Quiz Form

Question Date: 23/07/2023

Question: A 44-year-old man develops a tremor after being fired from his job. The tremor started suddenly on the day he lost his job and worsens with stress<br><br>On examination, he has a coarse bilateral postural tremor that increases in amplitude upon weighting the limb, suppresses during contralateral ballistic movements, and entrains to a different examiner-given tapping frequency<br><br>What is the most important initial element in the management of this patient?

Options:

• Cognitive-behavioral therapy
• Diagnostic debriefing
• Hypnosis
• Psychodynamic psychotherapy

Correct Answer: Diagnostic debriefing

Explaination: This patient has a psychogenic tremor. Many of the features of the history and examination are suggestive of this diagnosis including the abrupt onset, variability of amplitude and frequency and suppression with distraction. The most important element in the treatment of psychogenic movement disorders is disclosing the diagnosis in an empathetic manner. Cognitive-behavioral therapy and psychodynamic psychotherapy may be useful in selected cases, but all patients should first have an open and frank discussion with their physician regarding the nature of the diagnosis

Reference: Morgante F, Edwards MJ, Espay AJ. Psychogenic movement disorders. Continuum (Minneap Minn). 2013 Oct;19(5 Movement Disorders):1383-96. doi: 10.1212/01.CON.0000436160.41071.79. PMID: 24092294; PMCID: PMC4234133