SLATER REVISITED - 6 YEAR FOLLOW-UP-STUDY OF PATIENTS WITH MEDICALLY UNEXPLAINED MOTOR SYMPTOMS

Objective: To investigate psychiatric and neurological morbidity diagn ostic stability and indicators of prognosis in patients previously ide ntified as having London medically unexplained motor symptoms. Design: Follow up study. Setting: National Hospital for Neurology and Neurosu rgery; London-a secondary and tertiary referral hospital for neurologi cal disorders. Subjects: 73 patients with medically unexplained motel symptoms admitted consecutively in 1989-91. 35 (48%) patients had abse nce of motor function (for example, hemiplegia) and 35 (52%,) had abno rmal motor activity (for example, tremour dystonia, or ataxia). Main o utcome measures: Neurological clinical diagnosis at face to face reass essment by a neurologist and a psychiatric diagnosis after a standardi sed assessment interview-the schedule for affective disorders and schi zophrenia-conducted by a psychiatrist. Results: Good follow up data we re available for 64 subjects (88%). Only three subjects had new organi c neurological disorders at follow up that fully or partly explained t heir previous symptoms. 44/59 (75%) subjects had had psychiatric disor ders; in 33 (75%) patients, the psychiatric diagnosis coincided with t heir unexplained motor symptoms. 31/59 (45%) patients had a personalit y disorder: Three subjects had developed new psychiatric illnesses at follow up, but in only one did the diagnosis account for tile previous motor symptoms. Resolution of physical symptoms was associated with s haft length of symptoms, comorbid psychiatric disorder, and a cl-range in marital status during follow up. Conclusions: Unlike Slater's stud y of 1965, a low incidence of physical or psychiatric diagnoses which explained these patients' symptoms or disability was found. However, a high level of psychiatric comorbidity existed.