causes the tremor to stop. These tremors often increase if the affected person is experiencing an especially stressful time.

Psychogenic Dystonia

Psychogenic dystonia resembles dystonia, but has a psychological origin as the root of the cause. A dystonia is considered any contraction or spasm of a muscle, which may include a rotation or squeeze of a muscle. At times, it is possible that the body part becomes stuck in a particular position, which is referred to as fixed dystonia. These occur most often in an individual's limbs, and can occur individually, or together as an attack.

Psychogenic Myoclonus

Psychogenic Myoclonus is when a particular muscle (or muscles) jerk vigorously. Abrupt noises or movements can sometimes trigger these to happen. In some cases, individuals with this type of psychogenic disease have had a surgery in the past that caused this movement. Like most psychogenic diseases, it can be hard to understand if this type of myoclonus is from a psychogenic cause or not, but neurologists, through neurophysiological testing, should be able to differentiate. Like many other forms of this disease, these cannot be controlled. They occur as both isolated events, as well as together in "attacks".

Psychogenic Parkinsonism

This type of psychogenic disease results in individuals experiencing many of the symptoms of Parkinson's disease, but the origin is psychogenic. Individual's that are afflicted with this have mostly tremors, but can sometimes have trouble with their speech. The symptoms of this are not limited to one side of the body, though it has often been found in an individual's dominant hand. Typically, this is the least common out of all of the psychogenic movement disorders.

Psychogenic Tics

A psychogenic tic is a tic, which is a spasm, typically in the face, that occurs due to psychological reasons. Unlike some other psychogenic movements, tics can usually be controlled or prevented by the person because they can sense when it is about to happen. This type of psychogenic disease often comes in hand with other diseases.

Psychogenic Paroxysmal Dyskinesia

This type of disease occurs when an individual experiences these abnormal disorders, but they occur together at the same time, and are often referred to as "attacks". Therefore, these symptoms would only be noticeable when someone was having this attack. They include many different movements, and are likely caused by a trigger.

Psychogenic Gait Disorders

Psychogenic Gait Disorders occur when someone's walking and balance is affected. This type of disease often exists with others simultaneously. Individuals experiencing this usually do not fall, but their balance becomes unsteady.

Cause of Psychogenic Movement Disorders

While this disorders often resemble other biological disorders, they are not a result of any sort of damage or problem in the spinal cord, or nervous system. They are a bodily response to a stressor, or other underlying psychological turmoil. They often can show up somewhat abruptly, and can progress to become more serious. While there is treatment for these disorders, if they go untreated it can become a chronic condition which can be especially problematic. Typically, this disorder presents itself later in life.

Diagnosis of Psychogenic Movement Disorders

The first step in treating these disorders is differentiating them from other underlying, diagnosable, organic diseases. Once those disorders are ruled out, neurological exams become common. Electromyography, as well as electroencephalography, examine electrical patterns in the brain and can help detect these diseases. Typically, neurologists are able to diagnose people with this disorder and differentiate it from other diseases. If it is not properly diagnosed, it can lead to more extensive health problems. The main diagnosis for these disorders are if the motions happening are not controllable, and are affecting the individual's daily life and their ability to take part in basic activities. Just like in the broader sense of psychogenic disease, the course of the disease, how it started, and when it shows up are examined to try to differentiate it from an organic disease.

Treatment of Psychogenic Movement Disorders

Once it is determined that individuals have a Psychogenic Movement Disease, there are a variety of treatment options that individuals test. Neurologists, psychologists, psychiatrists, physical therapists, and occupational therapists are all extremely useful in treating this disorder. Physical and Occupational Therapists help the individual correct these disorders, through a process of "motor reprogramming". Psychologists and psychiatrists are used to try to find the source of stress, determine the cause, and teach stress management skills.

There are certain medications that can potentially treat this disorder as well. Antidepressants and anti anxiety medications can help treat the root of the disorder, while muscle relaxers can help minimize the symptoms.

Psychogenic Pain

Psychogenic pain is another subset of psychogenic disorders. It is physical pain that is characterized by a psychological or mental cause. It can result in pain in areas such as the muscle, stomach, back, or head. Although severe, the pain once again does not have an organic or physical root, and therefore cannot be alleviated with typical pain treatments, such as anti inflammatory drugs. Psychogenic pain be just as much of a stressor as chronic pain, preventing individuals from engaging in daily activities.
When diagnosing psychogenic pain, doctors rule out physical problems first. They then will try to uncover emotional and psychological problems. Treatments for psychogenic pain include try psychotherapy, or antidepressants.