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PubMed2000

Case study: negative reinforcement and behavioral management of conversion disorder.

Behavioral interventions have been advocated for conversion disorder, but controlled trials are lacking. The authors report the case of a 12-year-old boy with conversion disorder after 3 months of persistent right arm pain and immobility whose symptoms rapidly resolved after an outpatient behavioral intervention using negative reinforcement. The importance of careful assessment, frank discussion of the diagnosis, patient and family psychoeducation, and a rehabilitative mindset are emphasized. Negative reinforcement may be a powerful tool in the management of pediatric conversion disorder, with the potential to reduce parental anxiety and prevent unnecessary physical assessments and interventions.

Arm↗
PubMed2002

Childhood abuse in patients with conversion disorder.

OBJECTIVE: Despite the fact that the assumption of a relationship between conversion disorder and childhood traumatization has a long history, there is little empirical evidence to support this premise. The present study examined this relation and investigated whether hypnotic susceptibility mediates the relation between trauma and conversion symptoms, as suggested by Janet's autohypnosis theory of conversion disorder. METHOD: A total of 54 patients with conversion disorder and 50 matched comparison patients with an affective disorder were administered the Structured Trauma Interview as well as measures of cognitive (Dissociative Experiences Scale) and somatoform (20-item Somatoform Dissociation Questionnaire) dissociative experiences. RESULTS: Patients with conversion disorder reported a higher incidence of physical/sexual abuse, a larger number of different types of physical abuse, sexual abuse of longer duration, and incestuous experiences more often than comparison patients. In addition, within the group of patients with conversion disorder, parental dysfunction by the mother-not the father-was associated with higher scores on the Dissociative Experiences Scale and the Somatoform Dissociation Questionnaire. Physical abuse was associated with a larger number of conversion symptoms (Structured Clinical Interview for DSM-IV Axis I Disorders). Hypnotic susceptibility proved to partially mediate the relation between physical abuse and conversion symptoms. CONCLUSIONS: The present results provide evidence of a relationship between childhood traumatization and conversion disorder.

Adult↗
PubMed2006

A case of conversion disorder presenting as a severe acute stroke.

Conversion disorders often present with dramatic physical presentations suggestive of severe organic disease. We present the case of a young woman who presented to the Emergency Department with a dense left hemiparesis suggestive of a severe acute stroke. Emergent referral to a regional stroke center facilitated rapid medical evaluation, exclusion of organic disease, and confirmation of conversion disorder as the etiology for the symptoms. This report highlights the dramatic clinical presentations that may result from conversion disorders as well as the benefits of rapid medical evaluation by specialty stroke centers.

Adult↗
PubMed2003

Conversion disorder and its subtypes: a need for a reclassification.

Four subtypes of conversion disorder were described in DSM-IV. There are few publications concerning studies aimed at separating the subtypes of the conversion disorder. Usually, pseudoseizures are in focus and attempts are made to differentiate these seizures from other disorders. The aim of the present study has been to investigate differences between the four subtypes of the conversion disorder and to discuss the possibilities for a reclassification. Ninety-five patients were seen by two researchers and diagnosed as conversion disorders. The subtypes were determined according to DSM-IV criteria. All completed the Patients Information Form, developed by the researchers, and the Dissociative Experience Scale (DES). Twenty-four (25.2%) of the patients had motor symptoms or deficits (Type 1), 5 (5.2%) sensory symptoms or deficits (Type 2), 23 (24.2%) seizures or convulsions (Type 3) and 43 (47.3%) had mixed presentations (Type 4). There were statistically significant differences between the subtypes as concerns occupation, family history of psychiatric disorders, hospitalizations and place of settlement. Furthermore, the DES scores were statistically different between the groups of patients with different subtypes of conversion disorder.

Adult↗
PubMed2006

Temperamental traits associated with conversion disorder.

The aim of this study was to analyze the temperamental traits associated with conversion disorder in children. Thirty children with conversion disorder attending a child guidance clinic were compared with an age and sex matched control group of normal children for life stresses and temperament dimensions. The temperament measurement schedule (TMS) and the life event scale for Indian children (LESIC) were used for evaluating the temperament dimensions and life stresses respectively. Children with conversion disorder experienced significantly more stressful life events compared to the children in the control group. The stress factors included scholastic difficulties, examination failures, punishment by teacher, conflict with peers, parental disharmony and family problems and sibling rivalry. The characteristic temperamental traits associated with conversion disorder were low emotionality and low threshold of responsiveness.

Case-Control Studies↗
PubMed2006

Conversion disorder in stroke: a case report.

Conversion disorder is caused by previous severe stress, emotional conflict, or an associated psychiatric disorder, and usually presents with one or more neurologic symptoms. Clinically, it is challenging to diagnose diseases such as transient ischemia attack, stroke, brain tumor, spinal cord injury, and neuropathy. In this case report, we present a male stroke patient who had a typical conversion disorder.

Conversion Disorder↗
PubMed1995

Conversion disorder presenting as gait disturbance in an adolescent.

Conversion disorder is a psychiatric diagnosis in which the loss of function on presentation mimics organic disease. Although rare, it is most common in adolescents and young adults. This report describes an adolescent with conversion disorder who presented with progressive bilateral lower-extremity weakness and impaired gait. As with all patients with conversion disorder, prompt diagnosis without extensive testing was essential to initiating appropriate therapy in this patient.

Child↗
PubMed2004

Pseudolabor: A New Conversion Disorder Subtype? A Case Presentation and Literature Review.

Pseudolabor is not a recognized conversion disorder subtype. The diagnosis of conversion disorder is suspected when a patient presents with symptoms under voluntary control that mimic a neurologic or medical condition. The term pseudolabor was first used in 1994 to describe a patient who presented at 27 weeks' gestation with monitored contraction activity and no palpable uterine contractions. A second case is presented herein. Both patients were initially managed as though they had preterm labor or uterine irritability with minimal cervical changes. The diagnosis was suspected only after each patient failed to respond to aggressive tocolysis. On external tocodynamometry, contractions were abrupt in onset and abrupt in descent. Only after palpating abdominal contractions and not uterine contractions did the attending physicians make the correct diagnosis. The development of pseudolabor in a patient with previously diagnosed pseudoseizures suggests that the condition was conversion disorder. The prevalence of pseudolabor is unknown and may be underestimated: electronic fetal monitoring has minimized the need to palpate uterine contractions in the laboring patient. The diagnosis of pseudolabor as a subtype of conversion disorder should be considered in any patient who presents with recurrent preterm uterine contractions, no (or minimal) cervical changes, and an atypical contraction pattern.

Journal Article↗
PubMedDate not supplied

[The neurotic conversion disorder spectrum in neuropediatrics].

The incidence and symptomatology of conversion disorders in a neuropaediatric department was described. One year was retrospectively evaluated. From totally 12 patients with conversion disorders 7 were suffering for an impaired walk and each 1 patient for visual defect, choreoathetosis and confusion, convulsive seizures, tic, paralysis. "Conversion disorder" is an important and often ignored diagnosis in neuropaediatrician.

Adolescent↗
PubMed1996

Behavioral management of conversion disorder: retrospective study.

OBJECTIVE: To assess whether operant behavioral treatment of conversion disorder provides effective and durable symptom resolution, and to evaluate the prognostic value of duration of symptoms, as to the time required to effect symptom resolution. DESIGN: Retrospective case series (consecutive sample). SETTING: Inpatient rehabilitation unit in a tertiary care center. PATIENTS: The first 10 patients with conversion disorder treated by the author. There were 5 men and 5 women, age range 19 to 69 years, mean 32.7 years. The duration of conversion disorder symptoms (all involving gait) ranged from 0.5 to more than 112 weeks (mean 27.8 weeks, median 12 weeks). Follow-up range was 7 to 36 months (mean 20 months). INTERVENTION: All patients were treated as inpatients using a behavioral approach. A 'pseudo-scientific' explanation of the symptoms was provided, with an explanation that stressors can exacerbate symptoms. patients were in a wheelchair when no in therapy, and a physical therapy program was devised, using a treatment sequence based treatment of the analogous neurological condition. Other therapies were also utilized for positive reinforcement of normal function. All patients had psychological evaluation, with treatment as indicated. Patients were hospitalized long enough to restore normal gait and begin psychological treatment. MAIN OUTCOME MEASURES: Functional Independence Measure ambulation score at admission, discharge, and follow-up, and descriptive data, including symptom recurrence after discharge, new neurological symptoms after discharge, new treatment since discharge, and new psychiatric or neurological diagnosis since discharge. RESULTS: All patients attained normal ambulation before discharge (n = 10, Wilcoxon signed rank test p = .002). At followup, 7 of 9 patients maintained normal ambulation (Wilcoxon signed rank test of pretreatment ambulation score versus followup ambulation score p = .1016). Two patients resumed partial dependence on wheelchair use. There was a Spearman correlation coefficient of .68196 (p = .0298) when comparing duration of symptoms against duration of treatment. No patient had symptom substitution or new diagnosis made during the follow-up period. CONCLUSION: (1) Behavioral treatment of conversion disorder is effective, and appears to provide a clinically (but not statistically) significant long-lasting resolution of symptoms. (2) There is a strong positive correlation between duration of conversion symptoms and the time required to eradicate them.

Adolescent↗
PubMed1995

Emergency department presentation of patients with conversion disorder.

OBJECTIVE: To describe the presenting symptoms and other features of ED patients diagnosed as having conversion disorder. METHODS: A retrospective chart review was carried out on the records of ED patients who had had final ED or in-hospital diagnoses of conversion disorder. Cases from 1982 to 1992 at a 566-bed rural tertiary care hospital with a residency program in emergency medicine were reviewed for patient age and gender, presenting signs and symptoms, ED diagnostic evaluation, disposition, and comorbidity. RESULTS: Of 42 patients who had conversion disorder diagnoses, 24 were women and 18 were men. Twenty-one (50%) of the patients were diagnosed in the ED, and of those patients, ten were released home from the ED. Patient age ranged from 5 to 70 years, with a mean age of 33 years for women and 34 years for men. Most clinical symptoms mimicked neurologic disorder (weakness, pain, seizure-like activity, loss of consciousness, etc). Thirty patients (71%) received laboratory studies in the ED and two others received laboratory studies on admission. Seventeen (40%) patients had computed tomography of the head and five (12%) patients had magnetic resonance imaging of the head. Twelve (29%) patients had previous histories of psychiatric disorders, four (10%) had histories of alcohol and drug abuse, two (5%) had prior conversion reactions, three (7%) had chronic illnesses, and four (10%) had been victims of previous head trauma. CONCLUSION: Patients with conversion disorder in the ED usually present with neurologic symptoms and undergo multiple diagnostic tests. Comorbidity is common. Early psychiatric evaluation may assist in the diagnosis and evaluation of patients with suspected conversion disorder in the ED.

Adolescent↗
PubMed1993

Tetanus, pseudotetanus, or conversion disorder: a diagnostic dilemma?

Failure to consider conversion disorder in a patient with acute, tetanus-like symptoms led to unnecessary medical expenditures and delayed appropriate psychiatric intervention. Patients presenting these clinical symptoms need a comprehensive evaluation, with careful attention to details in the psychosocial history. While tetanus is rarely encountered now in the United States, conversion disorder is commonly encountered in both medical and psychiatric populations.

Adult↗
PubMed2004

Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder.

OBJECTIVE: The aim of this study was to evaluate dissociative disorder and overall psychiatric comorbidity in patients with conversion disorder. METHOD: Thirty-eight consecutive patients previously diagnosed with conversion disorder were evaluated in two follow-up interviews. The Structured Clinical Interview for DSM-III-R, the Dissociation Questionnaire, the Somatoform Dissociation Questionnaire, and the Childhood Trauma Questionnaire were administered during the first follow-up interview. The Structured Clinical Interview for DSM-IV Dissociative Disorders was conducted in a separate evaluation. RESULTS: At least one psychiatric diagnosis was found in 89.5% of the patients during the follow-up evaluation. Undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, and dissociative disorder not otherwise specified were the most prevalent psychiatric disorders. A dissociative disorder was seen in 47.4% of the patients. These patients had dysthymic disorder, major depression, somatization disorder, and borderline personality disorder more frequently than the remaining subjects. They also reported childhood emotional and sexual abuse, physical neglect, self-mutilative behavior, and suicide attempts more frequently. CONCLUSIONS: Comorbid dissociative disorder should alert clinicians for a more chronic and severe psychopathology among patients with conversion disorder.

Adolescent↗
PubMed1997

Conversion disorder presenting in a patient with an implantable morphine pump and an epidural abscess resulting in paraplegia.

Conversion disorders are symptoms or deficits affecting voluntary motor or sensory function that suggest a neurological or medical condition. The psychological symptoms associated with the medical condition must be preceded by conflict or other stressors. We present an individual who developed conversion disorder and paraplegia secondary to a sterile epidural abscess near the tip of her surgically implanted, epidural morphine infusion pump. She manifested at varying times both transient bilateral blindness and pseudoseizures consistent with a diagnosis of conversion disorder. Neurological evaluation for seizure activity and meningitis were negative. The etiology of the sterile epidural abscess remained unknown. The essential features of conversion disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, are discussed. Treatment of patients diagnosed with conversion disorder remains primarily supportive, with the focus on consistency and behavioral management. Extreme caution is suggested in regards to further investigations.

Abscess↗
PubMed2003

Sociodemographic and clinical characteristics of patients with conversion disorder in Eastern Turkey.

BACKGROUND: Conversion disorder (CD) is a common disease and its importance still continues in Turkey and particularly in Eastern Turkey. The aim of this study is to examine sociodemographic and clinical characteristics of CD. METHOD: Among 198 consecutive patients having CD diagnosed by structured DSM-III-R clinical interview, the psychosocial characteristics of the patients were clinically investigated. RESULTS: The most common subtype of CD was non-epileptic seizure (NES) (41.4 %). The psychosocial stress factors were found in the initiation or at the last episode of the disorder (88.9 %). The most prominent problem related with primary support group was traumatic event (37.9 %) followed by problems associated with migration and related economical problems which are the most important problems of the study area. The incidence of depressive disorders was high in patients with CD, and the histrionic personality disorder was the most prominent personality pathology among the patients. Direct referral to psychiatry clinics appeared to be low (12.1 %). CONCLUSION: Our findings have shown that traumatic events may have an important role in the occurrence, severity and duration of CD, and most of the patients seek help from religious healers. The study has also revealed that lower education level and socioeconomic and sociocultural problems may play a role in the occurrence of the disorder as well as regarding its course.

Adult↗
PubMed1997

Behavioral management of conversion disorder in children.

OBJECTIVE: To describe the behavioral management of conversion disorder in children and to preliminarily assess its effectiveness. DESIGN: Retrospective case series. SETTING: Inpatient pediatric rehabilitation unit. PATIENTS: The first eight patients with conversion disorder treated on our pediatric rehabilitation unit, between 9 and 18 years of age. Six were girls. Three cases are described in detail. INTERVENTIONS: All patients were treated as inpatients, using a behavioral approach. Inadvertent reinforcement of illness behavior was identified, and a reward system was established for good attainment. Some patients had a "level" system instituted, with increasing privileges for goal achievement. All patients and their families had psychological assessment and instruction in pain and stress management strategies. MAIN OUTCOME MEASURES: Restoration of normal gait and function, independence in activities of daily living (ADL), and symptom recurrence after discharge. RESULTS: All patients attained normal gait and ADL function before discharge. CONCLUSIONS: (1) Behavioral management of conversion disorder in children appears to be as effective as in adults, although at times a behavioral reward or "level" system may be necessary for adequate reinforcement. (2) Instruction of the patient and family in appropriate stress and pain management appears key to maintaining treatment effect over time.

Adolescent↗