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PubMed1980

Diagnosis and management of hysteria.

Patients with the diagnosis of hysteria are a perennial management problem for the nonpsychiatric physician. Hysteria is an operationally defined clinical entity characterized by onset before age 30 and by multiple medically unexplainable symptoms. Such patients should be differentiated from those with psychiatric disorders resulting in somatization, especially conversion disorders, and should be managed in such a way as to minimize sick-role incapacitation and reduce injudicious use of medication, medical procedures, and hospitalization.

Adult↗

PubMed2006

People with MECP2 mutation-positive Rett disorder who converse.

BACKGROUND: People with useful speech after regression constitute a distinct group of those with mutation-positive Rett disorder, 6% (20/331) reported among mutation-positive people in the British Survey. We aimed to determine the physical, mental and genetic characteristics of this group and to gain insight into their experience of Rett syndrome. METHODS: Clinical and molecular data for people with Rett, aged 10 or more years at follow-up (the study group, n = 13), with the ability to converse and a MECP2 mutation are presented. They were compared with an age-matched control group (n = 110), who could not converse and had a pathogenic MECP2 mutation. RESULTS: The study group differed significantly from the control group with regard to their disease severity (P < 0.001); feeding difficulty scores (P < 0.001); health scores (P < 0.001); epilepsy (P < 0.001); head circumference (P < 0.004); age at onset of the regression period (P < 0.001) (six in the study group did not regress) and mutation frequency (C-terminal deletions P = 0.014, R133C P < 0.006). The results indicate that favourable skewing of X-inactivation is only present in a small proportion of mild cases. Speech was fragmented with a soft, breathless quality, and all but two had obviously irregular breathing. One person with an R168X mutation preferred signing to speech. All enjoyed interpersonal contact, showing affection and preferring people to objects, clearly distinguishing the condition from autism. Most were habitually anxious. Music was a source of pleasure and relaxation also providing a valuable educational asset. Even in these most able cases, understanding was severely restricted in most and little initiative was shown. CONCLUSIONS: While the Rett profile is present in these people they are commonly not classic, and the presence of speech, good head growth and lack of regression may lead to missed diagnoses. A strong association was demonstrated between this milder form of the disease and R133C and C-terminal deletions.

Adult↗

PubMed2002

Clinical presentations in neuropsychiatry.

In this report, the special clinical presentations found in neuropsychiatry are discussed. The point is made that conventional diagnostic schedules such as DSM-IV do not serve neuropsychiatry well, and have contributed to a failure to view neuropsychiatry as an independent specialist discipline. In this review some of the characteristic neuropsychiatric syndromes seen in epilepsy, movement disorders, demyelinating, and cerebrovascular diseases are described, followed by a brief discussion of conversion disorder. A plea is made that any future diagnostic schedules contain references to neuropsychiatric disorders and presentations.

Cerebrovascular Disorders↗

PubMed2002

Motor initiation and execution in patients with conversion paralysis.

Motor initiation and motor execution in four patients with conversion paralysis were investigated in a non-affected motor modality (speech). In line with the hypothesis of dissociated control in conversion disorder [Cognit. Neuropsychiatry 8 (1) (2001) 21] motor initiation, but not response duration, was expected to be impaired. The motor initiation times (reaction time: RT) and motor execution times (response duration: RD) were compared on four RT-tasks that required the production of a verbal response: a simple choice RT-task, a mental letter rotation task, and an implicit and an explicit mental hand rotation task. Because conversion disorder is expected to primarily involve an impairment in the initiation of movement, we expected the following task characteristics to uniquely affect RT and not RD: type of instruction (implicit versus explicit instructed imagery), angle of rotation, and target arm (affected versus non-affected arm). The results indeed showed the task characteristics to significantly affect the participants' RT and not their RD. It was concluded that conversion paralysis is associated with a specific impairment in the explicit initiation of processes with a spatial and motor component.

Adult↗

PubMed2005

Abnormal brain activation during movement observation in patients with conversion paralysis.

Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.

Adult↗

PubMed2001

Psychological factors and hyperemesis gravidarum.

Hyperemesis gravidarum (HG) is a condition of severe, intractable nausea and vomiting during pregnancy. It has long been held that HG is a psychosomatic illness reflective of a long-term psychological trait, that is, conversion disorder. We investigated this possibility by conducting a two-phase study: (1) a comparison of women with (n = 9) and without (n = 10) HG during pregnancy and (2) a comparison of nonpregnant women who did (n = 10) and did not (n = 12) have HG during their most recent pregnancies. The pattern of findings differed between experiments 1 and 2. During pregnancy, women with HG scored significantly higher on three scales associated with conversion disorder (all p values <0.01) than did women without HG. There were no significant differences between HG subjects and controls after pregnancy. We find no support for the theory that HG is a psychosomatic condition. Rather, it appears to be a complex interaction of biological, psychological, and sociocultural factors.

Adult↗

PubMed2005

Dissociation in children and adolescents as reaction to trauma--an overview of conceptual issues and neurobiological factors.

The discovery of trauma as an aetiological factor in mental dissociation is more than a century old, but neurobiological research in the last decade has started to clarify a neurobiological basis that may shed light on the complex symptomatology observed in traumatized children. Dysfunctional stress responses, emotional-based style of functioning, hyperarousal, anxiety, irritability, impulsivity, disengaged attention and educational underachievement may thus begin to be better understood. The aim of this overview is to give an update on the concept of dissociation and the links to new neurobiological findings, hopefully to reduce unawareness, wrong diagnostics or even neglect of dissociative symptomatology by clinicians in child and adolescent psychiatry in the Nordic countries. A systematic overview of studies of mental dissociation in children and adolescents published over the last decade disclosed a total of 1019 references; 309 papers regarding the concept of dissociation, memory, trauma and the neurobiological correlates were studied in detail. The assumption of a trauma-genic basis of dissociation is still most discussed in the literature. The importance of other childhood trauma in addition to sexual abuse is outlined, focusing on childhood interpersonal trauma. Recent research on traumatized children and adolescents has demonstrated some permanent neurochemical as well as functional and structural abnormalities in brain areas that are involved in the integrative process of cognition and memory. This research begins to clarify the cerebral basis and mechanisms for the trauma-related dissociation observed in dissociative (conversion) disorders, post-traumatic stress disorder (PTSD) and somatoform disorders. New perspectives on the nature of subcortical processes linking the phenomena of dissociation and traumatic experiences may have important implications for the understanding of dissociative disorders in children and adolescents. They may be regarded as complex environmentally induced developmental, supporting the view that PTSD and somatization disorders may be specific forms of dissociative processes to be categorized together with dissociative (conversion) disorders as "trauma-related dissociative disorders".

Adolescent↗

PubMed1994

[Psychogenic thoracic pain attacks. Pathogenesis, follow-up, therapy].

Over a five-month period a 10-year-old girl presented repeatedly with attacks of chest pain that were eventually diagnosed as a conversion disorder (DSM-III-R). A detailed case report of the (just) three sessions with both mother and daughter is given and the process of identifying the conflict constellation (death of a loved one, reproachful attitude toward the mother), aspects of primary and secondary gain, and factors influencing choice and localization of the pain symptoms (models: father and brother) are discussed. The therapeutic lead-in was achieved by noticing and inquiring about the patient's equivocal use of the term "joke" during an interview and in a projective sentence completion test. The therapeutic approach comprised psychoanalytically oriented components, elements of family therapy, suggestive measures, exercises and counseling. Over a follow-up period of two years the patient remained symptom-free and her further development was unproblematic. Aspects of this case that are typical of conversion disorder and factors indicating a good prognosis are discussed with reference to the literature.

Chest Pain↗

PubMedDate not supplied

Camptocormia: a biomechanical analysis. A case report.

Although camptocormia, a conversion disorder associated with the disability of severely forward-bent posture, has been reported in the literature, to date there has been no report of a detailed kinematic or biomechanical analysis of this disability. Presented is a 47-yr-old male engineer with severely forward-bent posture during walking. One year ago, after playing tennis, he developed low back pain followed by a sensation that to walk comfortably he had to assume a forward-bent posture. Two months later, although the low back pain had resolved, he maintained the same unusual walking pattern. Although he could walk a few steps in the upright position, he would spontaneously revert to the forward-bent posture. Physical examination was normal except for bilateral 10 degree hip flexion contractures. Gait laboratory analysis, including kinematics, kinetics, and dynamic electromyography, revealed exaggerated anterior pelvic tilt during terminal stance when he walked in an upright posture. In the forward-bent posture, however, this anterior pelvic tilt was significantly less. It is possible that his unusual forward-bent posture was a compensatory mechanism to reduce excessive pelvic tilt. Although this rare disability has been previously attributed to a conversion disorder, there may be, in some instances, a biomechanical component.

Biomechanical Phenomena↗

PubMedDate not supplied

ICD-10 mild cognitive disorder following meningitis due to neurosarcoidosis.

We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder as a diagnostic entity, our patient met the criteria for it. The reported case exemplifies the difficulties in classifying mild cognitive deficits in patients suffering from brain diseases without major morphological damage.

Adult↗

PubMed1983

Briquet and Briquet's syndrome viewed from France.

Briquet's contributions to the description of hysteria have been almost completely forgotten in France. One may wonder how he, as well as contemporary French psychiatrists, would react to the approach to hysteria introduced and officialized by DSM III. In particular, its fragmentation into syndromes without apparent link to each other (psychogenic amnesia, conversion disorders, histrionic personality disorder, etc.) and its psychological causation, unbalanced by the consideration of organic factors in etiology, may raise questions. The correlation of conversion disorders with hysterical personality remains a feature of the WHO classification (ICD 9), as well as a feature of French contemporary texts, although it is no longer viewed as a regular association by American psychiatry. It may be that cultural factors lead, as suggested by Brisset, to a repression of conversion phenomena and of hyperexpressivity of affects replaced by more psychosomatic disorders in many contemporary societies. Finally, one may question whether the choice of the term "Briquet Syndrome" is appropriate, as many of the patients described by him did not have the chronic and malignant course described by Guze: It tends to limit hysteria to one end (the most severe one) of a spectrum of disorders.

Cross-Cultural Comparison↗

PubMedDate not supplied

Nonepileptic events in normal and neurologically handicapped children: a video-EEG study.

Nonepileptic episodic phenomena are reported in 27 of 124 children (21.8%) who had video-electroencephalographic studies performed. Mean age was 7.4 years (S.D.: 6.0; range: 0.1-19). Nineteen (70%) were neurologically impaired (Group 1) and 8 (30%) neurologically normal (Group 2). The final diagnoses included movement sequences (48%), conversion disorder (22%), behavioral staring (18%), sleep disorder (11%), behavioral episodes (8%), and central apnea (8%). In Group 1, abnormal movements (58%) and staring (26%) were most common; conversion disorder (62.5%) was most common in Group 2. Unnecessary medication therapy was prevented in many children. Video-electroencephalography is valuable in preventing over-medication and misdiagnosis.

Adolescent↗

PubMedDate not supplied

[Somatomorphic and factitious disorders. Our experience in a regional reference neuropaediatric department].

INTRODUCTION AND OBJECTIVES: Children often consult for fictional or very exaggerated symptoms, grouped together as factitious disorders (TF), disorders due to somatomorphic pain (TDS), disorders due to somatization (TS) and conversion disorders (TC). Patients and method. We studied cases of TF, TDS, TS and TC evaluated by the neuropaediatric department of the Hospital Miguel Servet de Zaragoza between May 1990 and August 2001. RESULTS: There were 134 children identified as having TF TDS TS TC: There were 91 girls (67.9%) and 43 boys (32.1%). They made up 2.47% of the 5,417 children included in the neuropaediatric data base. The mean age was 10 years and 9 months, ranging between 3 and 16 years with only 9 children aged under 7 years. The commonest syndromes were: paroxystic disorders, headache, other pain, paraesthesia, hypovision, and other visual alterations, paresias, tremors and other disorders of movement, disorders of gait, lack of air, hyperventilation and dysphagia. There was often more than one motive for consultation, with sometimes more than four. The commonest complementary tests done were: EEG, fundus oculi, cranial CAT scan, CPK, EMG/ENG, cranial MR, spinal MR, CSF and osseous gammography. No further studies were made of 12 children (9%). CONCLUSIONS: The TF TDS TS TC are a common cause of assessment in neuropaediatric practice. It should be suspected in cases of multiple symptoms in children aged over 6 years, usually in girls. It is often necessary to carry out various complementary tests to rule out organic disorders.

Adolescent↗

PubMed2002

Conversion motor paralysis disorder: overview and rehabilitation model.

It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)-'Conversion Motor Paralysis'. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.

Behavior Therapy↗

PubMed2004

Complex regional pain syndrome as a stress response.

A man in his 50's with a prior traumatic brain injury and multiple psychiatric disorders developed acute pain and swelling in his left leg distal to the mid shin. These symptoms arose during an exacerbation of his post-traumatic stress disorder (PTSD). Among his traumatic memories, he reported having witnessed the combat injury and death of a friend who had lost his left leg distal to the mid shin. A diagnosis of conversion disorder was technically excluded because the findings met criteria for Complex Regional Pain Syndrome (CRPS) type I. Based on recent research into the neurobiology of CRPS, PTSD and conversion disorder, we propose a supraspinal mechanism which could explain how emotional stress can produce both symptoms and signs.

Antidepressive Agents↗

PubMedDate not supplied

Order and disorder in conversation: encounters with dementia of the Alzheimer's type.

After a brief introduction to Dementia of the Alzheimer's Type (DAT), its behavioral diagnostic symptom complex and a summary of communicative implications, we present data from two conversations involving participants with and without DAT. We discuss the concept of "order" in conversation, and the central importance of interactional monitoring. Conversational success and problems in interactions with persons with DAT are seen as emergent from situationally embedded conversations in the presence of cognitive and linguistic impairments on the part of the person with DAT, and of contextually situated communicative impairment resulting therefrom.

Aged↗

PubMed2000

[Psychogenic paralysis. A prospective study].

INTRODUCTION: Patients with motor conversion disorder are frequently seen in neurological departments. Long term prognosis is usually considered to be good, although earlier research has been somewhat unsystematic and mostly retrospective. This study follows a well investigated sample of patients for two to five years and attempts to identify predictors associated with prognosis. MATERIAL AND METHODS: Thirty patients with a recent onset of motor conversion disorder were assessed for key psychiatric and demographic variables. They were reassessed two to five years later. RESULTS: Nineteen patients had recovered completely and eight patients had improved, while only three patients were unchanged or worse. Contrary to other follow-up studies none of the patients received a rediagnosis of neurological disease. The presence of a personality disorder, concomitant somatic disease, and low DSM-IV axis V score proved to be associated with poor outcome. DISCUSSION: The results of this study stresses the need for careful and well-conducted neurological and psychiatric assessments in patients with psychogenic paralyses, bearing in mind the substantial possibility for coinciding illnesses. If this is ensured, it appears that the risk of subsequent neurological rediagnosis is negligible.

Adolescent↗

PubMed2005

Reevaluating spells initially identified as cataplexy.

BACKGROUND AND PURPOSE: Cataplexy, transient episodes of bilateral muscle weakness with areflexia provoked by emotions, is a state highly specific to narcolepsy. Cataplexy is diagnosed based on clinical interview. Two screening tools have been developed recently but their usefulness has been limited because of length or current lack of psychometric data. Used effectively even these screening tests require the interpreting physician to have an understanding of the typical features of cataplexy. Most physicians encounter patients with cataplexy fairly infrequently, making it difficult to gain proficiency in detecting cataplexy based on clinical interview alone. Relatively little attention has been given to the differential diagnosis of cataplexy, which increases the likelihood of unnecessary sleep testing or false positive diagnosis. PATIENTS AND METHODS: This case series describes six cases where cataplexy was initially diagnosed. In all cases the weakness spells were eventually not attributed to cataplexy. The presentation and characteristics of these cases will be presented as a means to discuss the differential diagnosis of cataplexy. RESULTS: These cases represent a diverse set of medical disorders including bradycardia, migraine, delayed sleep phase syndrome, conversion disorder, malingering and a chronic psychotic disorder. CONCLUSIONS: A more in-depth understanding of the classic features of cataplexy should improve recognition of this fascinating state. Improved cataplexy recognition will enhance the appropriate usage of sleep tests and eventually increase the timeliness and accuracy of the diagnosis of narcolepsy with cataplexy.

Adolescent↗