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Abstract: Ms. Chen, 40 years old, recently had recurrent limb tremors, and in severe cases, it also caused whole-body tremors, which could not be controlled, and she was conscious. The tremors usually lasted 10-30 minutes and then relieved on their own, and today the tremors appeared again, and her family was very worried, so they brought her to the hospital for examination. The tremor stopped after psychological guidance and medication was given.
Basic information】Female, 40 years old
Disease Type】Functional tremor
Hospital】Shandong Provincial Third Hospital
Date of consultation】July 2021
Treatment plan】Medication (citalopram hydrobromide tablets + glutamate tablets) + psychological counseling
Treatment period】1 week of outpatient treatment, 1 month of follow-up by phone
Treatment effect】Stable condition, no reappearance of symptoms
I. Initial consultation
Ms. Chen’s family complained that 15 days ago, the patient’s whole body trembled after a heated argument with her family and could not be controlled. After that, there were still repeated tremors, and the attack was usually preceded by emotional excitement and excessive panting. The family was concerned about a serious illness and brought the patient to the hospital outpatient clinic, where tremor was considered. Since tremor can be seen in a variety of diseases, it is necessary to improve the relevant examinations: cranial CT, EEG, electromyography of the extremities, psychological assessment, blood sampling and laboratory tests to clarify the diagnosis. The patient and his family expressed their understanding and actively cooperated with the examination, and none of the examination results showed any abnormality.
II. Treatment history
The patient was examined in the outpatient clinic, including routine blood tests, liver and kidney functions, blood lipids, blood glucose, cardiac enzymes, glycosylated hemoglobin, and trace elements, and no significant abnormalities were found. Combining the patient’s current condition, the characteristics of the onset of the disease and the examination results, the possibility of functional tremor is considered high. The psychological assessment suggested moderate anxiety, and the patient’s tremor gradually subsided and returned to normal after psychological counseling. The patient was given citalopram hydrobromide tablets and glutamate tablets for mood regulation, and a follow-up consultation was recommended in 1 week.
III. Treatment effect
Functional tremor can be clinically manifested as subtle tremors of the limbs, with no organic lesions on examination, and is generally associated with psychosomatic disorders. The patient came to the hospital with clear consciousness, normal limbs and normal walking posture. After giving psychological guidance and anti-anxiety medication, the symptoms were significantly relieved and the tremor disappeared. 1 week later, there was no special discomfort in the outpatient follow-up, and it was recommended to maintain a good mood. 1 month later, the patient was returned by telephone and the condition was stable without special discomfort.
IV. Notes
I am glad that after active treatment, the patient’s tremor symptoms were relieved. Functional tremor is commonly associated with psychosomatic diseases, such as emotional excitement after a quarrel, excessive fatigue, and strenuous exercise, so patients are advised to correct bad habits in the living environment and adjust psychological diseases for psychological relief, which is beneficial to the relief of symptoms. During the treatment period, patients should take their medication on time, not to stop it privately, and regularly visit the psychology department for psychological counseling. Family members should give patients a comfortable environment to avoid increased psychological pressure, ensure good work and rest time and good mood to help the disease improve, and usually should supplement nutrition, exercise, and avoid exertion and emotional excitement.
V. Personal insight
Functional tremor, as the name implies, is the symptom of tremor caused by a functional disease, which can usually be effectively relieved after proper treatment and psychological guidance as in this patient. The disease is generally associated with psychological disorders as well as the living environment, diet and exercise conditions. If the psychological pressure is high, seek an outlet for catharsis or do psychological counseling. Family members should be gentle and polite when discussing problems and avoid violent arguments.