Psychogenic Tremor: Report of Five Cases

Abstract

In this article we present 5 patients (3 woman , 2 men) ranging in age from 10 to 86 years with a diagnosis of psychogenic tremor (PT) based on personal observations and clinical evaluations. Tremor duration was longer than 20 years in two patients, 4 months in other two patients and nearly 3 years in one patient. Their common clinical features were as follows: 1) described triggering psychogenic conditions prior the onset of tremor, 2) in all but one tremor onset was acute developing in a few hours, 3) the tremor consisted of resting, postural and kinetic components, 4) reduction of the frequency and amplitude of the tremor or its disappearance during distraction , 5) diurnal variability in characteristics of the tremor such as direction,amplitude and frequency, 6) selective disability with ability to perform some routine daily activities despite severe tremor, 7) absence of neurologic, laboratory ar radiologic evidence ofa disease causing tremor. In most of the patients there were accompanying somatizations and secondary gain. In some of the patients we observed occasional spontaneous remissions and/or transient placebo response. Recently, there are some reports considering PTs as a "positive" diagnosis with its self characteristics rather than a diagnosis based on exclusions. From this point of view, we believe that our patients fulfil the criteria for the diagnosis of PT . Since three of our patients had persistent tremor for years we share the recent opinion of some authors that PT is not a benign disorder as believed previously.