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PubMed2004

Lewis and Clark treat a case of paralysis: speculation on the etiology of the problem.

In their monumental journey across North America and back, the explorers Lewis and Clark encountered and treated a Native American Chief with flaccid paralysis of about five years duration. The etiology of the paralysis is unclear from the historical sources. Intracranial, spinal cord, neuropathic, neuromuscular and muscular diagnoses are possible. The diagnosis that appears best to fit the case, however, is conversion disorder. In spite of limited diagnostic and treatment resources, the unfortunate man was apparently treated successfully.

Conversion Disorder↗

PubMed1998

An epidemic of collective conversion and dissociation disorder in an indigenous group of Colombia: its relation to cultural change.

We describe a collective episode of psychogenic illness in an indigenous group (Embera) of Colombia, geographically isolated from its native homeland and surrounded by non-indigenous settlers. The condition, which affected three young adult men and six adolescent women, was attributed by them to a spell (maleficio). It was designated as ataques de locura (madness attacks) according to their traditional medical system; and as a conversive disorder with dissociative features by psychiatrists. Different therapeutic approaches, including antipsychotic medication, religious healers and traditional herbal remedies were unsuccessful. Contact with shamans of the same ethnic origin, on the other hand, proved to be an effective way of dealing with the symptoms. We interpret the situation as an expression of psychosocial stress secondary to cultural change. This medical problem bears close resemblance to other specific culture-bound syndromes such as ataques de nervios or possession syndromes and gives clues to ways of dealing with psychogenic expressions of cultural stress.

Adolescent↗

PubMed2001

Nondominant hemisphere lesions and conversion nonepileptic seizures.

To explore the hypothesis that lateralized hemispheric dysfunction may contribute to the development of conversion symptoms, the authors studied frequency of unilateral cerebral physiological or structural abnormalities in 79 consecutive patients with conversion nonepileptic seizures (C-NES), who were also compared with two groups of epilepsy patients without C-NES. Sixty (76%) of the C-NES patients had unilateral cerebral abnormalities on neuroimaging, of which 85% were structural. Ictal or interictal epileptiform abnormalities on EEG were found in 78% of C-NES patients and focal slowing in another 10%. Fifty (63%) of the C-NES patients had both structural and epileptiform abnormalities. Among the 60 with unilateral abnormalities, 43 (71%) had right hemisphere structural lesions or physiologic dysfunctions (C-NES>non-C-NES, P<0.02). This study supports prior studies and clinical observations that cerebral dysfunction can contribute to the pathogenesis of conversion disorder, and that nondominant hemisphere dysfunction may play a greater role.

Adolescent↗

PubMed2006

[Unexplained somatic symptoms and underlying psychologic disorders in the neurology clinic].

The aim of our study was to determine pseudoneurological symptoms (PNS) and related mental disorders among patients referred to the neurology clinic. All cases of somatoform disorders (SD) as main discharge diagnosis, made on the basis of neuropsychiatric interview after exclusion of neurological disease, have been retrospectively reviewed. Among 623 patients, hospitallized to the Institute of Neurology between 2000-2001 years, SD prevalence was 3,69%, where conversion disorder accounted for 69,6% and somatization disorder - for 13%. Mean age was 27,8 (+/-10,1) and female/male ratio was 1,55. Results show that PNS appear to be a good marker of SD. We suggest that early detection of PNS would provide a correct management of patients.

Adolescent↗

PubMed1999

Pseudo-narcolepsy: case report.

This report describes the case of a 44-year-old woman presenting to a Sleep and Alertness clinic with symptoms of narcolepsy. The patient had clinical and polysomnographic features of narcolepsy, which disappeared after disclosure of severe psychological stress. Following a discussion of the differential diagnosis of narcolepsy, alternative diagnoses are considered. The authors suggest that the patient had a hysterical conversion disorder, or "pseudo-narcolepsy." Careful inquiry into psychological factors in unusual cases of narcolepsy may be warranted.

Adult↗

PubMed2005

Three extraordinary complications of adenotonsillectomy.

In a 6-month period, three patients aged 5-11 years were transferred to our tertiary care children's hospital for management of severe complications following adenotonsillectomy. The first patient presented with headaches and lethargy and was found to have a sagittal sinus thrombosis from severe dehydration. The second patient was admitted immediately following an intra-operative oral cavity fire due to electrocautery malfunction. She suffered partial-thickness burns to the buccal mucosa, palate, and lips. The third patient was admitted with torticollis. Grisel's syndrome was initially suspected, but a thorough work up resulted in the diagnosis of a conversion disorder. These cases comprise an interesting cohort of three little-known complications of adenotonsillectomy.

Adenoidectomy↗

PubMed1989

'Bhanamati' sorcery and psychopathology in south India. A clinical study.

We describe the patterns of illness attributed to sorcery among 209 patients who attended a special clinic in south India. Somatisation and conversion disorders accounted for the majority of patients, although several other psychiatric and medical disorders were also seen. Aspects of treatment of such patients in the sociocultural context are discussed.

Adolescent↗

PubMed2002

Motor imagery during hypnotic arm paralysis in high and low hypnotizable subjects.

Previous research suggests that conversion disordered patients with hand/arm paralysis exhibit slowed reaction times for mental hand-rotation tasks that correspond to their affected arm when the tasks are explicitly instructed and not when they are implicitly cued. Because of the many similarities between hypnotic phenomena and conversion symptoms, the authors tested whether similar motor imagery impairment would occur among normal high hypnotizable subjects when paralysis is suggested. Nine high and 8 low hypnotizable subjects were administered an implicit and an explicit mental hand-rotation task during hypnotically suggested paralysis of the right arm. On the implicit task, there were no significant reaction time (RT) differences between highs and lows. On the explicit task, only highs showed a significantly larger RT increase per degree of rotation with the paralyzed arm, compared to the normal arm. These preliminary findings suggest that the motor imagery impairment observed in conversion paralysis can be induced in highs using hypnosis.

Adult↗

PubMedDate not supplied

Psychogenic hearing loss with panic anxiety attack after the onset of acute inner ear disorder.

A very rare case of a 50-year-old female showing psychogenic hearing loss with a panic anxiety attack that complicated an acute organic sensorineural hearing loss is reported. At the first visit to our clinic, the patient showed left sensorineural hearing loss with an inner ear disorder pattern. Five days after the onset, her left hearing threshold markedly increased without any subjective signs. On the next day, she suddenly experienced a severe panic attack with anxiety. After the attack, she felt mildly anxious and depressed. A combined therapy using primary corticosteroid therapy for the acute inner ear disorder, psychiatric counseling based on cognitive therapy and the administration of a minor tranquilizer was performed. Her left hearing threshold recovered to within normal ranges except in the high-frequency ranges immediately after the treatment. This case was considered very rare because: (1) the panic anxiety attack occurred in the conversion disorder as psychogenic hearing loss and (2) the psychogenic hearing loss complicated the primary sudden deafness. We suggest that otorhinolaryngologists should have psychiatric knowledge and be able to treat psychogenic hearing loss as a primary care.

Acute Disease↗

PubMed2004

Role of imaginary companion in promoting the psychotherapeutic process.

An imaginary companion (IC) has been considered to be a transitory phenomenon sometimes seen in the normal developmental process of children. In recent years, however, it has been observed that ICs are related to various disorders, and their clinical significance is again attracting notice. Although an IC may in certain ways aggravate the patient's symptoms and regression, an IC may also serve to advance the therapy, for example by indicating the location of the patient's troubles, or acting as an intermediary between the therapist and patient. In cases of dissociative (conversion) disorders, it is generally difficult for patients to verbalize their troubles, but the present patients gained insight into themselves by closely examining their ICs. Imaginary companions are not simply entities incidental to the disorder, and by incorporating them into the therapeutic strategy as a presence supporting the patient's growth, it is possible that the psychotherapy may proceed more smoothly.

Adolescent↗

PubMed1985

Akinesia and mutism following a methylphenidate challenge test.

A case of akinesia and mutism is described in a menopausal, depressed woman with onset following a mood challenge with 40 mg of methylphenidate taken orally over a 3-hour period. Various diagnoses are considered with preference given on clinical grounds to conversion disorder precipitated by drug-induced dysphoria. It is suggested that increased susceptibility to dysphoria may have been related to prior clomipramine administration and hypoestrogenism.

Adult↗

PubMedDate not supplied

Unexpected neurologic deficit following spinal anesthesia.

BACKGROUND AND OBJECTIVES: A case of unexpected neurologic deficit of the left lower extremity following a successful spinal block is reported. METHODS: A spinal block was performed in a 45-year-old woman with a 25-gauge Whitaker needle at the L3-L4 interspace. After establishing flow of clear cerebrospinal fluid, 1.6 mL of 0.75% bupivacaine was injected into the subarachnoid space. The patient had a good motor and sensory block (level T4), and she underwent uneventful extracorporeal shock wave lithotripsy of a right kidney stone. After satisfactory recovery in the postanesthesia care unit, she was transferred to the ambulatory surgical center for further recovery and discharge home. RESULTS: About 11 hours after administration of the spinal anesthetic and recovery from the spinal block, the patient complained of not being able to move her left leg. Neurologic examination revealed motor loss and hyperesthesia to touch, vibration, pressure, and temperature from her groin to toes in the left leg only. The remainder of the neurologic examination was normal. A nuclear magnetic resonance scan of the spine revealed no abnormality. Neurologic and psychiatric consultations were sought, and the patient was diagnosed to have a conversion disorder. She responded to psychological intervention and returned to her previous state of health in 2 weeks. CONCLUSIONS: Neurologic deficit following spinal or epidural block should be investigated completely and appropriate consultations sought. Psychiatric disorder may be a rare cause of neurologic deficit after successful regional anesthesia and should be made part of a complete workup.

Anesthesia, Spinal↗

PubMedDate not supplied

The attribution of affect in pain clinic patients: a psychophysiological study of the conversion process.

In a study to examine the relationship between the conversion process and physiological correlates of emotional arousal, three key elements of conversion were assessed separately in patients experiencing chronic pain for which no adequate somatic cause could be demonstrated. Thirty-seven patients referred to a pain clinic were categorized as members of either high, intermediate, or low conversion groups on the basis of their scores on the Disease Conviction, Affective Disturbance and Denial scales of the Illness Behaviour Questionnaire (IBQ). All patients scored in the high range on Disease Conviction. High conversion patients acknowledge little dysphoric affect and denied life problems apart from physical illness. Intermediate conversion patients also denied life problems other than somatic, but acknowledged high levels of dysphoria. Low conversion patients reported dysphoria and acknowledged life problems which they did not attribute to physical illness. The prediction that the high conversion group would show lower levels of resting skin conductance than the low conversion group was confirmed. Patients in the intermediate conversion group resembled those in the high conversion group in that their resting skin conductance was significantly lower than that observed in members of the low conversion group. These findings are consistent with those of previous studies of conversion disorders. They point to the importance in these conditions of the interaction between dysphoria and the cause to which it is attributed by the patient.

Adult↗

PubMed1988

Neuropsychiatric assessment of a spinal cord injury patient with sudden recovery.

Reported here is the case of a 23-year-old man who, presenting as a spinal cord injury patient with paraplegic and bilateral sensory impairments in the legs, made a rather dramatic recovery after receiving a trivial jolt while moving about in his wheelchair. In addition to clinical findings, both hypnotic and somatosensory evoked potential test results were used to help determine whether there was or was not actual spinal cord injury and whether there was or was not a psychologic overlay involving either malingering or a conversion disorder. In this case, evidence pointed to malingering in the presence of a minor spinal cord injury documented by somatosensory evoked potential patterns.

Adult↗

PubMedDate not supplied

[Psychogenic tremor: clinical, electrophysiologic and psychopathologic assessment].

There are few studies analyzing the incidence, clinical characteristics and diagnostic work-up of psychogenic tremor. We studied the clinical and electrophysiological characteristics and the associated psychopathology in a series of patients with psychogenic tremor. All patients (n = 8) diagnosed with documented or clinically established psychogenic tremor in the movement disorders section of our Department of Neurology in a two-years period were analysed. Psychogenic tremor was diagnosed in 9.5% of the patients that consulted for postural or action tremor of the upper limbs. In all cases tremor had a variable frequency and amplitude and improvement with distraction. Electrophysiological studies revealed asynchronic muscle activity and considerable variation of the dominant frequency when weight was added to the patient hands. Six patients were initially misdiagnosed of essential tremor (n = 3); Parkinson's disease (n = 1); and cerebrovascular disease (n = 2). Final psychiatric diagnoses were depression (n = 4); conversive disorder (n = 2); and malignering (n = 2). Psychogenic tremor is a relatively frequent cause of tremor in a Movement Disorders Clinic and has a characteristic clinical and electrophysiological pattern.

Adult↗

PubMed1998

Unrecognized Tourette syndrome in adult patients referred for psychogenic tremor.

BACKGROUND: The diagnosis of Tourette syndrome may be overlooked in patients with severe psychopathologic disorder but mild motor manifestations of Tourette syndrome. OBJECTIVE: To describe 4 patients with long-lasting general psychopathologic disorder and previously unrecognized mild motor and phonic tics exacerbated during adulthood by the onset of tremor; all of the patients had been referred for the evaluation of psychogenic tremor. SUBJECTS: Four adult patients, with previous psychiatric diagnoses of depression (2 cases), generalized anxiety disorder (3 cases), malingering (1 case), and conversion disorder (3 cases). METHODS: Single case studies. RESULTS: Clinical interviews disclosed that the 4 patients had positive family histories of Tourette syndrome, and all had mild motor and phonic tics that had started before the age of 18 years. On neurologic examination, 2 patients had bilateral postural tremor of the hands that varied in frequency, rhythmicity, and amplitude, and the other 2 had resting tremor mimicking parkinsonism. All 4 patients described involuntary somatic sensations of the affected limbs, which they attempted to alleviate by executing movements. No consistent positive placebo response was observed, but in all patients tremoric movements improved with haloperidol. CONCLUSIONS: These cases illustrate an unusual movement disorder (tremor as a "tic equivalent") in adults with Tourette syndrome and emphasize that cases of the syndrome with mild tics often go unrecognized, precluding adequate treatment.

Adult↗

PubMed1986

Mutism: review, differential diagnosis, and report of 22 cases.

Mutism is a common manifestation of both psychiatric and neurologic illness. Psychiatric disturbances associated with mutism include schizophrenia, affective disorders, conversion reactions, dissociative states, and dementias. Neurologic disorders producing mutism involve the basal ganglia, frontal lobes, or limbic system structures. In psychiatric and neurologic conditions, mutism is often associated with other signs of catatonia. The authors review the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes. Methods to discriminate among the many causes of mutism in the clinical setting are discussed, and 22 new cases of mutism are reported to emphasize the wide differential diagnosis.

Adolescent↗

PubMed1996

Comorbidity of depression and panic disorder.

The high comorbidity of panic disorder and depression might be anticipated on epidemiologic grounds alone. Both are common disorders with a characteristically chronic course, increasing the probability that a given patient with one disorder will develop the other. Symptoms of anxiety are highly prevalent among depressed patients; however, not all such symptoms represent an actual comorbid anxiety disorder. Conversely, about 50% of patients with panic disorder ultimately experience an episode of major depression. The comorbidity of panic disorder and depression has significant and potentially ominous prognostic implications; the high rate of suicide attempts observed in panic disorder are further exacerbated by the presence of a comorbid depression. Panic disorder and depression share well-defined disturbances in hypothalamic-pituitary-adrenal axis function, serotonergic neurotransmission, and growth hormone response to pharmacologic challenge. In addition, most of the available medications used to treat depression are also first-line therapy for panic disorder. Although initial studies suggested that patients with comorbid panic disorder and depression have a poorer treatment outcome, recent data show similar outcomes for patients with both disorders and those with panic disorder uncomplicated by depression.

Adult↗