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PubMed1999

Are we overusing the diagnosis of psychogenic non-epileptic events?

In order to determine how often results of video/EEG (V-EEG) studies may change the clinical diagnosis of paroxysmal events, we prospectively studied 100 consecutive patients (75 females, 25 males) admitted for diagnosis of recurrent paroxysmal spells. The presumed diagnosis of the referring physician was obtained. Episodes were classified as epileptic seizures (ES), psychogenic non-epileptic events (PNEE), or physiologic non-epileptic events (PhysNEE). Eighty-seven patients had diagnostic events. A final diagnosis of ES was made in 21 patients, PNEE in 39, PNEE + ES in 20, and PhysNEE in seven. All PhysNEE were unsuspected. ES were misdiagnosed as PNEE more frequently than the reverse (57% vs. 12%, P < 0.001). Among the 64 patients with recorded events who had been suspected of having PNEE, 14 (21.9%) were misdiagnosed: two had PhysNEE and 12 (18.75%) had ES. Among the 23 patients with recorded events who were thought to have ES, 12 (39.1%) were misdiagnosed: seven had PNEE, five PhysNEE. V-EEG changed the clinical diagnosis in 29.8% of the patients with recorded events. Our data suggests that clinicians have become more aware of PNEE since the advent of V-EEG and have little problem recognizing them. However, they may be more prone to make a false-positive diagnosis of PNEE in ES with some atypical features. At this point, efforts should be channeled to better training in the proper recognition of ES that mimic PNEE.

Adolescent↗
PubMed1999

Headaches and other pain symptoms among patients with psychogenic non-epileptic seizures.

Studies of patients with psychogenic non-epileptic seizures (NES) typically focus upon the phenomenology and outcome of NES episodes. Little is known, however, about the frequency and nature of other somatic symptoms such as pain, in this population. To assess the frequency, location and severity of symptoms of pain among NES patients, we administered structured interviews to 56 patients, 6 or more months following the diagnosis of psychogenic non-epileptic seizures (NES). Patients were recruited from a tertiary hospital-based epilepsy monitoring unit. Seventy-seven percent of patients suffered from moderate to severe pain, most commonly headache (61%), while neck pain and backache were also common. Twenty-six of 27 patients with persistent NES vs. 17 of 29 patients whose NES resolved experienced moderate to severe pain (P < 0.001). Pain is an under-recognized problem that occurs frequently and with significant severity among NES patients. Pain symptoms are more common among patients with persistent NES than those whose NES resolve.

Adolescent↗
PubMed2000

An estimate of the prevalence of psychogenic non-epileptic seizures.

The prevalence of psychogenic non-epileptic seizures is difficult to estimate. We propose an estimate based on a calculation. We used the following data, which are known or have been estimated, and are generally accepted. A prevalence of epilepsy of 0.5-1%; a proportion of intractable epilepsy of 20-30%; a percentage of these referred to epilepsy centers of 20-50%; and a percentage of patients referred to epilepsy centers that are psychogenic non-epileptic seizures: 10-20%. Using the low estimates, the prevalence of psychogenic non-epileptic seizures would be 1/50 000. Using the high estimates, the prevalence of psychogenic non-epileptic seizures would be 1/3000. The prevalence of psychogenic non-epileptic seizures is somewhere between 1/50 000 and 1/3000, or 2 to 33 per 100 000, making it a significant neurologic condition.

Conversion Disorder↗
PubMed2001

Patients with coexistent psychogenic pseudoepileptic and epileptic seizures: a psychological profile.

Despite significant advances in epileptology, the differential diagnosis of epileptic and pseudoepileptic seizures continues to be a considerable challenge. The problem becomes even more complicated when epileptic and psychogenic pseudoepileptic seizures coexist in the same patient. Appropriate psychological measures may be helpful in the diagnosis and may improve knowledge about aetiological factors which can provoke psychogenic pseudoepileptic seizures. The purpose of this paper is to present the psychological profile of patients with mixed seizures (epileptic and psychogenic pseudoepileptic) developed on the basis of the Minnesota Multiphasic Personality Inventory (MMPI) and to discuss the personality differences between patients with psychogenic epileptic seizures and epileptic patients. In patients with diagnosed epilepsy and/or suspected psychogenic pseudoepileptic seizures long-term video-monitoring was performed. On the basis of the gathered data the patients were divided into three groups: group I (N= 32 : 25 F and 7 M) had coexistent psychogenic pseudoepileptic and epileptic seizures, group II (N= 38 : 30 F and 8 M) had psychogenic pseudoepileptic seizures only and group III (N= 36 : 18 F and 8 M) had epileptic seizures only and was treated as the control group. All three groups were given the MMPI. Comparison of the averaged personality profiles of the three groups revealed significant differences (P< 0.0001) in hypochondriasis (Hs) and hysteria (Hy), similarity of the profiles of groups I and II, and significantly higher Hs and Hy scores than D (Depression) scores (P< 0.001). Unlike groups I and II, group III (the epileptic group) had significantly higher D scores than Hs and Hy scores (P< 0.01). Our findings suggest that conversion, manifested in the typically elevated Hs and Hy scores as compared to D scores, is present in both groups of patients demonstrating pseudoepileptic seizures but absent in the patients with epilepsy where the Hs and Hy to D ratio is reversed. Patients with mixed seizures and patients with psychogenic pseudoepileptic seizures only have similarly shaped profiles.

Adult↗
PubMed2004

[The "AMDP scale for dissociation and conversion (AMDP-DK)": development of an observer-rated scale and first psychometric properties].

The AMDP scale for dissociation and conversion (AMDP-DK) represents an observer-rated scale for the assessment of dissociative and conversive phenomena, which closes the gap between available self-report questionnaires and time-consuming structured interviews with their respective disadvantages. The instrument comprises 30 operationalized items, which are rated according to the AMDP rules, and which are theoretically-driven divided into the subscales dissociation (15 items), conversion (9 items) and a "formal" dimension (6 items) to cover associated phenomena. In a sample of psychiatric inpatients (n = 73) the covered symptoms showed a great variety of frequency and intensity. The AMDP-DK and its subscales had good internal consistency (Cronbachs alpha between 0.76 and 0.85). A factor-analysis mostly replicated the theoretically constructed subscales. The convergent and divergent validity of the scale was good, as well as its ability to discriminate between high- and low-dissociating patients. The findings are discussed with regard to the psychometric properties and the relevance for the theories of dissociation and conversion.

Adolescent↗
PubMed2006

[Is Akinesia algera by Paul Julius Möbius (1891) as a coenästhetic appearance a still up-to-date phenomenon?].

OBJECTIVE: Considering as example Akinesia algera - postulated in 1891 as a disease by Paul Julius Möbius, the relevance for diagnosing body-related mental disturbances will be demonstrated . METHOD: Relevant original works of Möbius and of some of his well known contemporaries for instance Kraepelin, Binswanger, Erb were explored. The correlation of the described phenomenon to current textbook doctrine has been attempted. RESULTS: Möbius, case histories, described as Akinesia algera, can be subsumed under the typology of coenästhetic schizophrenia. CONCLUSION: Akinesia algera is by primary source to be evaluated as a coenästhetic symptom and remains in daily practice a diagnostic challenge.

Conversion Disorder↗
PubMed1986

[Conversion symptoms in childhood and adolescence].

Departing from a review of definitions of conversion phenomena and hysteria, the necessity to conceptually disentangle these two terms, particularly in childhood and adolescence, becomes evident. Divergent literature reports concerning occurrence rates, gender and age distributions, symptomatology, therapy, and long-term outcome hardly justify the notion of a conversion syndrome representing a clearly distinguishable clinical entity. Thus, it is recommended that diagnosis and treatment of conversion symptoms should not depend on restrictive theoretical considerations. In accordance with the wide range of underlying aetiological factors, the suggested strategy rather emphasizes the advantages of supplementing a basic understanding of the involved psychodynamic aspects by the application of behaviour therapy as well as family therapy techniques.

Adolescent↗
PubMed1996

[Psychogenic hand dystonia and hereditary polyneuropathy with liability to pressure palsies. A contribution to etiology of dystonias].

We report on a case of a female who had developed a fixed flexion contracture of the 4th and 5th fingers of the right hand which was painless and at-rest right in the beginning at the age of 19. By means of neurographical examinations a hereditary neuropathy with liability to pressure palsies was established in her and her mother, which had clinically manifested with symptoms of the ulnar nerve at the affected hand. The dystonic symptoms did not show any progression within ten years follow-up. A remarkable feature of the course was the twice repeated occurrence of short, sudden and complete remissions immediately following invasive diagnostic procedures. The thorough discussion of differential diagnostic aspects and the analysis of the familiar situation and psychodynamics of the patient resulted in the diagnosis of a psychogenic hand dystonia.

Adult↗
PubMed1997

Freud and consciousness: the first one hundred years of neuropsychodynamics in theory and clinical practice.

Psychoanalysis emerged out of Freud's neuropsychologic studies of consciousness and cognition. This article describes the historical development of neuropsychodynamic theories of consciousness and personality, and traces their application to several neuropsychiatric syndromes of intense contemporary clinical interest. Even in this era of narrow syndromic differentiation and classification, an appeal is made for a more integrated approach to the evaluation and treatment of neurobehavioral syndromes.

Consciousness↗
PubMed1988

[Functional monocular hemianopsia].

Certain patients with reduction or loss of central visual function and/or hemianopic changes of the visual field can be classified as well-informed malingerers, individuals who are easily influenced by suggestion, or neurotics suffering from "conversion hysteria." The main symptom is one of a functional sensory change (loss or reduction of visual field). The task falling to the ophthalmologist is to prove the contrary, using certain subjective and objective tests to prove the incompatibility of the results with the physiological facts. The authors discuss the specificity of these tests in this context and present a number of cases with the characteristic temporal or nasal functional hemianopsia comparing them with patients who have hemianopsias due to real anatomic lesions.

Adolescent↗
PubMed1995

[Globus sensation].

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Conversion Disorder↗
PubMed1981

[Diagnosis and differential diagnosis of hysteric amblyopia using psychophysical and electro-ophthalmological examination methods (author's transl)].

In three patients with psychogenic amblyopia the computerized visual field, the ERG, the flash light (H-EP) and pattern reversal stimulated (M-EP) cortical potentials were recorded. Differential diagnosis between psychogenic amblyopia on the one hand, and functional amblyopia and organic lesions of the retrobulbar visual pathways on the other was shown to be possible. In the cases with organic retrobulbar lesions of visual pathways, visual field defects and pathologic H-EP's and M-EP's were found. In functional amblyopia only the M-EP responses are diminished in amplitude. In psychogenic amblyopia only the computerized visual field shows pathologic changes.

Adolescent↗