The eye of the beholder: Inter-rater agreement among experts on psychogenic jerky movement disorders

Sandra M.A. Van Der Salm, Rob J. De Haan, Daniëlle C. Cath, Anne Fleur Van Rootselaar, Marina A.J. Tijssen, K. P. Bhatia, P. Brown, A. Carson, A. E. Cavanna, JN Caviness, R. Davenport, M. J. Edwards, A. Espay, Edoardo Ferlazzo, S. Franceschetti, V. Fung, D. L. Gilbert, C. G. Goetz, R. Guerrini, M. HallettA. G. Hounie, J. Jankovic, C. Klein, A. Lang, P. Limousin, D. Martino, K. R. Muller-Vahl, A. Münchau, F. Nahab, M. Orth, M. Reuber, E. Roze, G. Rubboli, P. Sandor, C. Schrader, A. Schrag, H. Shibasaki, J. Stone, P. Striano, S. Striano, E. Tolosa, Y. Ugawa, M. Vidailhet, W. Weiner

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. Methods: 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. Results: After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56 ±0.1) with absolute agreement (100%) of experts on the diagnosis in 12 (20%) patients and reasonable agreement (>75%) in 43 (72%) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. Conclusions: Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.

Original languageEnglish (US)
Pages (from-to)742-747
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume84
Issue number7
DOIs
StatePublished - Jul 1 2013

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Movement Disorders
Conversion Disorder
Psychiatry
Hyperkinesis
Tics
Myoclonus
Neurologic Examination
Nervous System Diseases
Diagnostic and Statistical Manual of Mental Disorders
Interviews
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Van Der Salm, S. M. A., De Haan, R. J., Cath, D. C., Van Rootselaar, A. F., Tijssen, M. A. J., Bhatia, K. P., ... Weiner, W. (2013). The eye of the beholder: Inter-rater agreement among experts on psychogenic jerky movement disorders. Journal of Neurology, Neurosurgery and Psychiatry, 84(7), 742-747. https://doi.org/10.1136/jnnp-2012-304113

The eye of the beholder : Inter-rater agreement among experts on psychogenic jerky movement disorders. / Van Der Salm, Sandra M.A.; De Haan, Rob J.; Cath, Daniëlle C.; Van Rootselaar, Anne Fleur; Tijssen, Marina A.J.; Bhatia, K. P.; Brown, P.; Carson, A.; Cavanna, A. E.; Caviness, JN; Davenport, R.; Edwards, M. J.; Espay, A.; Ferlazzo, Edoardo; Franceschetti, S.; Fung, V.; Gilbert, D. L.; Goetz, C. G.; Guerrini, R.; Hallett, M.; Hounie, A. G.; Jankovic, J.; Klein, C.; Lang, A.; Limousin, P.; Martino, D.; Muller-Vahl, K. R.; Münchau, A.; Nahab, F.; Orth, M.; Reuber, M.; Roze, E.; Rubboli, G.; Sandor, P.; Schrader, C.; Schrag, A.; Shibasaki, H.; Stone, J.; Striano, P.; Striano, S.; Tolosa, E.; Ugawa, Y.; Vidailhet, M.; Weiner, W.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 84, No. 7, 01.07.2013, p. 742-747.

Research output: Contribution to journalArticle

Van Der Salm, SMA, De Haan, RJ, Cath, DC, Van Rootselaar, AF, Tijssen, MAJ, Bhatia, KP, Brown, P, Carson, A, Cavanna, AE, Caviness, JN, Davenport, R, Edwards, MJ, Espay, A, Ferlazzo, E, Franceschetti, S, Fung, V, Gilbert, DL, Goetz, CG, Guerrini, R, Hallett, M, Hounie, AG, Jankovic, J, Klein, C, Lang, A, Limousin, P, Martino, D, Muller-Vahl, KR, Münchau, A, Nahab, F, Orth, M, Reuber, M, Roze, E, Rubboli, G, Sandor, P, Schrader, C, Schrag, A, Shibasaki, H, Stone, J, Striano, P, Striano, S, Tolosa, E, Ugawa, Y, Vidailhet, M & Weiner, W 2013, 'The eye of the beholder: Inter-rater agreement among experts on psychogenic jerky movement disorders', Journal of Neurology, Neurosurgery and Psychiatry, vol. 84, no. 7, pp. 742-747. https://doi.org/10.1136/jnnp-2012-304113
Van Der Salm, Sandra M.A. ; De Haan, Rob J. ; Cath, Daniëlle C. ; Van Rootselaar, Anne Fleur ; Tijssen, Marina A.J. ; Bhatia, K. P. ; Brown, P. ; Carson, A. ; Cavanna, A. E. ; Caviness, JN ; Davenport, R. ; Edwards, M. J. ; Espay, A. ; Ferlazzo, Edoardo ; Franceschetti, S. ; Fung, V. ; Gilbert, D. L. ; Goetz, C. G. ; Guerrini, R. ; Hallett, M. ; Hounie, A. G. ; Jankovic, J. ; Klein, C. ; Lang, A. ; Limousin, P. ; Martino, D. ; Muller-Vahl, K. R. ; Münchau, A. ; Nahab, F. ; Orth, M. ; Reuber, M. ; Roze, E. ; Rubboli, G. ; Sandor, P. ; Schrader, C. ; Schrag, A. ; Shibasaki, H. ; Stone, J. ; Striano, P. ; Striano, S. ; Tolosa, E. ; Ugawa, Y. ; Vidailhet, M. ; Weiner, W. / The eye of the beholder : Inter-rater agreement among experts on psychogenic jerky movement disorders. In: Journal of Neurology, Neurosurgery and Psychiatry. 2013 ; Vol. 84, No. 7. pp. 742-747.
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abstract = "Objective: The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. Methods: 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. Results: After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56 ±0.1) with absolute agreement (100{\%}) of experts on the diagnosis in 12 (20{\%}) patients and reasonable agreement (>75{\%}) in 43 (72{\%}) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. Conclusions: Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.",
author = "{Van Der Salm}, {Sandra M.A.} and {De Haan}, {Rob J.} and Cath, {Dani{\"e}lle C.} and {Van Rootselaar}, {Anne Fleur} and Tijssen, {Marina A.J.} and Bhatia, {K. P.} and P. Brown and A. Carson and Cavanna, {A. E.} and JN Caviness and R. Davenport and Edwards, {M. J.} and A. Espay and Edoardo Ferlazzo and S. Franceschetti and V. Fung and Gilbert, {D. L.} and Goetz, {C. G.} and R. Guerrini and M. Hallett and Hounie, {A. G.} and J. Jankovic and C. Klein and A. Lang and P. Limousin and D. Martino and Muller-Vahl, {K. R.} and A. M{\"u}nchau and F. Nahab and M. Orth and M. Reuber and E. Roze and G. Rubboli and P. Sandor and C. Schrader and A. Schrag and H. Shibasaki and J. Stone and P. Striano and S. Striano and E. Tolosa and Y. Ugawa and M. Vidailhet and W. Weiner",
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T1 - The eye of the beholder

T2 - Inter-rater agreement among experts on psychogenic jerky movement disorders

AU - Van Der Salm, Sandra M.A.

AU - De Haan, Rob J.

AU - Cath, Daniëlle C.

AU - Van Rootselaar, Anne Fleur

AU - Tijssen, Marina A.J.

AU - Bhatia, K. P.

AU - Brown, P.

AU - Carson, A.

AU - Cavanna, A. E.

AU - Caviness, JN

AU - Davenport, R.

AU - Edwards, M. J.

AU - Espay, A.

AU - Ferlazzo, Edoardo

AU - Franceschetti, S.

AU - Fung, V.

AU - Gilbert, D. L.

AU - Goetz, C. G.

AU - Guerrini, R.

AU - Hallett, M.

AU - Hounie, A. G.

AU - Jankovic, J.

AU - Klein, C.

AU - Lang, A.

AU - Limousin, P.

AU - Martino, D.

AU - Muller-Vahl, K. R.

AU - Münchau, A.

AU - Nahab, F.

AU - Orth, M.

AU - Reuber, M.

AU - Roze, E.

AU - Rubboli, G.

AU - Sandor, P.

AU - Schrader, C.

AU - Schrag, A.

AU - Shibasaki, H.

AU - Stone, J.

AU - Striano, P.

AU - Striano, S.

AU - Tolosa, E.

AU - Ugawa, Y.

AU - Vidailhet, M.

AU - Weiner, W.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Objective: The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. Methods: 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. Results: After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56 ±0.1) with absolute agreement (100%) of experts on the diagnosis in 12 (20%) patients and reasonable agreement (>75%) in 43 (72%) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. Conclusions: Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.

AB - Objective: The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. Methods: 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. Results: After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56 ±0.1) with absolute agreement (100%) of experts on the diagnosis in 12 (20%) patients and reasonable agreement (>75%) in 43 (72%) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. Conclusions: Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.

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