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PubMed1984

The validity of broadly defined hysteria and DSM-III conversion disorder: outcome, family history, and mortality.

Patients who fail to meet criteria for Briquet's syndrome (or somatization disorder) despite a chart diagnosis of hysteria have been shown previously to resemble patients with primary depression in terms of familial psychopathology. The same patients are shown here to have excess mortality which also resembles that seen in patients with primary depression. The isolation of patients meeting DSM-III criteria for conversion disorder yielded very similar results. Outcome and mortality data clearly separated conversion disorder from Briquet's syndrome patients; family history data suggested substantial diagnostic heterogeneity. Until the validity of this diagnosis is established, the label "conversion disorder" is recommended as a descriptive alternative to the label "undiagnosed."

Adult↗

PubMedDate not supplied

Metaphor and meaning in conversion disorder: a brief active therapy.

The concept of conversion disorder as a change in somatic function that symbolically represents an unconscious conflict is currently challenged in the literature. In this article, the author elaborates on the psychodynamic concept of conversion and defines its characteristics and mode of diagnosis. The usefulness of this approach is demonstrated in a detailed case presentation of a brief, active psychodynamic psychotherapy of six sessions that led to the rapid disappearance of symptoms. In particular, the metaphoric meanings of the physical symptoms were interpreted and followed by an immediate disappearance of symptoms. The logic of this therapeutic approach and its implications as a transference cure are discussed in detail.

Aged↗

PubMed2007

Visual conversion disorder in a harbor pilot leading to sudden loss of control of a large vessel.

We describe an accident caused by the rapid onset of visual impairment in a ship's pilot, who was subsequently diagnosed as having visual conversion disorder (hysterical blindness). This case is documented to draw attention to the unusual cause of sudden incapacitation in transport crew and the consequential threat to transportation safety. Because sudden visual impairment incidents caused by conversion disorder are isolated and rare, they may be under-reported in the scientific literature. While it is unlikely that current systems for medical screening could anticipate and/or prevent crew incapacitation due to conversion disorders, this condition should be borne in mind when consulted by crew who report otherwise unexplained physical symptoms in the context of high levels of personal stress. It should also be considered when investigating possible medical incapacitation in transportation incidents or accidents.

Accidents, Occupational↗

PubMed1996

Ten-year prognosis of conversion disorder.

BACKGROUND: Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected. METHOD: Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services. RESULTS: Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up. CONCLUSIONS: The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.

Adaptation, Psychological↗

PubMed2001

Treating adolescent conversion disorders: are hypnotic techniques reusable?

When treating disabling conversion disorders in hospitalized adolescents, clinicians must act to restore function as rapidly as possible. After attempting to rule out physical causes for the symptoms and trying to find persuasive psychological reasons that the patient will accept and use to resolve the condition, the inpatient staff of a multidisciplinary therapeutic milieu must seek additional approaches to the care of these seriously ill individuals. This clinical forum reports the author's experience treating 2 young patients, a 12-year-old girl and a 15-year-old boy, with hypnosis. Therapists of every experience level find hypnotic techniques that work for them in a variety of patients, but are hypnotic techniques really reusable? The author reports what he learned once again.

Adolescent↗

PubMed1982

[Organic versus functional factors in the diagnosis of conversion disorders (author's transl)].

Conversion symptoms involving conspicous pseudoneurological signs of the motor system are very seldom today. To differentiate in these cases between organic and functional disturbances is highly difficult. Two patients are described. A 25 year old soldier with the symptomatology of a repetitive transverse lesion of the spinal cord and a 70 year old pensioner with a blepharospasm. They both showed an accompanying depression. Diagnostic criteria, psychodynamic models and especially the organic background of conversion symptoms are discussed.

Adult↗

PubMed1989

Visual conversion disorder: a case analysis of the influence of visual information.

We examined the influence of visual information on a decision task that was administered to an individual with monocular visual conversion disorder. Findings indicated that his performance was influenced by the visual information and by motivation instructions. The findings are discussed in terms of a model of hysterical blindness that recognizes the interplay of cognitive and motivational processes.

Adult↗

PubMed2006

Conversion disorder in a pediatric transgender patient.

Somatoform disorders are difficult to diagnosis and often present as a neurological illness in pediatric populations. Conversion disorder is the somatoform disorder most commonly seen in children, particularly adolescents, who have anxiety related to sexual behaviors and orientation. In a transgender patient, the risk of conversion disorder is even higher. The patient described in this article presented with multiple neurological symptoms that disappeared after she began presenting herself as a male. There is a significant need for research into somatoform disorders as well as research into the transgender population.

Child↗

PubMed1983

The differentiation of vomiting/weight loss as a conversion disorder from anorexia nervosa.

The authors studied patients with weight loss and vomiting, distinguishing by means of objective criteria those who had what they feel is a conversion disorder from those with anorexia nervosa. The group of patients with conversion disorder were quite different from those with anorexia nervosa and could be considered as suffering from less pervasive psychological deficits. Medical and psychotherapeutic intervention must take into account the differences between these two groups for treatment to achieve maximal benefit.

Anorexia Nervosa↗

PubMed1986

Emergency room management of conversion disorders.

The authors present guidelines for diagnosing and managing conversion disorders in an emergency room setting. Assessment of the patient must be based on a careful physical and psychiatric evaluation that will identify any underlying physical illness or concurrent psychopathology. An accurate assessment is also vital to the clinician's decision about whether to use simple supportive interventions, to refer or hospitalize the patient, or to try to uncover the conflicts generating the conversion symptoms. If there are no contraindications to uncovering the conflicts, such as chronic symptomatology or a pathological family network, the clinician may use such techniques as hypnosis or a sodium amytal interview.

Adult↗

PubMedDate not supplied

Conversion disorder mimicking Dejerine-Roussy syndrome (thalamic stroke) after spinal cord stimulation.

OBJECTIVE: Dejerine-Roussy syndrome is a complex of various signs and symptoms in patients suffering from central thalamic pain, usually secondary to a vascular etiology. We describe a patient presenting with the potentially devastating signs and symptoms of thalamic stroke, at least temporally related to spinal cord stimulator implantation. The etiology of the patient's affliction was subsequently revealed to be a conversion disorder. Case report A 37-year-old woman presented for spinal cord stimulation as treatment of her brachial plexopathy after failure of conservative therapy. Before implantation, she underwent a clinical interview with a psychologist and psychometric testing. No psychological pathology was detected. Trial and permanent implantation of the cervical stimulator lead and pulse generator were uneventful. Eleven days after receiving the permanent implant, the patient experienced right-sided hemicorporal numbness and burning dysesthesia. The patient was admitted, and a diagnosis of Dejerine-Roussy syndrome (thalamic stroke) was made. She was discharged, and her symptomatology waxed and waned over a period of weeks. The patient was subsequently admitted for psychiatric evaluation because of anxiety attacks. During her protracted admission, her psychiatrists strongly suspected a conversion disorder. The stimulator was removed, and the patient received supportive care only. Within 6 months, sensory symptoms and all motor deficits had completely resolved. CONCLUSIONS: Despite careful preoperative evaluation, latent psychosocial issues may limit the effectiveness of spinal cord stimulation. We present a case of conversion disorder masquerading as Dejerine-Roussy syndrome after spinal cord stimulation. The implications of the failure of preoperative psychological evaluation and screening to avert implantation are discussed.

Adult↗

PubMed1990

Behavioural treatment of a food refusal conversion disorder in a mentally retarded adult.

A 31-year-old woman with mental retardation who demonstrated total food refusal as the symptom of a conversion disorder was successfully treated with behavioural management techniques. The treatment utilized a shaping paradigm combined with relaxation procedures. The results supported the hypothesis that conversion disorder symptoms are maintained through their consequences, and the efficacy of behavioural treatments for those disorders.

Adult↗

PubMed1983

Conversion disorder following termination of pregnancy.

A variety of psychologic disorders may present as physical complaints without organic basis. As characterized by Sydenham over 300 years ago, such disorders "mimic all the physical disease to which man is heir." The case here presents the evolution of a conversion disorder (urinary retention) in response to a decision to terminate pregnancy. The predominant disturbance in a conversion disorder is an involuntary loss or alteration in somatic function that is temporally related with an environmental stressor. Conversion, as a defense mechanism, provides primary gain by keeping the conflict from the patient's awareness and secondary gains by generating environmental support and avoidance of undesired activities. Awareness of a patient's current life events, past responses to stress, and support systems is essential in order to recognize and manage this array of physical complaints of functional origin.

Abortion, Induced↗

PubMed2005

A foreign speech accent in a case of conversion disorder.

OBJECTIVE: The aim of this paper is to report the psychiatric, neuroradiological and linguistic characteristics in a native speaker of Dutch who developed speech symptoms which strongly resemble Foreign Accent Syndrome. BACKGROUND: Foreign Accent Syndrome is a rare speech production disorder in which the speech of a patient is perceived as foreign by speakers of the same speech community. This syndrome is generally related to focal brain damage. Only in few reported cases the Foreign Accent Syndrome is assumed to be of psychogenic and/or psychotic origin. METHOD: In addition to clinical and neuroradiological examinations, an extensive test battery of standardized neuropsychological and neurolinguistic investigations was carried out. Two samples of the patient's spontaneous speech were analysed and compared to a 500,000-words reference corpus of 160 normal native speakers of Dutch. RESULTS: The patient had a prominent French accent in her pronunciation of Dutch. This accent had persisted over the past eight years and has become progressively stronger. The foreign qualities of her speech did not only relate to pronunciation, but also to the lexicon, syntax and pragmatics. Structural as well as functional neuroimaging did not reveal evidence that could account for the behavioural symptoms. By contrast psychological investigations indicated conversion disorder. CONCLUSIONS: To the best of our knowledge this is the first reported case of a foreign accent like syndrome in conversion disorder.

Articulation Disorders↗

PubMed2004

[Conversion disorders. From neurobiology to treatment].

The two international systems of diagnostic classification for psychiatric disorders, ICD-10 and DSM-IV, differentiate a variety of disorders or syndromes characterized by the common feature of the presence of physical symptoms without "organic correlate." Conversion disorders (DSM) or dissociative disorders (ICD) are historically related to the concept of hysteria. Like psychoanalytical theories, the DSM and ICD refer to a psychological conflict preceding the onset of physical symptoms, although in a purely descriptive manner. The etiology of these disorders is still not very well understood. This article summarizes present knowledge from clinical and epidemiological studies. Functional neuroimaging studies on conversion disorders, although still very rare, allow testing of hypotheses about neuronal mechanisms. Such studies question the traditional and often misinterpreted dichotomy between organic and psychogenic diseases.

Cerebral Cortex↗

PubMedDate not supplied

A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type.

BACKGROUND: The primary aim of this study was threefold: (1) to examine the additional effects of hypnosis aimed at symptom reduction, using symptom-oriented and expression- and insight-oriented techniques in a comprehensive clinical treatment programme for in-patients with a persistent conversion disorder of the motor type; (2) to assess whether the level of hypnotisability was predictive of treatment outcome, and (3) to explore the efficacy of the total clinical treatment programme. METHODS: The study population consisted of 45 in-patients between 18 and 65 years of age meeting the DSM-III-R criteria for conversion disorder of the motor type or somatisation disorder with motor conversion symptoms. A randomised controlled clinical trial was undertaken. The primary outcome measures were the Video Rating Scale for Motor Conversion Symptoms, the D(isabilities) code items from the International Classification of Impairments, Disabilities and Handicaps and the Symptom Checklist-90. Measures of the credibility of treatment and patient expectations of treatment outcome were used as manipulation checks. Hypnotisability was measured using the Stanford Hypnotic Clinical Scale. RESULTS: Significant treatment results for all outcome measures were found for the total sample. These effects proved to be clinically significant. The use of hypnosis had no additional effect on treatment outcome. Hypnotisability was not predictive of treatment outcome. CONCLUSION: A comprehensive treatment programme, either with or without hypnosis, can be worthwhile for patients with long-standing conversion symptoms.

Adolescent↗

PubMed1991

Differential diagnosis and treatment of conversion disorder and Guillain-Barre syndrome.

Three cases are presented which illustrate the possible difficulties in differentiating between the diagnoses of Guillain-Barre Syndrome and conversion disorder. Accepted criteria are specified for each condition, as well as some associated features often characteristic of similar cases. Supportive interdisciplinary treatment for Guillain-Barre Syndrome is reviewed, and an interdisciplinary multi-modal approach to treatment of conversion disorder is described.

Adolescent↗

PubMed1997

Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study.

OBJECTIVES: Previous studies have suggested associations between conversion and many different clinical characteristics. This study investigates these findings in a prospective design including a control group. METHODS: Thirty consecutive patients with a recent onset of motor disability due to a conversion disorder were compared with a control group of patients with corresponding motor symptoms due to a definite organic lesion. Both groups had a similar duration of symptoms and a comparable age and sex profile and were assessed on a prospective basis. Background information about previous somatic and psychiatric disease was collected and all patients were assessed by means of a structured clinical interview linked to the diagnostic system DSM III-R, the Hamilton rating depression scale, and a special life events inventory. RESULTS: The conversion group had a higher degree of psychopathology with 33% of the patients fulfilling the criteria for psychiatric syndromes according to DSM-III-R axis I, whereas 50% had axis II personality disorders compared with 10% and 17% respectively in the control group. Conversion patients also had significantly higher scores according to the Hamilton rating depression scale. Although patients with known neurological disease were not included in the conversion group, a concomitant somatic disorder was found in 33% of the patients and 50% complained of benign pain. The educational background in conversion patients was poor with only 13% having dropped out of high school compared with 67% in the control group. Self reported global assessment of functioning according to the axis V on DSM IV was significantly lower in conversion patients, who also registered significantly more negative life events before the onset of symptoms than controls. Logistic regression analysis showed that low education, presence of a personality disorder, and high Hamilton depression score were significantly associated with conversion disorder. CONCLUSION: The importance of several previously reported predisposing and precipitating factors in conversion disorder is confirmed. The results support the notion that conversion should be treated as a symptom rather than a diagnosis and that efforts should be made in diagnosing and treating possible underlying somatic and psychiatric conditions.

Adult↗