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PubMed1993

[Neurological conversion disorders in older children].

BACKGROUND: Conversion symptoms with a neurological character are not unusual in children. Little is known about prognosis. This study aimed to determine the outcome in a group of children with conversion. PATIENTS AND METHODS: Over the period 1979-1989 35 children from 6 to 16 who met DSM-III-R criteria for conversion were selected from the case-records of the Child Neurology department of the University Hospital in Leiden. Case histories were analysed and 20 patients were interviewed at home and a standard questionnaire was used additionally. RESULTS: Conversion symptoms disappeared with time in 15 patients. In comparison with the control group, patients with conversion scored higher on nervousness. CONCLUSION: Conversion disorder runs a favourable course. The place of child psychiatric treatment should be analysed prospectively.

Adolescent↗
PubMed2001

Conversion disorder: difficulties in diagnosis using DSM-IV/ICD-10.

OBJECTIVE: Conversion disorder presents differently in various cultures. The commonest symptoms in the Asian subcontinent may be very different from those seen in Western Hemisphere. This causes some difficulty in making a diagnosis while using DSM-IV and ICD-10. METHOD: This study searched inpatient records for the last 10 years at the Aga Khan University and collected some demographic data as well as assessed the phenomenology of conversion disorder in the patient population. RESULTS: We found unresponsiveness to be the most common symptom in this sample thus not exactly fitting the DSM-IV/ICD-10 picture. CONCLUSION: We observed that current criteria of conversion disorder as stated in two major classification systems are not totally relevant to the clinical practice in Pakistan and other parts of subcontinent.

Adolescent↗
PubMed2006

Conversion disorder presenting as hemiplegia and hemianesthesia with loss of neurologic reflexes: a case report.

Conversion disorders can present with a variety of sensorimotor signs and symptoms. We present the case of a young woman who presented with sudden onset hemiplegia and hemianesthesia including unilateral loss of deep tendon reflexes, Babinski reflex, and loss of rectal tone with bladder incontinence. The loss of rectal tone, loss of deep tendon reflexes, and a flaccid Babinski reflex are unusual signs in conversion disorders. A thorough medical workup including x-rays, CT scans, and magnetic resonance imaging revealed no organic causes for the neurologic deficits. Before the onset of symptoms, the patient was emotionally upset during an argument, which may have provided the psychologic stressor necessary for a conversion disorder. The young woman gradually regained full neurologic function over the next 14 hours. Conversion disorders should be considered when the neurologic findings do not correspond to known anatomic or physiologic pathways, although a thorough medical investigation must be performed to search for organic causes.

Adult↗
PubMed2007

Conversion disorder in Australian pediatric practice.

OBJECTIVES: To describe the incidence and clinical features of children presenting to Australian child health specialists with conversion disorder. METHOD: Active, national surveillance of conversion disorder in children younger than 16 years of age during 2002 and 2003. RESULTS: A total of 194 children were reported on. The average age was 11.8 years; 23% were younger than 10 years of age. Presentations were complex, with 55% presenting with multiple conversion symptoms. The most common presentations were disturbance of voluntary motor function (64%), sensory symptoms (24%), pseudoseizure (23%), and respiratory problems (14%). Hospital admission was required for 70%, with an average stay of 10.2 days. Antecedent stressors were also reported in 62% and a history of mental health concerns in 42%, with 14% of children taking psychotropic medications for comorbid anxiety or depression. The incidence of conversion disorder in Australian specialist child health practice is estimated to be between 2.3 and 4.2/100,000. CONCLUSIONS: Conversion disorder is associated with a significant burden for the child, family, and the health system. This study emphasizes the comorbidity with anxiety, depression, and symptoms of pain and fatigue. It also highlights the potential impact of "commonplace" stressors such as family conflict and children's loss of attachment figures.

Adolescent↗
PubMedDate not supplied

Cardiac angiography and conversion disorder.

BACKGROUND: Somatoform disorders are disorders in which "psychic energy" is transferred to somatic symptoms secondary to stressors. The concept of somatoform disorders and their associations among patients with cardiac disease is a relatively unfamiliar area. OBJECTIVE: The authors present a case that illustrates how conversion disorder, a specific type of somatoform disorder, may be associated with the psychologic stressor involved with cardiac angiography. The authors will discuss the literature concerning the identification and treatment of this disorder. METHODS: The relevant literature in the area of conversion disorder and cardiac angiography was reviewed. RESULTS: This report is the first documented case of a woman who developed conversion disorder after coronary catheterization. Using the case, a summary of diagnostic and treatment modalities used in this disorder is provided. CONCLUSIONS: The case highlights how conversion disorder can occur as a sequelae of coronary catheterization. The principles involved in the diagnosis and treatment of conversion disorder were successful in managing this patient. It is hoped that the case can aid cardiologists in becoming cognizant of this uncommon psychiatric disorder.

Angina, Unstable↗
PubMed2005

Conversion disorder in a child presenting as sudden sensorineural hearing loss.

Pseudohypoacacusis is a form of conversion disorder in which a hearing loss is found in the absence of organic disease. A case of an 11-year-old boy with auditory conversion disorder after mild head trauma is reported. The child presented with unilateral hearing loss, with no accompanying vestibular symptoms and no history of otologic disease. Auditory testing revealed severe right-sided sensorineural hearing loss, however, CT scan was normal. There was a family history of conversion disorder and the child was undergoing an emotionally stressful period. It was decided to treat the child conservatively with close monitoring and a repeat audiogram 2 weeks later. One week after presentation, the child's hearing suddenly returned to normal after a second very minor head injury. It is important to consider pseudohypoacusis or conversion disorder even in cases such as trauma, when the clinical history supports a diagnosis of hearing loss.

Audiometry, Pure-Tone↗
PubMed2005

The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder.

Although the presence of psychological stress factors in the evolution of conversion symptoms forms an important criterion for the DSM-IV diagnosis of conversion disorder, little is known about the nature and timing of these stress factors. Fifty-four patients with conversion disorder and 50 control patients with an affective disorder were screened for life events experienced in the year before the symptom onset. Conversion patients did not differ from control patients in the number or severity of life events, but showed a significant relation between the recent life events and the severity of conversion symptoms. Especially life events with respect to work and relationships contributed to this effect. These results remained when controlling for the previously found effects of childhood traumatization on the severity of conversion symptoms. The findings imply that conversion symptoms may be elicited by a complex of early and later negative life events and that traditional unifactorial trauma-theories of conversion disorder should be replaced by multifactorial stress models.

Adult↗
PubMed1994

[Conversion disorders in children and adolescents. A multidisciplinary approach].

Conversion disorders are characterized by change or loss of physical functions which indicates a neurological disorder (e.g. paralysis, sensory disturbances, or epilepsy like seizures). Clinical/neurological examination does not confirm any organic basis for the symptoms. Conversion disorders are more frequent in girls than in boys. They are rarely seen below the age of seven. A correspondence is often found between the personality of the child, (a conscientious attitude) and family relations. The families seem quite normal, but often have high expectations of their children, are sensitive to social stigmatization and have an underlying anxiety for health problems. A model is often found for the child's symptoms. Symptoms may be precipitated by an infection or a physical trauma. Sexual abuse is sometimes discovered. Multiprofessional assessment and treatment by a neuropediatrician, physiotherapist, child psychiatrist/psychologist and educational therapist may reduce "doctor shopping" and contribute to a favourable outcome.

Adolescent↗
PubMed1985

The use of contingent reinforcement in the treatment of a conversion disorder: a multiple baseline study.

Behavioral conceptualizations of conversion disorders emphasize the role of operant conditioning. However, this literature is methodologically weak, with few controlled studies. Thus, this study, by using multiple baseline and changing criterion designs, investigated the utility of operant procedures. It involves the treatment by contingent social reinforcement of a conversion disorder in a teenage girl. Treatment outcome and suggestions for future research are discussed.

Adolescent↗
PubMed2000

Organic syndromes diagnosed as conversion disorder: identification and frequency in a study of 85 patients.

BACKGROUND: The percentage of patients initially diagnosed with a conversion disorder and later identified as having an organic disorder has been decreasing in recent studies. METHOD: Consecutive patients with a diagnosis of conversion disorder were referred for psychiatric diagnosis and treatment. Research questions were: (1) What incidence of neurological disorder is revealed by neurological reassessment and by which diagnostic technique is the final diagnosis established? (2) What differences can be observed between true-positive and the false-positive results? RESULTS: Ten (11.8%) of the 85 patients examined appeared to suffer from a neurological disorder. In this sample, variables discriminating between the true positives and false positives were: (1) prior suspicion of neurological disorder; (2) older age at referral; (3) older age at onset of symptoms; (4) longer duration of symptoms; and (5) use of medication. Three variables contributed significantly to the prediction of organic disorder: prior suspicion of neurological disorder; age at onset of symptoms; and duration of symptoms. CONCLUSIONS: Although our results are in line with those of other recent studies, the percentage of false positives was still high. The data further emphasize the dangers of making a diagnosis of conversion disorder in the absence of positive evidence. It is important to continue to provide follow up for patients with a diagnosis of conversion disorder. Unfortunately, unreliable psychiatric indications, like certain behavioral characteristics, are still used in the diagnostic process. The results show that a general neurological examination is still a valuable diagnostic instrument in addition to modern diagnostic techniques.

Adolescent↗
PubMed1990

Treatment outcome for children and adolescents with conversion disorder.

This paper describes the clinical impressions of conversion disorders developed after long term in-depth clinical work with 137 children and adolescents and their families. Almost half of the 89 patients who were directly treated and followed by the author through an integrative child and family therapy approach recovered less than two weeks after the initiation of the treatment. Only three out of 89 patients required longer than four weeks for recovery. The rest responded well to the therapy and recovered with two to four weeks of treatment. Factors associated with positive treatment outcome are: younger age of patient, healthy personality characteristics, lack of psychopathology, insight and treatment compliance, healthy family functioning, acceptance by the family of the psychological nature of the illness, positive feelings towards the child and the family by the staff, lack of internal conflict and inflexible neurotic defences, and early therapeutic interventions. It was found that child and adolescent patients with conversion disorders responded quite well to an integrative, condensed treatment approach.

Adolescent↗
PubMed1996

Conversion disorder after maxillofacial trauma and surgery.

Three cases of conversion disorder are reported: one after orthognathic surgery and two after facial trauma. Two of the cases involved facial anesthesia and one case involved facial palsy. It was thought to be important to bring this phenomenon to the attention of oral and maxillofacial surgeons, to consider its management, and to define the patients with a high risk of developing conversion disorder. The prognosis is dependent on the circumstances of the onset of the disorder, the premorbid psychologic health of the patient, and how rapidly treatment is prescribed.

Adolescent↗
PubMed1998

Reflex sympathetic dystrophy in a 12-year-old twin with comorbid conversion disorder in both twins.

A case of reflex sympathetic dystrophy is presented in a 12-year-old girl with comorbid conversion disorder. Her identical twin also had a conversion disorder. This is the first reported case of coexistence of reflex sympathetic dystrophy and conversion disorder. It is important for clinicians to be aware that these conditions may coexist since the presentation of symptoms differ, even though there are shared features of treatment.

Child↗
PubMed1997

Limited utility of ICD-10 and DSM-IV classification of dissociative and conversion disorders in India.

Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification. We studied the prevalence of various ICD-10 and DSM-IV categories of dissociative (conversion) disorders and our own proposed category of 'brief dissociative stupor' (BDS), among all the in-patients of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining subjects with a diagnosis of any other subcategory of dissociative disorder according to ICD-10. Our analysis revealed that there were no patients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significantly more female patients in the BDS group, and they also had significantly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in patients from other centres. The classification of these patients with this phenomenology is problematic. Inclusion of a subcategory of dissociative non-epileptic seizures, instead of dissociative convulsions, should improve the classification of dissociative (conversion) disorders.

Adolescent↗
PubMed2002

Conversion disorder in children and adolescents: a 4-year follow-up study.

OBJECTIVE: To assess the outcome of conversion disorder in children and adolescents and to identify factors affecting the prognosis. METHOD: Forty adolescents with conversion disorder were reevaluated 4 years after their initial interview. Changes in demographic and clinical data and the presence of any mood and anxiety disorders were recorded using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). In addition, Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were applied. RESULTS: Thirty-four patients (85%) had completely recovered from their conversion symptoms and two patients had improved (5%), whereas only four (10%) were unchanged. Fourteen (35%) patients received the diagnosis of mood and/or anxiety disorder. Favourable outcome was associated with early diagnosis (P=.04) and good premorbid adjustment (P=.01). CONCLUSION: Conversion disorder has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate in these patients even after recovery from conversion symptoms. Long clinical follow-up seems appropriate in children and adolescents with conversion disorder.

Adolescent↗
PubMedDate not supplied

Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders.

The aim of this study was to determine some of the demographical and clinical characteristics of conversion disorder in children and adolescents and to ascertain comorbidity with depressive and anxiety disorders. For this purpose 51 children and adolescents (mean age: 13.2 +/- 1.9, range: 9-16 years) who met DSM-IV criteria for conversion disorder were compared with a control group. The subjects of this study were mostly postpubertal girls, and pseudoseizure was the most frequent presentation. Misdiagnoses were frequent among these patients. Eight (15.7%) patients received a comorbid diagnosis of major depression and 19 (37.2%) patients had comorbid anxiety disorders according to DSM-IV diagnostic criteria. Significant differences between the two groups on depression and anxiety scales supported the clinical findings. It was concluded that clinicians should screen every patient with conversion disorder for major depression and anxiety disorders for a better outcome.

Adolescent↗
PubMed1997

Interrogative suggestibility in patients with conversion disorders.

We tested the hypothesis that increased interrogative suggestibility may contribute to the shaping and maintaining of conversions symptoms. Interrogative suggestibility was measured in 12 patients with conversion disorder and 10 control patients with confirmed neurological disease matched for age, premorbid intelligence, and as closely as possible in terms of their neurological symptoms to the patients with conversion disorder. Our observations do not support the contention that individual differences in interrogative suggestibility are of importance in the etiology of conversion disorders.

Adult↗
PubMed1997

Distinguishing conversion disorder from neurologic impairment.

Hysteria/conversion disorder has been described since antiquity. One French neurologist dubbed it "neurological nonsense" because its presentation was so complex and confusing. For nosological purposes for inclusion into the Diagnostic Statistical Manual, multiple revisions of conversion disorder terminology were made for each edition published from 1952-1994. Until recently, conversion disorder was thought to be solely psychological in origin: new studies raise the possibility that what is called conversion disorder is actually early disruption in the functioning of the nervous system in predisposed individuals. Because of its uncanny resemblance to neurological disease, the differential diagnosis is critical and should be exhaustive in its efforts to rule out neurological disease. The neuroscience nurse needs to be aware of this perplexing syndrome called conversion disorder and the never theories that suggest organic causation and interventions to enhance recovery.

Conversion Disorder↗