Psychogenic tremor, also referred to as functional tremor, commonly appear as shakes of the hands when one is anxious or nervous. Its symptoms may vary but often start abruptly and may affect other body parts as well.
The tremor increases in times of stress and decreases or disappears when distracted. Many individuals with psychogenic tremor have an underlying psychiatric disorder such as generalised anxiety disorder, social anxiety disorder, panic disorder, major depressive disorder or post-traumatic stress disorder (PTSD).
Tremor is diagnosed based on a physical and neurological examination and an individual’s medical history. During the physical evaluation, a doctor will assess the tremor based on:
· whether the tremor occurs when the muscles are at rest or in action
· the location of the tremor on the body
· the appearance of the tremor (tremor frequency and amplitude).
The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood tests can rule out metabolic causes such as thyroid malfunction that can cause tremor.
Persons with Parkinson's disease typically experience a hand tremor when their muscles are at rest and see a reduction in the tremor when their muscles are in use.
Shaky hands can also be due to side effects of medications, such as due to certain psychiatric, anti-epileptic, anti-asthma, and immunosuppressant medications. At my clinics, I have also come across cases who drink many cups of coffee and tea a day, and thus experiencing an overdose of caffeine, which cause them to have severe shakes of the hands. Alcohol withdrawal also manifests as tremors of the hands.
In persons with anxiety disorder, cognitive behavioural therapy (CBT) and medications would be effective in helping them. In CBT, the therapist will help the person focus on their responses to events, and help to modify their thinking and behaviour.