Neuropsychiatric Approaches to Essential and Functional Tremor: A Comparative Study

Mehmet Balal,1 Soner Çakmak,2 Miray Erdem,3 Meltem Demirkiran4 1Department of Neurology, Çukurova University, Adana, 01330, Türkiye; 2Department of Psychiatry, Çukurova University, Adana, 01330, Türkiye; 3Department of Neurology, University of Health Sciences, Adana, 1370, Türkiye; 4Independent Researcher, Adana, 1120, TurkeyCorrespondence: Mehmet Balal, Department of Neurology, Çukurova University, Adana, 01330, Türkiye, Tel +90505 544 69 49, Email [email protected]: Differentiating essential tremor (ET) from functional tremor (FT) remains a challenge due to their overlapping clinical presentations. This study aimed to elucidate the demographic and psychometric differences between the aforementioned tremor types to enhance diagnostic accuracy and therapeutic strategies.Patients and Methods: This prospective study included 96 patients diagnosed with ET or FT and analysed their related demographic data, clinical symptoms, and psychometric evaluation scores. The statistical analysis involved Pearson’s chi-square tests, Fisher’s exact tests, and logistic regression to determine how the different variables impact tremor diagnosis.Results: Our study demonstrated a higher prevalence of ET in males (p = 0.015). Furthermore, we demonstrated that patients with ET displayed a significantly lower body mass index and a lower age of onset compared to those with FT (p = 0.050 and p = 0.023, respectively). Psychometric assessments revealed higher cognitive and body image scores in patients with ET, whereas those with FT scored higher on the depression and anxiety scales. The misdiagnosis rate was 14.5%, emphasising the requirement for improved diagnostic criteria.Conclusion: We established specific demographic and psychometric distinctions between ET and FT, which could potentially benefit clinicians in making accurate diagnoses and tailoring treatment approaches. These findings support the inclusion of comprehensive psychometric evaluations into standard diagnostic procedures to better differentiate tremor types.Plain Language Summary: Essential Tremor (ET) and Functional Tremor (FT) can be more accurately identified. Functional and Essential tremor are frequently misdiagnosed. Due to misdiagnosis of both diseases, treatment is often delayed and treatment costs increase. This study distinguishes between Essential and Functional Tremor by exploring gender, age, and psychometric variables, highlighting crucial differences and the significant issue of misdiagnosis, aiming to refine diagnostic criteria and treatment approaches. We identified distinct profiles for ET and FT, particularly in psychometric assessments where FT patients showed significantly higher anxiety and depression scores. Our study brings to light the importance of incorporating psychological evaluations in routine assessments, marking a significant advancement in tremor diagnosis and treatment. In addition, psychiatry and neurology emphasize that they need to cooperate more by following this patient group together. The expected future implications in clinical settings include improved diagnostic accuracy, personalized treatment plans based on detailed patient profiles, and a decrease in the misdiagnosis rates currently seen in tremor disorders.Keywords: essential tremor, functional tremor, neuropsychiatric evaluation, tremor diagnosis