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PubMed1987

The case of Anna O.: a neuropsychiatric perspective.

Previous interpretations have not adequately explained the presence of focal neurological signs, delirium, and a variety of highly specific disturbances of perception, language, and sensorium in the case of Anna O. Examination of the neurological details suggests that Anna suffered from complex partial seizures exacerbated by drug dependence, and that she developed conversion symptoms patterned after the preexisting organic pathology. Hysterical conversion symptoms that mimic ictal events are not uncommon in psychomotor epilepsy. Recent neuropsychiatric models of hysteria are remarkably similar to the hypnoid states theory Breuer formulated, based on his observation of Anna O. The hypothesis presented here does not conflict with previous psychodynamic interpretations. I submit that it was the development of a conversion disorder patterned on actual organic phenomena, which highlighted for Breuer and Freud the "psychical mechanism" of somatic symptoms, thus paving the way for the important psychodynamic discoveries for which the case is remembered.

Austria↗

PubMedDate not supplied

Using differential reinforcement to treat functional hypophonia in a paediatric rehabilitation patient.

Behaviour analysis studies have demonstrated the use of operant procedures for treating symptoms of psychiatric disorders. These symptoms are usually caused or maintained by a variety of variables including specific organic mechanisms, yet most can be modified by environmental social contingencies. In this case study, data is presented on a 16 year-old male admitted to a rehabilitation hospital following the onset of polymyositis. This patient also presented with functional hypophonia and met the DSM-IV diagnostic criterion for a conversion disorder. In conjunction with the medical team and a speech pathologist, a behavioural programme was developed and implemented to shape and differentially reinforce increasingly complex vocalizations. Results were evaluated using a moving treatment, multiple baseline across responses design. Differential reinforcement in the form of written and verbal feedback was effective in shaping normal speech. The protocol was applied comprehensively across staff and settings. Results are discussed in terms of basic behavioural research on 'learned non-use'.

Adolescent↗

PubMed1999

Recurrent psychogenic coma following tracheal stenosis repair.

Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following successful emergence from anesthesia. A 39-year-old woman with a history of tracheal stenosis, depression, and anxiety had complete unconsciousness on 3 separate occasions following surgical repair of her tracheal stenosis. In each case, the patient's endotracheal tube had been removed; she was alert and oriented to person, time, and place; and she was admitted to the hospital for observation. Within a few hours after the tube was removed, the patient became abruptly unconscious for periods of 36, 18, and 30 hours. Each time, the results of cardiac, pulmonary, metabolic, and neurologic examinations and radiological studies were normal. We hypothesize that the patient's apparent comas were the result of an underlying conversion disorder precipitated by unresolved psychological conflict surrounding a long history of abuse in which she was repeatedly smothered by a pillow.

Adult↗

PubMed2005

Religious stigmata, magnetic fluids and conversion hysteria: one survival of 'vital force' theories in scientific medicine?

A study of Natuzza Evolo, a contemporary Roman Catholic stigmatic in southern Italy, raises certain questions of mechanism and evidence. Was this a miracle, hysterical conversion or contrived? The medical interpretation of the phenomenon as conversion disorder raises questions about the popularity of hysteria as a medical diagnosis and the ways in which it functions like 'vital force', as a metaphoric mediator between the natural world, human agency, and the ultrahuman.

Christianity↗

PubMed2005

Pseudoseizures in children: a profile of 50 cases.

In contrast to adulthood hysterical disorders, childhood hysteria has not been accorded due recognition. Pseudoseizures are paroxysmal alterations in behavior that resemble epileptic seizures but are without any underlying organic cause. There is paucity of literature on pseudoseizures in children. In the present descriptive study of 2 years' duration, a series of consecutively seen 50 children with pseudoseizures is reported. After detailed history from parents, various socio-demographic and clinical variables were noted. Of 110 children seen with conversion disorder, 50 had pseudoseizures (45.5%). The average age was 8.2 years in boys and 9.4 years in girls. There were 28 girls (56.0%) and 22 boys (44.0%), and the majority of patients had the pseudoseizures for 1 to 3 months. When the mode of referral was studied, 52% were referred from pediatric outpatient department and the majority were referred to rule out comorbid psychiatric disorder. The fits mimicking generalized tonic-clonic seizures were most common and the duration of fits ranged from 10 to 35 minutes. The most common frequency of fits was 5 to 6 per week. The average duration of symptoms was 2.6 months in boys and 3.2 months in girls. Only 14 patients (28%) gave the history of having seen the fits in a relative or schoolmate. School phobia and the fear of examinations were the most common precipitating factors. Separation anxiety disorder, school phobia, and mood disorders were common comorbid diagnoses. The patients were put on appropriate drug treatment and/or psychotherapy for 3 months. Of 50 cases, 36 (72.0%) remitted, 10 (20.0%) showed a decrease in frequency of pseudoseizures, and 4 (8.0%) did not improve. With correct diagnosis and treatment, the children with pseudoseizures have a good outcome.

Child↗

PubMed1998

Globus hystericus or depressivus?

Globus hystericus has been often classified as a conversion disorder. More than half of the sufferers are overtly depressed and only a handful have hysterical personality. It is argued that it might be more appropriately viewed as a psychophysiological symptom of depression that responds to antidepressant treatment.

Adult↗

PubMed1997

Pseudoseizure "status".

Psychogenic pain, disturbances of gait and stance, sensory symptoms, dizziness, and psychogenic seizures have been found to be the most common conversion symptoms in neurology clinics. A retrospective analysis of 18 patients suffering from pseudoseizure "status" is presented in this study. All of the patients fulfilled the DSM-III-R criteria of conversion disorder. However, 5 of them had concomitant major depression, 6 suffered from bulimia nervosa, and 7 met the criteria for substance abuse. On Axis II, 10 cases of borderline personality disorder, 2 cases of antisocial personality disorder, and 3 cases of histrionic personality disorder were diagnosed. The majority of the patients had attempted suicide and other forms of self-destructive behavior. The findings suggest that patients with pseudoseizure "status" suffer from severe affective imbalances and disturbed impulse control.

Adolescent↗

PubMed1989

Covert psychiatric disturbance in patients with globus pharyngis.

There is currently little agreement concerning the aetiology of globus pharyngis (née hystericus), and both physical and psychological factors have been suggested as primary causes of this common disorder. Using validated research questionnaires we tested the hypothesis that there is significant psychiatric morbidity in female globus patients but not in males. One hundred and twenty-one globus patients (90F, 31M) were tested on the Crown-Crisp Experiential Index (CCEI), the General Health Questionnaire (GHQ), the Hysteroid Obsessoid Questionnaire (HOQ) and the Eysenck Personality Questionnaire (EPQ). Female globus patients, but not males, have low extraversion scores and high GHQ scores when compared with age- and sex-matched ENT patient controls, and high mean levels of anxiety, depression and somatic concern on the CCEI. In females the mean total CCEI score was not significantly different from the mean of a psychiatric out-patient group. The males had total CCEI scores similar to a group with no psychiatric symptoms. Globus patients did not have hysteroid traits. We conclude that a substantial minority of globus patients has significant psychiatric morbidity. It is important to exclude mild, reactive-type depression and conversion disorder in these patients, in whom invasive physical investigations are inappropriate.

Adult↗

PubMed1994

Psychogenic stridor.

In the past 20 years, several cases have been reported describing an upper airway obstruction reportedly caused by psychological factors. This paper reviews 48 reported cases of "psychogenic stridor." Patients with psychogenic stridor usually present to primary care physicians with symptoms of asthma or stridor unresponsive to conventional treatments. Of the 48 cases reviewed, 52% received a diagnosis of conversion disorder. The obstruction was severe enough to cause intubation and tracheostomies in some patients. In addition, many suffered from the unnecessary side effects of corticosteroids. The literature is reviewed and medical and psychiatric differential diagnosis and treatment are discussed.

Adolescent↗

PubMed1986

"Conversion reactions" in adolescents: a biofeedback-based operant approach.

This paper describes the brief in-patient treatment of two adolescents with hysterical conversion disorder. It is unique in that treatment was conducted on a general medical/surgical service. Although operantly based, the treatment utilized biofeedback and measurable psychophysiological changes as criteria to obtain reinforcement. The advantages of this approach to both patient and hospital staff are discussed.

Adolescent↗

PubMed1998

Differentiation of conversive sensory loss and malingering by P300 in a modified oddball task.

We applied the methodology of evoked potentials (EP) to reveal the functional level of abnormality in a patient with circumscribed complete anaesthesia due to conversion disorder. EP components related to sensory and perceptual processing of both innocuous electrical and noxious laser stimuli were normal. However, a P300 component indicating cognitive processing failed to appear when using a modified oddball task with rare stimuli applied to the anaesthetic right hand. P300 was present with this paradigm stimulating the healthy left hand, as well as in a 'malingerer' - a healthy subject who was instructed to feign the same deficit. These results suggest cognitive deficits underlying sensory loss as conversion symptom which can be differentiated from malingering by use of P300.

Adult↗

PubMed2003

[A child whose parents denied her psychiatric care].

A 15-year-old girl was admitted because of an abdominal tumour and inability to eat. History revealed that after an accident at 9 years of age she increasingly developed medically unexplained signs and symptoms (e.g. tunnel vision with blindness, paralysis and loss of sensitivity below the umbilicus, periods of diminished consciousness). No somatic explanation could be found; the parents rejected psychiatric examination. Upon physical examination the patient's weight's was far below the third percentile (32 kg) and the tumour appeared to be the lumbar spine, palpable through the abdominal wall. Following tube feeding and behavioural therapy the girl gained weight and the tumour disappeared. No cause for the underweight was found. Conversion disorder was diagnosed. However, the parents strongly refused to accept this diagnosis; they lodged complaints with various bodies and made further treatment and counseling impossible. Children with psychological problems who were treated as having a somatic disorder by their mothers have been described before. The outcome can be lethal. Children showing unexplained signs and symptoms whose parents strongly refuse psychiatric care will be seriously jeopardised in terms of their somatic and psychological development. Physicians should identify this situation at an early stage.

Adolescent↗

PubMed2006

Hysterical paralysis.

Hysterical paralysis is an uncommon type of conversion disorder. It can be difficult to diagnose. In cases in which symptoms are difficult to explain neuroanatomically or are functionally inconsistent, hysteria should enter into the differential diagnosis. We report a case of hysterical paralysis that had rapid improvement using physical therapy and antidepressant therapy.

Adult↗

PubMed1999

Psychiatric features of children and adolescents with pseudoseizures.

BACKGROUND: Pseudoseizures may occur as a somatoform disorder in children and adolescents as well as adults. However, few data are available about psychiatric features or outcome in pediatric patients. PATIENTS AND METHODS: We studied 34 patients (25 girls [74%]) who were evaluated by a child psychiatrist at our institution immediately after diagnosis of pseudoseizures by ictal video electroencephalogram (EEG) at ages 9 to 18 years (mean age, 14 years). Each patient had at least 1 pseudoseizure recorded by video EEG that was judged by the patient and family as typical, characterized by unresponsiveness plus limb twitching or limpness and other features, with EEG showing persistence of normal cortical background rhythms. RESULTS: In addition to conversion disorder, 11 patients (32%) had mood disorders including major depression, bipolar disorder, or dysthymic disorder, usually with severe psychosocial stressors. Eight children (24%) had separation anxiety and school refusal with moderate psychosocial stressors. Two patients (6%) had brief reactive psychosis or schizophreniform disorder. A few (1-3) patients each had panic disorder, overanxious disorder, adjustment disorder, oppositional/defiant disorder, or impulse control disorder. Four patients (12%) also had personality disorders. Eleven patients (32%) had a history of sexual abuse. This was especially frequent in the subgroup with mood disorders (7 [64%] of 11 patients). Fifteen patients (44%) had severe family stressors including recent parental divorce, parental discord, or death of a close family member. Two patients (6%) had a history of physical abuse. Freedom from pseudoseizures for the preceding 9 to 55 months (mean, 30 months) was achieved for 15 (72%) of the 21 patients who could be reached for telephone follow-up. For 8 (53%) of these 15 patients, the last pseudoseizure was within 1 month of diagnosis by video EEG. CONCLUSIONS: Major mood disorders and severe environmental stress, especially sexual abuse, are common among children and adolescents with pseudoseizures and should be considered in every case. A subgroup of children with separation anxiety and school refusal had less severe psychiatric problems and moderate psychosocial stressors. Clear diagnosis by video EEG, together with prompt psychiatric evaluation and treatment, may result in freedom from pseudoseizures for most children and adolescents.

Adolescent↗

PubMed1995

[Conversion hysteria].

Conversion disorder is characterized by symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological condition. The symptoms or deficits are related to psychological factors but not intentionally produced or feigned. They could be associated with true neurological disorders and their diagnosis is difficult. Neurologically they do not conform to known neurological mechanisms but instead follow the individual conceptualization of a condition and vary according to attention and emotions. Psychologically they are related to a psychic conflict or a stressful event. They could be associated to other manifestations of the hysterical neurosis or various mental conditions.

Conversion Disorder↗

PubMed1994

[Phylogenetic origin of symptoms in psychopathology. Exemplified by hysteria].

Setting behavioral disturbances affecting humans in a natural environmental context indicates the presence of phylogenetic components in their etiology. Hysterical conversion disorders provide a good illustration. The biological model to which they can be traced seems to be the "distraction display," originally intended to deceive predators and lure them away from the offspring or threatened related individuals. Hysterical tendance to draw attention on oneself could thus paradoxically be seen as performing an altruistic function.

Adaptation, Psychological↗

PubMedDate not supplied

Serial sodium Amytal interviews in the clinical setting.

The purpose of this study was to review the authors' experiences with serial sodium Amytal (amobarbital) interviews and to compare these results with those found in the literature. A chart review of 21 patients with suspected conversion disorder evaluated by Amytal interview was conducted retrospectively. Presenting symptoms included movement disorders, focal neurologic deficits, chronic pain, "spells," and pseudoseizures. The serial Amytal interviews confirmed the presence of psychopathology noted on admission and revealed underlying psychosocial stressors. In 2 of 21 patients, agents other than Amytal were used after the first interview. This series confirms that the serial Amytal interview has utility in the clinical setting as a diagnostic and therapeutic tool.

Adolescent↗

PubMed2002

Possible influence of defenses and negative life events on patients with chronic fatigue syndrome: a pilot study.

13 patients with a diagnosis of chronic fatigue syndrome and two contrast groups of conversion disorder patients (n = 19) and healthy controls (n = 13) were assessed using the projective perceptual Defense Mechanism Test to investigate if specific defense patterns are associated with chronic fatigue syndrome. Another objective was to assess the possible influence of perceived negative life events prior the onset of the illness. The overall results showed significant differences in defensive strategies among groups represented by two significant dimensions in a Partial Least Squares analysis. Compared to the contrast groups the patients with chronic fatigue syndrome were distinguished by a defense pattern of different distortions of aggressive affect, induced by an interpersonal anxiety-provoking stimulus picture with short exposures. Their responses suggested the conversion group was characterized by a nonemotionally adapted pattern and specific constellations of defenses, associated with interior reality orientation compared to the patients with chronic fatigue syndrome and the healthy controls. Rated retrospectively, the group with chronic fatigue syndrome reported significantly more negative life events prior to the onset of their illness than healthy controls. For instance, 5 of the 13 patients reported sexual assault or physical battery as children or teenagers compared to none of the healthy controls. A significant association was found between defense pattern and frequency of reported negative life events. However, these retrospective reports might be confounded to some extent by the experience of the patients' illness; for example, the reports may be interpreted in terms of present negative affect.

Adolescent↗