Objective: To examine the relationship of distress tolerance and symptom manifestation in patients with functional movement disorder(FMD), Parkinson’s disease(PD), and essential tremor(ET).

Background: Patients with PD have shown elevated depression, anxiety, and apathy, while patients with ET have demonstrated elevated anxiety and embarrassment regarding their tremor. Less information is known on the coping of patients with FMD. The Distress Tolerance Scale(DTS) measures one’s perceived ability to withstand negative emotional states and was used to assess differences in how patients coped with their tremor disorder.

Method: This cohort study included 37 adult patients with tremor diagnosed clinically with FMD(N=7), PD(N=18), or ET(N=12), who completed the Beck’s Depression Inventory, DTS, Bain and Findley Tremor ADL Scale, Adverse Childhood Experiences Scale, and Essential Tremor Embarrassment Assessment. Demographic information was collected via chart review. Videotaped movement examinations were scored using the MDS-UPDRS by blinded movement-trained reviewers. One-way ANOVA with a Bonferroni corrected post-hoc test was used for statistical analysis.

Results: Demographically, average age was 53, 71.6, and 65.2 years, and duration of symptoms was 6.4, 6.9, and 17.2 years for the FMD, PD, and ET groups, respectively. There were statistically significant differences in distress tolerance scores(FMD=3.08;PD=4.24;ET=3.83,p=0.024), embarrassment scores(FMD=43.4;PD=19.2;ET=32.6,p=0.020), and depression scores(FMD=23.2;PD=8.6;ET=12,p=0.0052). Bonferroni corrected post-hoc analysis showed significant difference between FMD and PD groups(DTS-p=0.0010; ETEA-p=0.0032; BDI-p=0.0026), and no significant difference between FMD and ET groups(DTS-p=0.165;ETEA-p=0.323;BDI-p=0.0648). The FMD group tended to report more adverse childhood events(FMD=3.86;PD=1.17;ET=2.58, p=0.053). There was no significant difference in ADLs between groups(FMD=39.9;PD=34.1;ET=35.8, p=0.504) nor average total tremor scores(FMD=5.25;PD=5.61;ET=6.0;p=0.936).

Conclusion: Results indicated lower distress tolerance, increased depression and embarrassment scores, and a greater amount of adverse childhood events in patients with FMD compared to PD and ET, despite no significant difference in tremor scores or ADLs. Enrollment is ongoing. This data has the potential to characterize coping patterns in FMD patients with tremor, thus providing a basis to develop a comprehensive treatment program for them.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/distress-tolerance-in-patients-with-tremor-disorders/