II. Pathophysiology

  1. Disappears when not under direct supervision
  2. Complex Tremor mimics other Tremor types
    1. Rest Tremor
    2. Postural Tremor
    3. Kinetic Tremor

III. Symptoms and Signs

  1. Abrupt Tremor onset with static course
  2. Spontaneous Tremor remission
  3. Tremor difficult to classify
  4. Unresponsive to Tremor medications or Tremor responds to Placebo
  5. Increased with attention
  6. Decreased with distraction
  7. Absence of other neurologic signs
  8. Clinical inconsistencies
  9. More common in allied health professionals

IV. Associated Conditions

  1. Somatization Disorder (or multiple undiagnosed subjective concerns)
  2. Psychiatric illness

V. Diagnosis

  1. Patient taps beat with limb contralateral to affected
  2. Psychogenic Tremor suggested if
    1. Tremor decreases in affected limb
    2. Tremor frequency shifts to tapping frequency

VI. Management

  1. Psychotherapy
  2. Medications not indicated

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