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Agarwal V, Sitholey P, Srivastava C. Clinical Practice Guidelines for the management of Dissociative disorders in children and adolescents. Indian J Psychiatry 2019; 61:247-253. [PMID: 30745700 PMCID: PMC6345132 DOI: 10.4103/psychiatry.indianjpsychiatry_493_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prabhat Sitholey
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chhitij Srivastava
- Psychiatry Unit, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India.,Institute of Psychiatry, King's College London, London, United Kingdom.,Centre for Behaviour and Cognitive Sciences, University of Allahabad, Allahabad, Uttar Pradesh, India
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Baykara S, Atmaca M, Yıldırım H. KONVERSİYON BOZUKLUĞU OLAN HASTALARDA SEREBELLAR HACMİN SAĞLIKLI KONTROLLERLE KARŞILAŞTIRILMASI. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.322834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Akyüz F, Gökalp PG, Erdiman S, Oflaz S, Karşidağ Ç. Conversion Disorder Comorbidity and Childhood Trauma. Noro Psikiyatr Ars 2017; 54:15-20. [PMID: 28566953 DOI: 10.5152/npa.2017.19184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/05/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study is to examine the socio-demographic and clinical characteristics, the presence of comorbidity, and the link with childhood traumatic experiences in patients with conversion disorder (CD) in a psychiatric outpatient clinic. METHODS A total of 60 literate, female patients between 18 and 65 years of age who were referred to the general psychiatry outpatient clinic and who were diagnosed with conversion disorder according to the DSM-IV diagnostic criteria were included in the study. A questionnaire on sociodemographic and clinical characteristics, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Childhood Trauma Questionnaire (CTQ), and the Dissociative Events Scale (DES) were used to assess the cases. RESULTS The mean age of the participants was 36.27±11.18 years. 72% of the patients were married and 63% were primary school graduates. The most common symptoms were asthenia (100%), aphasia (96.7%), and crying-convulsions (93%). The most common co-morbidities were depression (50%) and dissociative disorders (48.3%). Among the patients, 53.3% reported a history of exposure to physical violence and 25% reported a history of sexual assault in childhood. Assessment of the Childhood Traumatic Questionnaire revealed a significant positive relation between emotional, physical, and sexual abuse scores and DES score. CONCLUSION CD has not yet been fully analyzed in detail in health institutions; co-existence of another mental disorder and the presence of traumatic experiences in the past further complicate the issue. Consideration of these factors during treatment will have a positive impact on the course and prognosis of the disorder.
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Affiliation(s)
- Fatma Akyüz
- Department of Psychiatry, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Peykan G Gökalp
- Former Co-Director of Department of Neurosis, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Sezgin Erdiman
- Department of Psychiatry, Balıkesir Atatürk State Hospital, Balıkesir, Turkey
| | - Serap Oflaz
- Department of Psychiatry, Former Lecturer İstanbul University İstanbul Medical Faculty, İstanbul, Turkey
| | - Çağatay Karşidağ
- Department of Psychiatry, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
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Abstract
The prognosis of functional (psychogenic) neurologic disorders is important in being able to help answer patients' and carers' questions, determine whether treatment is worthwhile, and to find out which factors predict outcome. We reviewed data on prognosis of functional neurologic disorders from two systematic reviews on functional motor disorders and dissociative (nonepileptic) seizures as well as additional studies on functional visual and sensory symptoms. Methodologic problems include heterogeneity in studied samples and outcome measures, diagnostic suspicion and referral bias, small size and retrospective design of available studies, possible treatments during follow-up, and literature review bias. With these caveats, the prognosis of functional neurologic disorders does appear to be generally unfavorable. In most studies, functional motor symptoms and psychogenic nonepileptic attacks remain the same or are worse in the majority of patients at follow-up. Measures of quality of life and working status were often poor at follow-up. Frequency of misdiagnosis at follow-up was as low as other neurologic and psychiatric disorders. Long duration of symptoms was the most distinct negative predictor. Early diagnosis and young age seem to predict good outcome. Emotional disorders and personality disorders were inconsistent predictors. Litigation and state benefits were found to be negative predictors in some studies, but others found they did not influence outcome.
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Affiliation(s)
- J Gelauff
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
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Büyükaslan H, Kandemir SB, Asoğlu M, Kaya H, Gökdemir MT, Karababa İF, Güngörmez F, Kılıçaslan F, Şavik E. Evaluation of oxidant, antioxidant, and S100B levels in patients with conversion disorder. Neuropsychiatr Dis Treat 2016; 12:1725-9. [PMID: 27471386 PMCID: PMC4948713 DOI: 10.2147/ndt.s109174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Various psychodynamic, neurobiological, genetic, and sociocultural factors are believed to be involved in the etiology of conversion disorder (CD). Oxidative metabolism has been shown to deteriorate in association with many health problems and psychiatric disorders. We evaluated oxidative metabolism and S100B levels in the context of this multifactorial disease. METHODS Thirty-seven patients with CD (25 females and 12 males) and 42 healthy volunteers (21 females and 21 males), all matched for age and sex, were included in this study. The total oxidant status, total antioxidant status, oxidative stress index, and S100B levels were compared between the two groups. RESULTS The total oxidant status, oxidative stress index, and S100B levels were significantly higher in patients with CD than in the control group, whereas the total antioxidant status was significantly lower. CONCLUSION CD is associated with deterioration of oxidative metabolism and increased neuronal damage.
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Affiliation(s)
- Hasan Büyükaslan
- Department of Emergency Medicine, Faculty of Medicine, Harran University
| | | | - Mehmet Asoğlu
- Department of Psychiatry, Faculty of Medicine, Harran University, Sanliurfa
| | - Halil Kaya
- Bursa Yüksek Ihtisas Training and Research Hospital, Bursa
| | | | | | - Fatih Güngörmez
- Department of Emergency Medicine, Mehmet Akif İnan Research Hospital
| | | | - Emin Şavik
- Department of Biochemistry, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Atmaca M, Baykara S, Mermi O, Yildirim H, Akaslan U. Pituitary volumes are changed in patients with conversion disorder. Brain Imaging Behav 2015; 10:92-5. [DOI: 10.1007/s11682-015-9368-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Izci F, Hocagil H, Izci S, Izci V, Koc MI, Acar RD. P-wave and QT dispersion in patients with conversion disorder. Ther Clin Risk Manag 2015; 11:475-80. [PMID: 25848293 PMCID: PMC4381888 DOI: 10.2147/tcrm.s81852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive marker of ventricular arrhythmia and sudden cardiac death, and P-wave dispersion, which is the noninvasive marker of atrial arrhythmia, in patients with conversion disorder (CD). PATIENTS AND METHODS A total of 60 patients with no known organic disease who were admitted to outpatient emergency clinic and were diagnosed with CD after psychiatric consultation were included in this study along with 60 healthy control subjects. Beck Anxiety Inventory and Beck Depression Scale were administered to patients and 12-lead electrocardiogram measurements were obtained. Pd and QTd were calculated by a single blinded cardiologist. RESULTS There was no statistically significant difference in terms of age, sex, education level, socioeconomic status, weight, height, and body mass index between CD patients and controls. Beck Anxiety Inventory scores (25.2±10.8 and 3.8±3.2, respectively, P<0.001) and Beck Depression Scale scores (11.24±6.15 and 6.58±5.69, respectively, P<0.01) were significantly higher in CD patients. P-wave dispersion measurements did not show any significant differences between conversion patients and control group (46±5.7 vs 44±5.5, respectively, P=0.156). Regarding QTc and QTd, there was a statistically significant increase in all intervals in conversion patients (416±10 vs 398±12, P<0.001, and 47±4.8 vs 20±6.1, P<0.001, respectively). CONCLUSION A similar relation to that in literature between QTd and anxiety and somatoform disorders was also observed in CD patients. QTc and QTd were significantly increased compared to the control group in patients with CD. These results suggest a possibility of increased risk of ventricular arrhythmia resulting from QTd in CD patients. Larger samples are needed to evaluate the clinical course and prognosis in terms of arrhythmia risk in CD patients.
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Affiliation(s)
- Filiz Izci
- Department of Psychiatry, Istanbul Bilim University, Sısli Florence Nightingale Hospital, Zonguldak, Turkey
| | - Hilal Hocagil
- Department of Emergency, Faculty of Medicine Hospital Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Servet Izci
- Department of Cardiology, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Vedat Izci
- Department of Emergency, Kartal Training and Research Hospital, Istanbul, Turkey
| | - Merve Iris Koc
- Department of Psychiatry, Erenköy Training and Research Hospital for Psychiatry, Istanbul, Turkey
| | - Rezzan Deniz Acar
- Department of Cardiology, Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
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Yayla S, Bakım B, Tankaya O, Ozer OA, Karamustafalioglu O, Ertekin H, Tekin A. Psychiatric comorbidity in patients with conversion disorder and prevalence of dissociative symptoms. J Trauma Dissociation 2015; 16:29-38. [PMID: 25365395 DOI: 10.1080/15299732.2014.938214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The 1st objective of the current study was to investigate the frequency and types of dissociative symptoms in patients with conversion disorder (CD). The 2nd objective of the current study was to determine psychiatric comorbidity in patients with and without dissociative symptoms. A total of 54 consecutive consenting patients primarily diagnosed with CD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the psychiatric emergency outpatient clinic of Sisli Etfal Research and Teaching Hospital (Istanbul, Turkey) were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, Structured Interview for DSM-IV Dissociative Disorders, and Dissociative Experiences Scale were administered. Study groups consisted of 20 patients with a dissociative disorder and 34 patients without a diagnosis of any dissociative disorder. A total of 37% of patients with CD had any dissociative diagnosis. The prevalence of dissociative disorders was as follows: 18.5% dissociative disorder not otherwise specified, 14.8% dissociative amnesia, and 3.7% depersonalization disorder. Significant differences were found between the study groups with respect to comorbidity of bipolar disorder, past hypomania, and current and past posttraumatic stress disorder (ps = .001, .028, .015, and .028, respectively). Overall comorbidity of bipolar disorder was 27.8%. Psychiatric comorbidity was higher and age at onset was earlier among dissociative patients compared to patients without dissociative symptoms. The increased psychiatric comorbidity and early onset of conversion disorder found in patients with dissociative symptoms suggest that these patients may have had a more severe form of conversion disorder.
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Affiliation(s)
- Sinan Yayla
- a Department of Psychiatry , Kastamonu State Hospital , Kastamonu , Turkey
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9
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Abstract
In this paper, it was reviewed neuroimaging results of the pituitary gland in psychiatric disorders, particularly schizophrenia, mood disorders, anxiety disorders, and somatoform disorders. The author made internet search in detail by using PubMed database including the period between 1980 and 2012 October. It was included in the articles in English, Turkish and French languages on pituitary gland in psychiatric disorders through structural or functional neuroimaging results. After searching mentioned in the Methods section in detail, investigations were obtained on pituitary gland neuroimaging in a variety of psychiatric disorders. There have been so limited investigations on pituitary neuroimaging in psychiatric disorders including major psychiatric illnesses like schizophrenia and mood disorders. Current findings are so far from the generalizability of the results. For this reason, it is required to perform much more neuroimaging studies of pituitary gland in all psychiatric disorders to reach the diagnostic importance of measuring it.
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Affiliation(s)
- Murad Atmaca
- Department of Psychiatry, School of Medicine, Firat University, 23119, Elazig, Turkey,
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10
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Abstract
Anxiety is arguably an emotion that predates the evolution of man. Its ubiquity in humans, and its presence in a range of anxiety disorders, makes it an important clinical focus. Developments in nosology, epidemiology and psychobiology have led to significant advancement in our understanding of the anxiety disorders in recent years. Advances in pharmacotherapy and psychotherapy of these disorders have brought realistic hope for relief of symptoms and improvement in functioning to patients. Neurotic disorders are basically related to stress, reaction to stress (usually maladaptive) and individual proneness to anxiety. Interestingly, both stress and coping have a close association with socio-cultural factors. Culture can effect symptom presentation, explanation of the illness and help-seeking. Importance given to the symptoms and meaning assigned by the physician according to their cultural background also differs across culture. In this way culture can effect epidemiology, phenomenology as well as treatment outcome of psychiatric illness especially anxiety disorders. In this review an attempt has been made to discuss such differences, as well as to reflect the important areas in which Indian studies are lacking. An attempt has been made to include most Indian studies, especially those published in Indian Journal of Psychiatry.
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Affiliation(s)
- J. K. Trivedi
- Department of Psychiatry, C.S.M. Medical University, U.P. (erstwhile K.G. Medical University), Lucknow - 226 003, India
| | - Pawan Kumar Gupta
- Department of Psychiatry, C.S.M. Medical University, U.P. (erstwhile K.G. Medical University), Lucknow - 226 003, India
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Deveci A, Taskin O, Dinc G, Yilmaz H, Demet MM, Erbay-Dundar P, Kaya E, Ozmen E. Prevalence of pseudoneurologic conversion disorder in an urban community in Manisa, Turkey. Soc Psychiatry Psychiatr Epidemiol 2007; 42:857-64. [PMID: 17639308 DOI: 10.1007/s00127-007-0233-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 06/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is not a wide agreement upon rate of conversion disorder within Turkish population. The aim of this study was to determine the prevalence of conversion disorder with pseudoneurological symptoms or deficits and related risk factors in a city. METHOD In total, 1,086 people, aged 15-65 years old, were selected from the city of Manisa, Turkey to take part in the study. We applied sociodemographic and health information questionnaires and the Composite International Diagnostic Interview (CIDI) Somatization Subscales to the samples. RESULTS The likelihood that an individual might have conversion disorder with pseudoneurological symptoms or deficits was found to be 5.6% (n = 61). The prevalence of conversion disorder with pseudoneurological symptoms or deficits was significantly higher among women (p < 0.0001), 15-24 year old women (p = 0.011) and 25-34 year old women (p = 0.003), people who live as squatters (p = 0.03), those with a history of psychiatric disorder (p < 0.0001) and those having a mother with a psychiatric disorder (p = 0.04). CONCLUSION This study has shown the conversion disorder with pseudoneurological symptoms or deficits is inadequately frequent in the population.
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Affiliation(s)
- Artuner Deveci
- Dept. of Psychiatry, Celal Bayar University Medical School, 45030, Manisa, Turkey.
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Atmaca M, Aydin A, Tezcan E, Poyraz AK, Kara B. Volumetric investigation of brain regions in patients with conversion disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:708-13. [PMID: 16600450 DOI: 10.1016/j.pnpbp.2006.01.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2006] [Indexed: 11/29/2022]
Abstract
Preliminary evidence revealed a decrease of regional cerebral blood flow in the thalamus and basal ganglia contralateral to the deficit and suggested that hysterical conversion deficits might entail a functional disorder in striatothalamocortical circuits. However, there is no systematic structural magnetic resonance imaging (MRI) study in the literature in patients with conversion disorder (CD). Therefore, we aimed to perform structural MRI to evaluate the brain regions of interest in first applying patients with CD. Morphometric MRI was used to compare regional brain volumes in ten women with CD and same number of healthy comparison subjects. Intracranial volume (ICV), whole brain volume, gray and white matter volumes did not differ between the patient and control groups. Patients with CD had significantly smaller mean volumes of the left caudate nucleus, lentiform nucleus (p<0.01 for caudate nucleus and p<0.05 for lentiform nucleus) and right caudate nucleus and lentiform nucleus (p<0.05 for both structures). In patients, the right thalamus was significantly smaller, and the left thalamus rendered to be smaller compared to healthy controls. Age at onset showed a significant relation with left caudate, and a near-significant trend with right thalamus volumes. In conclusion, our findings suggest that patients with CD have significantly smaller mean volumes of the left and right basal ganglia and smaller right thalamus, with a trend toward to smaller left thalamus compared to healthy controls and that these findings provide novel constraints for a modern psychobiological theory of hysteria.
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Affiliation(s)
- Murad Atmaca
- Department of Psychiatry, School of Medicine, Firat University, 23119 Elazig, Turkey.
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Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ 2005; 331:989. [PMID: 16223792 PMCID: PMC1273448 DOI: 10.1136/bmj.38628.466898.55] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Paralysis, seizures, and sensory symptoms that are unexplained by organic disease are commonly referred to as "conversion" symptoms. Some patients who receive this diagnosis subsequently turn out to have a disease that explains their initial presentation. We aimed to determine how frequently this misdiagnosis occurs, and whether it has become less common since the widespread availability of brain imaging. DESIGN Systematic review. DATA SOURCES Medline, Embase, PsycINFO, Cinahl databases, and searches of reference lists. REVIEW METHODS We included studies published since 1965 on the diagnostic outcome of adults with motor and sensory symptoms unexplained by disease. We critically appraised these papers, and carried out a multivariate, random effect, meta-analysis of the data. RESULTS Twenty seven studies including a total of 1466 patients and a median duration of follow-up of five years were eligible for inclusion. Early studies were of poor quality. There was a significant (P < 0.02) decline in the mean rate of misdiagnosis from the 1950s to the present day; 29% (95% confidence interval 23% to 36%) in the 1950s; 17% (12% to 24%) in the 1960s; 4% (2% to 7%) in the 1970s; 4% (2% to 6%) in the 1980s; and 4% (2% to 6%) in the 1990s. This decline was independent of age, sex, and duration of symptom in people included in the studies. CONCLUSIONS A high rate of misdiagnosis of conversion symptoms was reported in early studies but this rate has been only 4% on average in studies of this diagnosis since 1970. This decline is probably due to improvements in study quality rather than improved diagnostic accuracy arising from the introduction of computed tomography of the brain.
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Affiliation(s)
- Jon Stone
- School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh EH4 2XU.
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Abstract
A common problem in neurology is the existence of disorders that present with neurologic symptoms but do not have an identifiable neurologic basis. These disorders are often thought to have a psychologic basis. Abnormal movements are among the most frequent symptoms in psychogenic neurologic disorders. Although these disorders have not been studied extensively in children, clinical experience in our busy pediatric movement disorders clinic and many case reports support their existence in this age group. Elements of history, physical examination, and therapeutic intervention must be combined to construct a clear diagnosis of a psychogenic movement disorder. This article reviews the diagnosis and treatment of these disorders and includes two illustrative cases. Review of the current literature reveals a need for prospective trials to provide a solid foundation for better diagnosis and treatment of these disorders.
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Affiliation(s)
- Douglas B Kirsch
- Department of Neurology, University of Rochester School of Medicine and Strong Memorial Hospital, New York 14642, USA
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Carson AJ, Best S, Postma K, Stone J, Warlow C, Sharpe M. The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. J Neurol Neurosurg Psychiatry 2003; 74:897-900. [PMID: 12810775 PMCID: PMC1738573 DOI: 10.1136/jnnp.74.7.897] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In a previous cross sectional study of 300 consecutive new attenders at neurology outpatient clinics, 90 were detected with symptoms that were rated as "not at all" or only "somewhat" explained by organic disease. OBJECTIVE To report a follow up study of this cohort. METHODS Patients were reinterviewed by telephone eight months after their initial assessment. They were asked to rate their overall improvement on a clinical global improvement scale, and their health status on the medical outcome short form 36 item scale (SF-36). The PRIME MD interview was administered to determine psychiatric diagnoses. Neurological and primary care records were reviewed for any changes in diagnostic opinion during the follow up period. RESULTS Of the 90 eligible patients, 66 (73%) participated in follow up. Among these, five (8%) rated themselves as "much worse," four (6%) as "somewhat worse," 27 (40%) as "just the same," 15 (23%) as "somewhat better," and 15 (23%) as "much better." There were no cases in which an organic cause for the presenting complaint was uncovered during the follow up period. Poorer physical function at baseline was the only predictor of poorer outcome at follow up. CONCLUSIONS Over half the patients who presented to neurologists with symptoms that were rated as largely or completely medically unexplained had not improved eight months later. In no case was a disease explanation for the original presenting symptoms subsequently identified.
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Affiliation(s)
- A J Carson
- Robert Fergusson Unit, Royal Edinburgh Hospital, Edinburgh, UK.
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Jans T, Warnke A. Der Verlauf dissoziativer Störungen im Kindes- und Jugendalter - Eine Literaturübersicht. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 1999. [DOI: 10.1024//1422-4917.27.2.139] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T. Jans
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Julius-Maximilians-Universität Würzburg (Direktor: Prof. Dr. A. Warnke)
| | - A. Warnke
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Julius-Maximilians-Universität Würzburg (Direktor: Prof. Dr. A. Warnke)
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Binzer M, Kullgren G. Motor conversion disorder. A prospective 2- to 5-year follow-up study. PSYCHOSOMATICS 1998; 39:519-27. [PMID: 9819952 DOI: 10.1016/s0033-3182(98)71284-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this prospective study, 30 patients with motor conversion disorder were assessed for key psychiatric and demographic variables. At reassessment 2 to 5 years later, 19 patients had completely recovered and 8 patients had improved, whereas only 3 were unchanged or worse. Contrary to other follow-up studies, none of the patients received a rediagnosis of neurological disease. The presence of a personality disorder and overall personality pathology, particularly within cluster C, the presence of a concomitant somatic disease, low DSM-IV Axis V score, and high score on the Becks Hopelessness Scale proved to be associated with poor outcome.
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Affiliation(s)
- M Binzer
- Department of Neurology, Umeå University, Sweden.
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Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997; 36:1329-38. [PMID: 9334545 DOI: 10.1097/00004583-199710000-00014] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To review the literature on somatoform disorders in children and adolescents relevant to recertification by the American Board of Psychiatry and Neurology. METHOD The psychiatric, pediatric, and psychological literatures were searched for clinical or research articles in the past 10 years dealing with somatization and somatoform disorders. RESULTS Somatizing presentations are organized conceptually; somatization disorder, body dysmorphic disorder, hypochondriasis, conversion disorder, vocal cord dysfunction, pain disorder, and recurrent abdominal pain are described in children and adolescents; empirical evidence for treatment efficacy is scant, but clinically reasonable approaches are applied. CONCLUSION More developmentally appropriate diagnostic schemas and better outcome studies are needed in all the somatoform disorders for children and adolescents.
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Affiliation(s)
- G K Fritz
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
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Abstract
A postal request to general practitioners in a catchment area (population 37,000) identified 18 patients fulfilling criteria for conversion disorder (age range 26-74 years; mean age of onset of first episode 38 years). There was a female preponderance, with two patients from ethnic minority groups. There was a temporal correlation with stress in 13 cases (72%) and a history of sexual abuse in 5 cases (28%). Three clinical groups were identified: acute onset with good premorbid functioning and full recovery; conversion symptoms as part of polysymptomatic presentation, with fluctuating course; and chronic, severely disturbed individuals with a past history of sexual abuse. One third of cases were referred to psychiatrists. There was no case of a missed organic disorder. The details of one case are discussed.
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Affiliation(s)
- S P Singh
- Department of Psychiatry, Queen's Medical Centre, Nottingham, UK.
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Abstract
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.
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Affiliation(s)
- C J Mace
- Department of Psychology, University of Warwick, Coventry
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