Are Patients with Psychogenic Movement Disorders More Likely to be Healthcare Workers?

作者：Perry Christina G; Holmes Katherine G; Gruber Baldini Ann L; Anderson Karen E; Shulman Lisa M; Weiner William J; Reich Stephen G

来源：Movement Disorders Clinical Practice, 2017, 4(1): 62-67.

DOI：10.1002/mdc3.12351

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Reported risk factors for the development of a psychogenic movement disorder (<jats:styled-content style="fixed-case">PMD</jats:styled-content>) include young age, female gender, history of abuse, current or past psychiatric disorder, lower levels of education and socioeconomic status, and employment as a healthcare worker. Although employment in healthcare is included in several diagnostic criteria for <jats:styled-content style="fixed-case">PMD</jats:styled-content>, as well as in many case series, this association has never been validated.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Using the University of Maryland Movement Disorder Database (<jats:styled-content style="fixed-case">UMMDD</jats:styled-content>), we identified <jats:styled-content style="fixed-case">PMD</jats:styled-content> cases, as well as patients with isolated focal dystonia as controls. An experienced movement disorder specialist diagnosed all patients, and all cases met criteria for clinically established <jats:styled-content style="fixed-case">PMD</jats:styled-content>. Demographic and occupational histories were obtained from medical records and were supplemented by telephone interviews. <jats:styled-content style="fixed-case">PMD</jats:styled-content> cases and controls were compared using <jats:italic>t</jats:italic> tests/χ<jats:sup>2</jats:sup> tests.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Controls (n = 148) were older than <jats:styled-content style="fixed-case">PMD</jats:styled-content> cases (n = 132), with an average age of 61.4 and 52.1 years, respectively (<jats:italic>P </jats:italic>&lt;<jats:italic> </jats:italic>0.001); there were no significant differences between groups with respect to gender, education level, and ethnicity. The proportion of healthcare workers was not significantly different between <jats:styled-content style="fixed-case">PMD</jats:styled-content> cases and controls (25% of <jats:styled-content style="fixed-case">PMD</jats:styled-content> cases vs. 20% of controls; <jats:italic>P </jats:italic>=<jats:italic> </jats:italic>0.28).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In contrast to traditional teaching, this investigation demonstrates that in our patient population, patients with a <jats:styled-content style="fixed-case">PMD</jats:styled-content> were no more likely to be employed as healthcare workers than patients with isolated focal dystonia. This study calls into question the use of employment in healthcare as a reliable criterion to support the diagnosis of <jats:styled-content style="fixed-case">PMD</jats:styled-content>.</jats:p></jats:sec>

• 出版日期2017-2