Comparison of Psychogenic Movement Disorder Patients with Non-epileptic Seizures and other Hyperkinetic Motor Manifestations: an Integrated Model of Psychosocial and Neuropsychological Functioning

Psychogenic movement disorders (PMDs) represent a complex and severe form of psychopathology, which even after a century of research remains poorly understood. As previous investigations have neglected to differentiate symptom phenotypes and have approached assessment from the perspective of cognitive dysfunction apparent in PMD patient\u27s neurological counterparts, the current study aimed to examine the neurocognitive performance and psychological profiles of PMD patients with hyperkinetic motor manifestations guided by a theoretical lens of frontal lobe pathology and informed by previous neuroimaging studies with this patient population. Subsequent to diagnostic confirmation of their condition by means of video-electroencephalographic monitoring or adherence to Fahn and Williams criteria, 16 patients with psychogenic non-epileptic seizures (PNES) and 16 patients with other hyperkinetic PMDs were administered an abbreviated neuropsychological battery and completed a series of self-report measures assessing psychological functioning. Results of the present study suggest that patients with psychogenic conditions demonstrate specific neurocognitive deficits mediated by frontal lobe structures, and that severity of posttraumatic symptomatology may be predictive of general cognitive impairment in this patient population. When considered in the context of extant neurobiological data, the present findings generally support a cortico-limbic disconnection conceptualization of psychogenic illness. The diagnostic and conceptual implications of these findings are discussed, as well as treatment implications for motor subgroups based on psychological and neurocognitive discrepancies observed between patients with PNES and other hyperkinetic PMDs. Future investigators are encouraged to adopt a multidisciplinary approach employing recent technological advances and utilizing theoretical models guided by empirically established principles of neurocognitive functioning