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PubMed1980

The Oklahoma complex. A common form of conversion hysteria.

Hysteria is not a homogeneous illness. Some patients with symptoms of apparent neurological dysfunction develop a disability because they cannot cope with life's demands. This article calls attention to several hysterical patients who share similar histories. Treatment by a nonpsychiatric physician in these three cases consisted of simple emotional support and easing of responsibilities, ie, saying no for the patient. Recognition of the psychological state of some patients with hysterical symptoms, and administration of treatment that eases environmental stresses, can be effective.

Adult↗
PubMed1989

Psychogenic respiratory distress.

Five patients developed recurrent episodes of psychogenic respiratory difficulty that were superimposed on psychogenic neurologic symptoms. Misdiagnosis resulted in long hospital stays, code blue alerts, intubation, mechanical ventilation, and, in one case, tracheostomy. Patients "learned" psychogenic respiratory distress because their breathing symptoms evoked distinct evidence of anxiety in physicians and staff. In these patients, gain was not incidental but exerted primary control over symptom selection. The behavioral mechanisms involved in the pathogenesis of psychogenic respiratory distress have significant implications for its diagnosis, treatment, and prevention.

Adult↗
PubMed1994

Astasia without abasia due to peripheral neuropathy.

OBJECTIVE: To describe an unusual symptom characterized by an inability to stand still despite the ability to walk in eight patients with paraparesis due to peripheral neuropathy. DESIGN: Case series during the past 18 years. SETTING: Referral center. PATIENTS: Six patients with acute or subacute polyneuropathies recovering from flaccid paralysis of the lower limbs and two patients with chronic progressive polyneuropathy for more than 10 years were studied. Weakness around the ankle joints was profound, while muscle strength around the hip joints was well recovered or preserved. MAIN OUTCOME MEASURES: Standing and walking were recorded and reviewed on videotape or motion pictures. Spectral content of postural sway was analyzed in three recent cases. RESULTS: The symptom was transient in acute or subacute cases and was continual in chronic cases. The patients were compelled to take a series of steps forward and backward while standing until they initiated locomotion. They swayed rapidly around the hip joints before stepping. The anteroposterior component of postural sway in three patients had frequency peaks around 1 Hz. CONCLUSION: We have termed this symptom astasia without abasia, or stilts phenomenon, in which maintenance of the body mass depends on a moving base of support. Both an abnormal pattern of postural movements and defective somatosensory feedback for postural stabilization may be responsible for the symptom.

Adolescent↗
PubMed1975

Use of the Lombard response in cases of hysterical aphonia.

Lombard is best known for his work on the effect of noise on vocal intensity. In 1917, he applied this concept to the treatment of hysterical aphonia and described the procedure he used in a military publication. He suggested that a masking noise will interfere with the auditory monitoring system sufficiently that the patient will not be aware he has regained use of phonation. Removal of the noise from the patient's ears confirms the return of phonation, and the aphonia disappears. Credit is given to Lombard for this pioneering effort, and suggestions for present-day clinical use are made.

Conversion Disorder↗
PubMed1990

Functional upper airway obstruction in adolescents.

Functional upper airway obstruction is an uncommon manifestation of a conversive reaction characterized by recurrent stridor attacks caused by adduction of the vocal cords during inspiration. The oxygen saturation never drops to pathologic levels. The stridor is not accompanied by an appropriate degree of anxiety and is not associated with other symptoms. Patients benefit from verbal reassurance and speech therapy, but stridor attacks tend to recur and psychiatric consultation seems necessary in most cases. We present the case histories of three adolescent patients with nonorganic upper airway obstruction and describe the features that may facilitate the diagnosis of this condition. Early diagnosis and intervention may prevent unnecessary and potentially harmful investigations and therapy.

Adolescent↗
PubMed1983

An approach to the treatment of pseudohypacusis in children.

Children will occasionally have hearing loss that is unsubstantiated by results of audiological evaluation and that persists in spite of the audiologist's efforts to obtain valid hearing thresholds. In two cases we used suggestion as an effective means of restoring normal hearing behavior while support was given to help the child deal effectively with the problem underlying the hearing loss.

Adolescent↗
PubMed1988

Hysterical conversion reactions mimicking neurological disease.

Seven children with illnesses diagnosed as hysterical conversion reactions (HCRs) were treated at our institution over a period of nine months. They all had neurological symptoms that included one or more of the following: paralysis, headache, seizures, and episodic blindness. All patients but one were misdiagnosed as having an organic disease prior to our final diagnosis. Five children were treated with medications for presumed organic illnesses. In all of these children a diagnosis of HCR was made on the basis of their history and neurological examination findings. They all recovered or began recovery within a few days of having HCR diagnosed, and none of them had had a relapse three to 11 months after the diagnosis of HCR was made. We believe, and there is ample evidence in the literature, that a positive diagnosis of HCR in childhood can be made when neurological manifestations cannot be explained on an anatomic and physiological basis. Although absence of an obvious organic cause is a helpful clue, exhaustive exclusion of all possible organic causes is not necessary for the diagnosis of HCR.

Adolescent↗