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PubMed2001

Psychiatric disorders among tortured Bhutanese refugees in Nepal.

BACKGROUND: The impact of torture on the distribution of psychiatric disorders among refugees is unknown. METHODS: We surveyed a population-based sample of 418 tortured and 392 nontortured Bhutanese refugees living in camps in Nepal. Trained interviewers assessed International Classification of Diseases, 10th Revision (ICD-10) disorders through structured diagnostic psychiatric interviews. RESULTS: Except for male sex, history of torture was not associated with demographics. Tortured refugees, compared with nontortured refugees, were more likely to report 12-month ICD-10 posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders. In addition, tortured refugees were more likely to report lifetime posttraumatic stress disorder, persistent somatoform pain disorder, affective disorder, generalized anxiety disorder, and dissociative (amnesia and conversion) disorders. Tortured women, compared with tortured men, were more likely to report lifetime generalized anxiety disorder, persistent somatoform pain disorder, affective disorder, and dissociative (amnesia and conversion) disorders. CONCLUSIONS: Among Bhutanese refugees, the survivors had higher lifetime and 12-month rates of ICD-10 psychiatric disorder. Men were more likely to report torture, but tortured women were more likely to report certain disorders. The results indicate the increased need for attention to the mental health of refugees, specifically posttraumatic stress disorder, persistent somatoform pain disorder, and dissociative (amnesia and conversion) disorders among those reporting torture.

Adult↗

PubMed2003

[A case of dissociative stupor with decorticated posture after neck clipping of brain aneurysm].

We experienced a case of dissociative stupor with decorticated posture in a 71-year-old woman after neck clipping of the brain aneurysm. Decorticated posture is observed with severe midbrain disorder caused by brain herniation. In this case, therefore, severe brain stem damage was suspected, although light reflex was observed and respiration was stable. In addition, in this case, the aneurysm was located at the junction of the internal carotid artery and the posterior communicating artery. Therefore, surgical damage to midbrain was not likely to have happened. Postoperative computed tomography showed no abnormality in this region. Two days later, her symptom disappeared, and she could clearly recollect memory of these two days just after surgery. However, she could not follow directions because of a sense of fear. Thus her symptom might be based on a kind of mental disorder. Patients with conversion disorder react abnormally to stimulus or stress. Stupor was diagnosed as due to defect of reaction to stimulus of sound, light and touch. She was diagnosed as dissociative stupor of the conversion disorder type. In this case, decorticated posture was caused by mental disorder. We have to pay attention not only to brain tissue damage but also to psychological damage of patients.

Aged↗

PubMed1999

Psychogenic stridor: a cause of acute upper airway obstruction.

A 17-year-old boy was seen in the emergency department with signs and symptoms of acute upper airway obstruction, closely resembling epiglottitis. Immediate management consisted of induction of general anesthesia with spontaneous ventilation. Because no organic pathologic process was found, and in combination with subsequently known psychosocial stressors, a diagnosis of psychogenic stridor, a conversion disorder, was made. Conversion disorders may be seen by the busy family practitioner or pediatrician and are frequently underdiagnosed.

Adolescent↗

PubMed1992

[Conversion symptoms of patients in psychiatric liaison care].

At the consultation-psychiatric service of a large university hospital conversion disorders present ca. 50% of the "somatoform disorders". The rate of incidence of conversion disorders was 4% of all patients seen in the service, i.e. 20-30 referrals per annum. A report on 103 patients referred during 1987-1990 is given concerning basic sociodemographic data, symptom clusters, course of illness, age at onset of the disorder, psychiatric and family history, psychosocial conditions and intrapsychic conflicts, additional affective disorders and psychophysiological symptoms, illness behaviour, cognitive attitudes towards illness. The rate of 35% patients showing an underlying somatic disorder in addition to their conversion symptoms had to be appreciated. Possible relations of conversion disorders to affective illness, somatization disorder and neurologic disease had to be discussed as to course of illness and theoretical concepts.

Adaptation, Psychological↗

PubMed2005

Antidepressant treatment outcomes of psychogenic movement disorder.

BACKGROUND: Psychogenic movement disorder (PMD) is a subtype of conversion disorder. We describe the outcomes of a series of PMD patients following antidepressant treatment. METHOD: Twenty-three outpatients with chronic PMD, diagnosed using Fahn and Williams' criteria, underwent psychiatric assessment. The patients were referred for assessment and management from January 2003 to July 2004. Fifteen agreed to be treated with antidepressants. Patients received citalopram or paroxetine; those who did not respond after 4 weeks of taking an optimal dose were switched to venlafaxine. Concurrently, 3 had supportive psychotherapy, and 1 had family intervention. Assessments included the DSM-IV-based Mini-International Neuropsychiatric Interview and scales measuring depression, anxiety, and motor and global severity. RESULTS: Eighteen patients (78%) had at least 1 Axis I diagnosis in addition to the somatoform diagnosis, and 3 (13%) had somatization disorder. Five (22%) had previous psychiatric contact. Nine (39%) had previously been treated with antidepressants, but only 4 (17%) had adequate trials. No significant differences existed in patient characteristics between treated and untreated groups. Among treated patients, Montgomery-Asberg Depression Rating Scale scores improved from baseline (p < .01). Two treated subgroups were identified: 10 patients (67%) had primary conversion disorder, of whom 8 had marked motor and global improvements with 7 complete remissions, and 5 (33%) had primary hypochondriasis, somatization disorder, or probable factitious disorder/malingering, of whom none improved. All of the patients with primary conversion disorder had a current or previous depressive or anxiety disorder compared with 40% (N = 2) of the patients with additional somatoform diagnoses. DISCUSSION: Our preliminary findings suggest that chronic PMD with primary conversion symptoms and with recent or current depression or anxiety may respond to antidepressants. Further well-designed studies, now under way, are required to confirm these findings.

Adult↗

PubMed2002

Hysterical paralysis: a report of three cases and a review of the literature.

STUDY DESIGN: Three cases of hysterical paralysis are reported and the literature is reviewed. OBJECTIVE: To report and discuss three cases of psychogenic paraplegia in order to increase the awareness and assist in the diagnosis and treatment of this uncommon disorder. SUMMARY OF BACKGROUND DATA: Hysterical paralysis, a form of conversion disorder, is an uncommon psychogenic, nonorganic loss of motor function precipitated by a traumatic event. The prevalence of conversion disorder in the general population reportedly is between 5 and 22 per 100,000 persons. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. If early recognition can be facilitated, these resources may be conserved. METHODS: The medical records for three healthy young women who presented to the authors' service reporting complete loss of lower extremity function were reviewed retrospectively along with the related laboratory, electrodiagnostic, and imaging studies. Two of the women were involved in motor vehicle accidents. One had a history of a previous hysterical seizure. Inconsistencies in physical examination and studies were noted. RESULTS: All three patients had normal laboratory, electrodiagnostic, and imaging studies. Discrepancies included complete loss of motor control and sensation in the lower extremities in the face of normal deep tendon reflexes as well as incontinence of bowel and bladder despite intact rectal tone. The patients spontaneously recovered and ambulated out of the hospital without assistance after their normal test results and physical examination inconsistencies were presented to them. CONCLUSIONS: Hysterical paraplegia is a type of conversion disorder. It is a diagnosis of exclusion that typically presents as mono-, hemi-, para-, or quadriplegia. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. The typical patient is a female from a low socioeconomic background with limited education. The DSM-IV-TR criteria must be met to fulfill the diagnosis of conversion disorder. Electrodiagnostic and imaging studies can aid in the diagnosis. Treatment revolves around explaining the normal diagnostic results to the patients and guiding them to appropriate psychiatric and physiotherapy. Rapid recovery should be expected, but can take up to 6 months.

Accidents, Traffic↗

PubMed2004

Conversion and somatization disorders; dissociative symptoms and other characteristics.

OBJECTIVE: There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis. METHODS: We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale. RESULTS: The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders. DISCUSSION: As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.

Adult↗

PubMedDate not supplied

Course and outcome of conversion and somatization disorders. A four-year follow-up.

Although the two disease concepts have very different histories, many previous studies have mixed conversion disorder and somatization disorder and none has made direct comparison between them. The authors applied DSM-III criteria to inpatient and outpatient medical records and attempted to follow 98 patients who met criteria for somatization disorder or conversion disorder. Five of these patients died 4 years later and, of those who survived, 70 (75.3%) were given follow-up interviews by a rater blind to baseline diagnosis. The 32 patients with a baseline diagnosis of conversion disorder were significantly less likely than the 38 patients with somatization disorder to be given the same diagnosis at follow-up. Six of the conversion disorder patients were given follow-up diagnoses of somatization disorder and, in four other cases, subsequent developments revealed medical explanations for the presenting complaint. Of the two baseline diagnoses, somatization disorder predicted substantially more impairment in a variety of domains.

Adult↗

PubMed1997

Epidemiology of somatoform disorders: a community survey in Florence.

Since the exclusion of somatic causes is necessary for somatoform disorders (SMD) to be diagnosed, there is little information on the prevalence of such disorders in the community. As the method we have previously developed [general practitioners (GPs) with psychiatric training who interview samples representative of the general population] seemed to be appropriate to deal with the problem, we carried out a community survey focused on somatoform disorders. The prevalence rates of DSM-III-R somatoform disorders were studied in two wards of the city of Florence. In order to be representative of the general population, 673 subjects randomly selected were interviewed by their own GP. Four GPs, all with specific training in psychiatry, participated in the interviewing process. The 1-year prevalence figures were as follows: 0.7% body dysmorphic disorder; 4.5% hypochondriasis; 0.6% somatoform pain disorder; 0.3% conversion disorder; 0.7% somatization disorder; 13.8% undifferentiated somatoform disorder. No specific comorbidity was found between somatoform disorders and mood or anxiety disorders. Although the sample investigated was small, this study may be seen as one of the first in an area where knowledge is still scant. The prevalence rates of somatoform disorders were generally found to be slightly lower than expected.

Adolescent↗

PubMed1996

Neurobiological and psychopharmacological basis in the therapy of bulimia and anorexia.

1. Eating disorders can be found in several psychiatric pathologies: schizophrenia, delusional disorder (somatic type), bipolar disorders, major depressive disorder, borderline personality disorder, generalized anxiety disorder, body dysmorphic disorder, somatization disorder and conversion disorder. 2. Although their clinical features have been defined, relatively little is known about the role of neurobiological patterns in the pathogenesis of these disorders. Several CNS neurotransmitters and neuromodulators are involved in the regulation of eating behavior in animals and have been implicated in symptoms such as depression and anxiety often observed in patients with eating disorders. The authors will review some studies on NA, DA, 5-HT, beta-endorphins, CRH, VP, OT, CCK, NPY and PYY involved in eating disorders. Furthermore, we will highlight some of the studies on drug therapy of eating disorders taking into account the effects of these agents on neurotransmitters and neuromodulators. 3. Antidepressant drugs have long been used for anorexia nervosa and bulimia, these disorders been claimed to be affective equivalent. Antidepressant agents seem to be effective in reducing the frequency of binge-eating episodes, purging behavior and depressive symptomatology. It is notable that antidepressant agents have been proved to be effective in patients with chronic bulimic symptoms, even in cases persisting for many years and in patients who had repeatedly failed courses of alternative therapeutic approaches. In all of the positive studies, antidepressant agents appeared effective even in bulimic subjects who did not display concomitant depression. 4. Few controlled studies on use of medications for anorexia nervosa have been published. Central serotonergic receptor-blocking compounds such as cyproheptadine cause marked increase in appetite and body weight. Zinc supplementation or cisapride could be a therapeutic option in addition to psychological and other approaches in anorexia nervosa. 5. There is no therapy as yet which is fully effective in alimentary disorders. Psychotropic drugs give some relief from symptoms, but they cannot cure the disorders. An integrated approach, either pharmacological or psychological, is still recommendable.

Anorexia↗

PubMed2001

Dysthymic disorder: clinical characteristics in relation to age at onset.

BACKGROUND: The variability in the clinical presentation of dysthymia has given rise to a rich debate in literature, and various hypotheses have been proposed. One is that the clinical presentation differs in relation to age at onset. The aim of the study was to evaluate differences in socio-demographic and clinical characteristics in a sample of patients with dysthymia (DSM-IV), in relation to age at onset. METHOD: 84 consecutive outpatients with a diagnosis of dysthymia (DSM-IV) were studied. All subjects were evaluated by a semistructured clinical interview and the following rating scales: HAM-A, HAM-D, MADRS, Paykel's Interview for Recent Life Events. RESULTS: 23.8% of the sample had early-onset (<21 yrs) dysthymia. Patients with early-onset disorder were significantly younger at the observation, more frequently female and single. They had a significantly longer duration of illness and in a significantly higher percentage had already received a specialist treatment before admission in the present trial. No differences in the frequency of symptoms were observed. A significantly higher percentage of patients with late-onset disease reported at least one stressful event in the year preceding the onset of dysthymia. A positive history of major depression was significantly more common among the early-onset group; social phobia, panic disorder and conversive disorder were also more frequent in this group. The late-onset patients frequently presented generalized anxiety disorder, substance abuse and somatization disorder. LIMITATION: The study is retrospective and enrolls a limited number of cases. CONCLUSIONS: The present study agrees with other reports on the differences in clinical presentation of dysthymia according to age at onset. Although they are not actually related to age at onset, some interesting findings emerged in the symptomatological characterization of the disorder, referring to the diagnostic criteria proposed in DSM-IV.

Adolescent↗

PubMed2001

The association between mild traumatic brain injury and psychiatric conditions.

The majority of patients with mild traumatic brain injury (TBI) recover fairly quickly and are usually restored to their previous level of functioning. However, a significant minority have prolonged, complicated, or incomplete recoveries and have outcomes disproportionately worse than would have been predicted by the objective facts of the injury. This failure to recover as expected was the focus of this study. The participants were 80 adults with actual or suspected mild TBI who were referred to an outpatient mild TBI clinic. Most were characterized by problematic recoveries. The results indicated that those individuals who only had brain injuries made good recoveries, but that those with psychiatric comorbidity did not (chi(2) = 19.65, p = 0.0002). Most of the new psychiatric conditions responsible for poor recovery consisted of depression, anxiety disorders or conversion disorder. Dissociative phenomena appeared common after mild TBI and scores on the Dissociative Experiences Scale predicted brain injury outcome with 77% accuracy.

Adult↗

PubMed1997

Somatoform disorders in children and adolescents: a review of the past 10 years.

OBJECTIVE: To review the literature on somatoform disorders in children and adolescents relevant to recertification by the American Board of Psychiatry and Neurology. METHOD: The psychiatric, pediatric, and psychological literatures were searched for clinical or research articles in the past 10 years dealing with somatization and somatoform disorders. RESULTS: Somatizing presentations are organized conceptually; somatization disorder, body dysmorphic disorder, hypochondriasis, conversion disorder, vocal cord dysfunction, pain disorder, and recurrent abdominal pain are described in children and adolescents; empirical evidence for treatment efficacy is scant, but clinically reasonable approaches are applied. CONCLUSION: More developmentally appropriate diagnostic schemas and better outcome studies are needed in all the somatoform disorders for children and adolescents.

Adolescent↗

PubMed1995

Somatoform pain disorder in a case of Klinefelter's syndrome with multiply operated lower back.

We report a case of Klinefelter's syndrome with multiply operated low back (MOB). Psychological and/or psychosocial problems related to MOB have been of recent interest in the field of orthopedic surgery. Based on psychiatric interviews, this case was diagnosed as a somatoform pain disorder of the DSM-III-R somatoform disorders. In addition to psychological problems, the pain was partly explicable by severe osteoporosis, which was prematurely caused by endocrinological disturbances associated with Klinefelter's syndrome. Patients with this syndrome are more likely to develop severe osteoporosis. In the presenile period of Klinefelter's syndrome with severe osteoporosis, liaison psychiatrists may pay attention to somatoform disorders (e.g. somatoform pain disorder and conversion disorder) linked with the MO.

Bone Density↗

PubMed2002

[Burning mouth syndrome and depression: a case report].

We present a 63-year-old male patient with major depression, characterised by prominent somatic symptoms localised especially around the mouth, whose complaints started just after a prostate operation. The symptoms consisting of burning in the mouth, pain, dry mouth (xerostomia), an unpleasant and strange feeling of taste and itching, are all consistent with burning mouth syndrome. Burning mouth syndrome is a common disorder, usually affecting elderly females, characterised by intractable pain and burning in the oral cavity, evident especially in the tongue, together with a normal mouth mucosa. In the scientific literature a variety of terms are used to describe similar symptoms, such as glossodynia, glossopyrosis, stomatodynia and oral dysestesia. Most patients suffer from the syndrome for a long time, ranging from months up to years. The onset was reported to be gradual for most of the subjects, although many patients relate the onset of symptoms to previous dental procedures or to a previous medical illness. Burning mouth syndrome has a multifactorial etiology. Anxiety disorder, hypochondriasis, conversion disorder and especially depression may be considered amongst the psychological factors responsible for this situation. The psychological findings in burning mouth syndrome patients may be either the consequence of the chronic pain condition or its cause. It is well known that those patients had a relatively high percentage of psychiatric or psychological treatment in the past and/or present. After excluding organic factors, depression should be considered in old patients with predominant mouth complaints.

English Abstract↗

PubMed2006

Clinical profile of depressive disorder in children.

The aim of this retrospective study was to evaluate the risk factors, clinical features and co-morbid disorders of depressive disorder in children below the age of 12 years. Children who attended the child guidance clinic between January 2000 and December 2003 formed the subjects for the study. The diagnosis of depressive disorder was based on DSMIV diagnostic criteria for Major Depressive Disorder, Single episode. There were 26 boys and 19 girls. Stress at school and in the family was significantly associated with depressive disorder. Children with depressive disorder had significantly more family members affected with mental illnesses. The clinical features included diminished interest in play and activities, excessive tiredness, low self- esteem, problems with concentration, multiple somatic complaints, behavior symptoms like anger and aggression, recent deterioration in school performance and suicidal behavior. Majority of children had other associated psychiatric disorders which included dysthymic disorder, anxiety disorders, conduct disorder and conversion disorder.

Child↗

PubMed2002

Conversion sensory symptoms associated with parietal lobe infarct: case report, diagnostic issues and brain mechanisms.

This case report suggests that diagnostic difficulties and brain mechanisms related to conversion disorder associated with cerebral lesions differ from those related to conversion disorder without cerebral lesions. A 35-year-old divorced woman was admitted to a psychiatric inpatient unit with multiple physical complaints. The symptoms first appeared 5 years previous and 2 months after a sexual assault. Three years later, she began to experience ill-defined sensory symptoms confined to the left half of her body (splitting the midline). Results of neurologic consultations were equivocal because of the subjective nature of the complaints, which were viewed as conversion symptoms. A magnetic resonance imaging scan demonstrated an old infarct in the right parietal lobe, suggesting a physical origin of the patient's symptoms. However, normal somatosensory-evoked responses from the affected area contributed little to establishing the diagnosis. The results of all further investigations to identify causes of the vascular pathology were negative. The multiple ill-defined somatic symptoms, the distribution of sensory symptoms and the resolution of symptoms with psychotherapy established the diagnosis of conversion disorder superimposed on a pre-existing right parietal lesion. This case highlights the importance of clinical features in establishing a diagnosis such as this. We suggest that reactivation of implicit sensory memories (represented at the thalamic level and resulting from decreased corticofugal inhibitions due to the lesion) may contribute to the formation of sensory conversion symptoms in individuals with parietal lobe lesions.

Adult↗

PubMed1992

Neuropsychological and psychiatric correlates of intractable pseudoseizures.

Psychogenic seizures can mimic convulsive epilepsy and with repetitive attacks, iatrogenic complications from aggressive treatment of status epilepticus can occur. We studied neuropsychiatric features of 20 patients in whom psychogenic seizures were intractable and at times continuous. Nineteen of 20 patients seen were female, and all but one were under 40 years of age. All had convulsive attacks resistant to various medications, normal neurological examinations, and negative imaging studies and electroencephalograms (EEGs). Sixteen had previous evidence of epilepsy and the other four had epileptic relatives. Seizures were atypically prolonged, included back arching and pelvic thrusting, and persisted despite intravenous diazepam and therapeutic phenytoin and phenobarbital levels. Seizures terminated spontaneously in five, were stopped by suggestion in four, and persisted until respiratory arrest or elective intubation in 11. Ten patients had conversion disorder, six borderline or mixed personality disorder and four mental retardation. Fifteen had had some precipitating stressor and the remainder had histories of exhibiting attention-seeking behaviour. Nine of 10 patients with conversion disorder had 'conversion V' Minnesota Multiphasic Personality Inventory (MMPI) profiles, while personality disorder patients had elevation of several psychopathological scales. Patients with conversion disorder gradually improved with anticonvulsant discontinuation, while retarded individuals were helped by behaviour modification, situational change or neuroleptics. Personality disorder patients continued to have attacks and eventually discontinued follow-up. Clinical evidence of non-epileptic seizures includes clinical atypicality and long duration, exacerbation by medications and frequent attacks despite normal examination and studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗