Download Conversion disorder

S. Arabzadeh, M.D.



Deficit in voluntary motor or sensory
function
Preceded by conflicts or other stressors
The gain is primarily psychological not social
monetary or legal

Ratio of women to men
◦ Range of 2/1 to 10/1 in adults
◦ Increased female predominance in children

Women with conversion symptoms more likely
to subsequently develop somatization disorder



Incidence less than 1% of general
population
5 to 15 % of psychiatric consultations in a
general hospital
Common age is adolescents and young
adults
Onset at any age, but most common in adolescent to early
adulthood (rare before 10 years of age, or after 35,
but reported as late as the ninth decade of life)


Probability of occult neurological or other medical
condition high with onset of symptoms in middle or
old age.

Motor symptoms

Sensory deficits

Most common symptoms
◦ Paralysis
◦ Blindness
◦ Mutism

Sensory symptoms
◦ Anesthesia
and paresthesia (extremities)
◦ Distribution of the neurological deficit inconsistent with either
central or peripheral neurological disease (e.g. stocking-andglove anesthesia, and hemianesthesia beginning precisely along
the midline)
◦
deafness, blindness, tunnel vision
◦ Unilateral or bilateral
 Intact sensory pathways by neurological exam
(e.g. conversion disorder blindness: ability to walk around
without collision or self-injury, with pupils reactive to light, and
normal cortical evoked potentials.)

Motor symptom:
Abnormal movements (choreiform, tics, jerks)
Gait disturbance
Weakness
Paralysis
 Motor symptoms
 Movements generally worsen with calling of attention
 Reflexes remain normal
 No fasciculations/muscle atrophy (except chronic
conversion)
 Normal electromyography

Seizure symptoms
◦ Pseudoseizures
 1/3 of those with pseudoseizures have coexisting
epileptic disorder
 Tongue biting, urinary incontinence, and injuries after
falling can occur (although generally absent)
 Pupillary and gag reflexes retained
 No postseizure increase in prolactin concentration
◦ Depressive disorders (increased suicide risk)
◦ Anxiety disorders
◦ Somatization disorders
◦ Personality Disorders

Medical and especially neurological disorders
Psychoanalytic factor


Repression of
unconscious
intrapsychic conflict
Conversion of anxiety
into a physical
symptom
Biological Factor


Hypometabolism of
dominant hemisphere
Hypermetabolism of
nondominant
hemisphere

Ruling out a medical disorder
25—50 % have neurological or
nonpsychiatric medical disorder

Can be resolved by suggestion

LA BELLE INDIFFERENCE
CONDITION
TEST
Tunnel vision
Visual fields
Profound monocular blindness
Swinging flashlight sign
(Marcus Gunn)
Binocular visual fields
Severe bilateral blindness
“Wiggle your fingers;
I’m just testing coordination.”
Sudden flash of bright light
“Look at your hand.”
“Touch your index fingers.”
CONDITION
TEST
Aphonia
Request a cough
Intractable sneezing
Observe
CONDITION
TEST
Coma
Examiner opens eyes
Ocular cephalic maneuver
Syncope
Head-up tilt test
CONDITION
TEST
Anesthesia
Map dermatomes
Hemianesthesia
Check midline
Astasia-abasia
Walking, dancing
Paralysis, paresis
Hand drop onto face
Hoover test
Check of motor strength
Insight-oriented supportive or behavior therapy
Relationship with a caring and confident
therapist most important feature of the therapy
Reassurance

helping the patient verbalize distress

simple behavioral interventions

 Presentation
of the diagnosis
avoid indirect and fragmentary discussion
 naming: non epileptic seizure
 Avoid mentioning ‘real’ or ‘unreal’
 Validate the reality of events
 Present the result of the tests

 Cause
of the disease
We do not know the cause
Symptoms have no clear physical cause
Is not intentionally made
Result from interaction between subconscious mind
and body
Role of stress
Need of psychological interview
Encourage the patient to acknowledge recent
stresses
 Give positive reinforcement
 Take brief rest from stress before returning to
usual activities
 Advise against prolonged rest or withdrawal
from activities


Symptoms usually resolve rapidly leaving no
permanent damage

Acute cases
◦ Reassurance/appropriate rehabilitation
 Resolution usually spontaneous

Chronic cases
◦ Aggressive therapy of comorbid psychiatric
illness
◦ Pharmacotherapy
 Anxiolytic or antidepressant medications ?
◦ Psychotherapy
 comorbid
psychiatric condition
SSRI
Beta-blockers
Analgesics
Benzodiazepines

psychological process by which one person
may guide the thoughts, feelings or
behaviour of another

waking suggestions

hypnotic suggestions







Family therapy
Cognitive behavior therapy
problem-solving techniques
reframing of distorted cognitive beliefs
Counseling
Group therapy
Hypnosis
Psychodynamic approaches
 Exploring intrrapsychic conflicts, and the symbolism of
conversion symptoms ???
Good prognosis
 Acute onset
 Identifiable stressor
 Short interval between onset and treatment
 Paralysis
 Aphonia
 blindness


95%

20-25%

remit spontaneously
Recurrence
25 to 50%
neurological disorders or
nonpsychiatric medical conditions affecting
the nervous system
THANK YOU
Any Question?