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Benhaddouch Y, Dumont F, Boukhalfa N, Bout A, Aarab C, Aalouane R. Somatic conversion in adolescents: A case study. L'ENCEPHALE 2024:S0013-7006(24)00099-X. [PMID: 38824043 DOI: 10.1016/j.encep.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/11/2024] [Accepted: 02/26/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Yassine Benhaddouch
- Service de psychiatrie, faculté de médecine et de pharmacie de Fès, CHU Hassan II, 30010 Fès, Morocco.
| | - Françoise Dumont
- Service de pédopsychiatrie, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - Naima Boukhalfa
- Service de pédopsychiatrie, centre hospitalier Victor-Dupouy, Argenteuil, France
| | - Amine Bout
- Service de psychiatrie, faculté de médecine et de pharmacie de Fès, CHU Hassan II, 30010 Fès, Morocco
| | - Chadya Aarab
- Service de psychiatrie, faculté de médecine et de pharmacie de Fès, CHU Hassan II, 30010 Fès, Morocco
| | - Rachid Aalouane
- Service de psychiatrie, faculté de médecine et de pharmacie de Fès, CHU Hassan II, 30010 Fès, Morocco
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2
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Kim YN, Gray N, Jones A, Scher S, Kozlowska K. The Role of Physiotherapy in the Management of Functional Neurological Disorder in Children and Adolescents. Semin Pediatr Neurol 2022; 41:100947. [PMID: 35450664 DOI: 10.1016/j.spen.2021.100947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Children and adolescents with functional neurological (conversion) disorder (FND) present with symptoms of impaired motor and sensory function. FND involves complex interactions between the brain, mind, body, and lived experience of the child. The gold standard for treatment is therefore a holistic, biopsychosocial approach with multimodal interventions delivered by a multidisciplinary team. In this narrative review we examine the role of physiotherapy in managing FND in children. We searched Embase, Medline, PsycINFO, and PubMed (back to 2000) for relevant physiotherapy articles and also manually searched their reference lists. Two review articles and ten observational studies were identified. Data were extracted concerning the type of study, therapies involved, outcome measures, and comorbid mental health outcomes. FND symptoms resolved in 85% to 95% of the patients, and about two-thirds returned to full-time school after completing the multidisciplinary intervention. Ongoing mental health concerns at follow-up were associated with poorer functional outcomes. Key themes included the following: use of psychological interventions embedded in the physiotherapy intervention; integration of play, music, and dance; role of physical exercise in modulating physiological, neural, and endocrine systems; need for FND-specific outcome measures; ethical issues pertaining to randomized trials; and need to develop alternate study methodologies for assessing combined treatments. Clinical vignettes were included to highlight a range of physiotherapy interventions. In conclusion, the emerging literature suggests that physiotherapy for children with FND is a useful intervention for improving motor dysfunction and for addressing other concurrent issues such as physical deconditioning, neuroprotection, chronic pain, disturbed sleep, anxiety and depression, and resilience building.
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Affiliation(s)
- Yu-Na Kim
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicola Gray
- Department of Physiotherapy, Sydney Children's Hospital Network, NSW, Australia
| | - Anna Jones
- Advance Rehab Centre, Artarmon, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA; University of Sydney Medical School, NSW, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; University of Sydney Medical School, NSW, Australia; Westmead Institute for Medical Research, Westmead, NSW, Australia.
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3
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Freedman D. Functional Neurological Disorders in Children - A Historical Perspective. Semin Pediatr Neurol 2022; 41:100950. [PMID: 35450665 DOI: 10.1016/j.spen.2021.100950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
The modern diagnosis of functional neurological disorders (FND) describes a diverse set of neurological symptoms without identifiable pathology. The history of FND and its prescientific predecessor, hysteria, is complex and deeply rooted in sexism. Key moments in this history have contributed to the advancement of understanding in functional disorders that neurologists should be aware of. Although pediatric FND has a much less extensive historical literature, there are many parallels between it and the initial interest in hysteria by Charcot and other early modern neurologists. This was followed by waning neurological attention as psychiatrists promoted conversion disorder in the early 1900s. Towards the end of the 20th century, neurologists have taken a renewed, collaborative role with psychiatry and other disciplines to diagnose and study FND.
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Gray N, Savage B, Scher S, Kozlowska K. Psychologically Informed Physical Therapy for Children and Adolescents With Functional Neurological Symptoms: The Wellness Approach. J Neuropsychiatry Clin Neurosci 2021; 32:389-395. [PMID: 32718273 DOI: 10.1176/appi.neuropsych.19120355] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Children with functional neurological disorder (FND) present with motor and sensory neurological symptoms that impair health and physical functioning and that create an ongoing clinical burden for caregivers and hospitals worldwide. Treatment programs for these children involve a multidisciplinary approach with physical therapy as a fundamental component. However, standard musculoskeletal approaches to physical therapy are ineffective or may even exacerbate symptoms because they are unresponsive to the biopsychosocial context in which FND emerges: FND typically occurs in the context of stress, either physical or emotional; symptoms are amplified by attention; and presentations are complicated by psychological factors. Informed, in part, by published guidelines for physical therapy with adult FND patients, this article examines common challenges that arise when working with children: overcoming previous negative encounters in the medical system; avoiding amplification of symptoms by drawing attention to them; and managing comorbid pain, falls, faints, nonepileptic seizures, dizziness, fatigue, and breathlessness, plus psychological symptoms such as anticipatory anxiety and panic attacks. What emerges is a psychologically informed therapeutic approach to physical therapy for children with functional neurological symptoms. This approach prioritizes interpersonal processes and physical therapy techniques that establish a therapeutic relationship and create a safe space for physical therapy, that use indirect physical therapy approaches redirecting the focus of attention away from symptoms and emphasizing the completion of tasks and activities engaging the sick body part indirectly, that tailor the intervention to address the needs and presentation of each particular child, and that integrate psychological interventions to manage common challenges.
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Affiliation(s)
- Nicola Gray
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Blanche Savage
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Stephen Scher
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Kasia Kozlowska
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
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5
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Wiggins A, Court A, Sawyer SM. Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity. Eur J Pediatr 2021; 180:1267-1275. [PMID: 33185780 DOI: 10.1007/s00431-020-03867-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.
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Affiliation(s)
- Aaron Wiggins
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia.
| | - Andrew Court
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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6
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Kasia K, Nicola G, Stephen S, Blanche S. Psychologically informed physiotherapy as part of a multidisciplinary rehabilitation program for children and adolescents with functional neurological disorder: Physical and mental health outcomes. J Paediatr Child Health 2021; 57:73-79. [PMID: 32861224 DOI: 10.1111/jpc.15122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 01/05/2023]
Abstract
AIM Children and adolescents with functional neurological disorder (FND) present with physical impairment and mental health comorbidities. Specialist physiotherapy programs for treating FND have been developed over the last two decades. This article reports outcome data from three cohorts of children treated with a multidisciplinary rehabilitation intervention - the Mind-Body Program - in which a psychologically informed physiotherapy intervention, known as the wellness approach to physiotherapy, was a key component. METHODS For three cohorts of children (n = 57, n = 60 and n = 25, respectively) treated in the Mind-Body Program, data about functional impairment and mental health concerns were collected at presentation and at follow-up (4 years, 12 months and 18 months, respectively). RESULTS Outcome data show that FND symptoms resolved in 54/57 (95%), 51/60 (85%) and 22/25 (88%) of children in the three cohorts, and that 31/57 (61%), 32/60 (53%) and 13/25 (52%) of children returned to full health and to full-time school attendance. Changes in Global Assessment of Function (GAF) were significant (t(54) = 21.60, P < 0.001; t(55) = 9.92, P < 0.001; t(24) = 6.51, P < 0.001). Outcomes were less favourable for children with chronic FND symptoms at presentation; those whose comorbid mental health disorders or other (comorbid) functional somatic symptoms did not resolve; and those who subsequently developed chronic mental health problems. CONCLUSIONS Implementation of a multidisciplinary rehabilitation intervention - with psychologically informed physiotherapy as one of the key treatment components - resulted in resolution of FND symptoms and return to health and well-being in the large majority of patients.
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Affiliation(s)
- Kozlowska Kasia
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,The Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Gray Nicola
- Department of Physiotherapy, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Scher Stephen
- Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, New South Wales, Australia.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Savage Blanche
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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7
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Chouksey A, Pandey S. Functional Movement Disorders in Children. Front Neurol 2020; 11:570151. [PMID: 33281706 PMCID: PMC7688912 DOI: 10.3389/fneur.2020.570151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Functional movement disorders (FMDs) are not uncommon in children. The age at onset may have a bearing on the phenomenological pattern of abnormal movement, risk factors, and response to different treatment modalities in this age group. FMDs in children resemble their adult counterparts in terms of gender preponderance, but risk factors are quite different, and often influenced by cultural and demographic background. FMDs contribute to a significant proportion of acute pediatric movement disorder patients seen in emergency settings, ranging from 4.3 to 23% in different case series. The most common movement phenomenologies observed in pediatric FMDs patients are tremor, dystonia, gait disturbances, and functional tics. Various social, physical, and familial precipitating factors have been described. Common social risk factors include divorce of parents, sexual abuse, bullying at school, examination pressure, or other education-related issues, death of a close friend, relative, or family members. Physical trauma like minor head injury, immunization, tooth extraction, and tonsillectomy are also known to precipitate FMDs. The response to treatment appears to be better among pediatric patients. We aim to review FMDs in children to better understand the different aspects of their frequency, clinical features, precipitating factors, diagnosis, treatment, and outcome.
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Affiliation(s)
- Anjali Chouksey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, India
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8
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Ganslev CA, Storebø OJ, Callesen HE, Ruddy R, Søgaard U. Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database Syst Rev 2020; 7:CD005331. [PMID: 32681745 PMCID: PMC7388313 DOI: 10.1002/14651858.cd005331.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them. OBJECTIVES To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults. SEARCH METHODS We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial). DATA COLLECTION AND ANALYSIS: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias. MAIN RESULTS We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence). Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence). Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence). Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment. Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence). CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence). Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence). Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17 studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect. AUTHORS' CONCLUSIONS The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
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Affiliation(s)
- Christina A Ganslev
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | | | | | - Ulf Søgaard
- Clinic of Liaison Psychiatry, Region Zealand, Denmark
- Psychiatric Research Unit, Psychiatry of Region Zealand, Slagelse, Denmark
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Leite VF, Araújo CA. A psychotic experience during adolescence: reasoning about differential diagnosis. case report. SAO PAULO MED J 2018; 136:479-483. [PMID: 28832806 PMCID: PMC9907769 DOI: 10.1590/1516-3180.2016.0307240317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT The aim of the present clinical review was to illustrate the diagnostic difficulty associated with psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying during this period. It was also intended to illustrate the observation that not all hallucinations occur in the context of a declared psychotic disorder. CASE REPORT The patient was a 16-year-old adolescent girl who came to the Emergency Department of Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the International Classification of Diseases, 10th edition. CONCLUSIONS Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpatient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient's conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.
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Affiliation(s)
- Vítor Ferreira Leite
- Medical Doctor, Master and Senior Resident of Child and Adolescent Psychiatry, Pediatric Psychiatry Service, Coimbra Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Carla Andrade Araújo
- Medical Doctor, Master and Senior Resident of Child and Adolescent Psychiatry, Pediatric Psychiatry Service, Coimbra Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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10
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Caulley L, Kohlert S, Gandy H, Olds J, Bromwich M. When symptoms don't fit: a case series of conversion disorder in the pediatric otolaryngology practice. J Otolaryngol Head Neck Surg 2018; 47:39. [PMID: 29843801 PMCID: PMC5975680 DOI: 10.1186/s40463-018-0286-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngology diseases in the pediatric population. Case presentation In this report, the authors describe 3 cases of conversion disorder that presented to a pediatric otolaryngology-head and neck surgery practice. This report highlights a unique population of patients who have not previously been investigated. The clinical presentation and management of these cases are discussed in detail. Non-organic otolaryngology symptoms of conversion disorder in the pediatric population are reviewed. In addition, we discuss the challenges faced by clinicians in appropriately identifying and treating these patients and present an approach to management of their care. Conclusion In this report, the authors highlight the importance of considering psychogenic illnesses in patients with atypical clinical presentations of otolaryngology disorders.
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Affiliation(s)
- Lisa Caulley
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Scott Kohlert
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Hazen Gandy
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Janet Olds
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Psychology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Matthew Bromwich
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. .,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada. .,Division of Otolaryngology - Head and Neck Surgery, Children's Hospital of Eastern Ontario, 400 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
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Bolger A, Collins A, Michels M, Pruitt D. Characteristics and Outcomes of Children With Conversion Disorder Admitted to a Single Inpatient Rehabilitation Unit, A Retrospective Study. PM R 2018; 10:910-916. [DOI: 10.1016/j.pmrj.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 11/16/2022]
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12
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Abstract
In this paper I outline the assessment, engagement and management of children and adolescents with somatising conditions. The major diagnostic groups, in rough order of prevalence, are adjustment, dissociative (transient and chronic), somatoform and factitious disorders and chronic fatigue. See Eminson (2001) for more detailed descriptions and subtypes.
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13
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Eminson DM. Somatising in children and adolescents. 1. Clinical presentations and aetiological factors. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.7.4.266] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Somatising disorders, characterised by complaints of unexplained physical symptoms, are common presentations in children and adolescents, both in primary and secondary care settings. They have significant impact on the children themselves and on health care resources: as in adults, there is a wide range of severity and resulting handicaps.
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Abstract
Liaison child and adolescent psychiatry has been described as the “partnership of child psychiatrists, paediatricians and other specialities concerned with children to provide integrated medical and psychological care for children” (Black et al, 1990). Although liaison work conjures up visions of the psychiatrist on the paediatric ward, it may also involve collaboration with community paediatric and primary care services. Indeed, the number of different professionals that may be involved with even quite mildly ill children is large (see Box 1). Much of the work is indirect (e.g. consultation with other professionals), but this and direct therapeutic work with children and families may continue long after discharge from the paediatric wards and clinics.
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Weber P, Erlacher R. Dissociative sensibility disorders - A retrospective case series and systematic literature review. Eur J Paediatr Neurol 2018; 22:27-38. [PMID: 28899586 DOI: 10.1016/j.ejpn.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused on. OBJECTIVE To identify the clinical characteristics and outcomes of dissociative sensibility disorders in children and adolescents, and to review the use of diagnostic procedures. DATA SOURCES For the review, a literature search used Pubmed, Embase, Web of Science, and PubPsych (to 02/2015) and the reference lists of the studies identified. STUDY SELECTION Screening of titles and abstracts; full-text assessment by two reviewers. DATA SELECTION The original case series was identified by using the local data register. DATA EXTRACTION Two reviewers independently reviewed the data and, if they agreed on the relevance, extracted the data. In the original case series, data were extracted retrospectively from the records. RESULTS Sixteen studies and seven case reports were identified, including 931 cases with dissociative disorders. In 210 cases the patient suffered either from a single sensibility disorder or predominantly from sensibility disorders. We identified thirteen further cases in our cohort. In both groups there was female predominance; the mean age of manifestation was early adolescence. The timing of admissions was variable. In approximately 50% of cases a premorbid stressful life event could be identified. Over 75% of cases had a good prognosis with complete resolution. LIMITATIONS Retrospective character of our own data collection, partially missing differentiation between the subgroups of dissociative disorders in the reviewed studies. CONCLUSIONS There is no uniform procedure for diagnostic work-up. The overall short-term prognosis is good.
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Affiliation(s)
- Peter Weber
- University of Basel, University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Switzerland.
| | - Rahel Erlacher
- University of Basel, University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Switzerland
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Milrod B. A 9‐year‐old with conversion disorder, successfully treated with psychoanalysis. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2017. [DOI: 10.1516/1f8k-t4cj-vl37-uffl] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Barbara Milrod
- Weill Medical College, Cornell University525 East 68th StreetNew YorkNY 10021USA
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Caes L, Orchard A, Christie D. Connecting the Mind-Body Split: Understanding the Relationship between Symptoms and Emotional Well-Being in Chronic Pain and Functional Gastrointestinal Disorders. Healthcare (Basel) 2017; 5:E93. [PMID: 29206152 PMCID: PMC5746727 DOI: 10.3390/healthcare5040093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022] Open
Abstract
Paediatric chronic conditions, e.g., chronic pain and functional gastrointestinal disorders, are commonly diagnosed, with fatigue, pain and abdominal discomfort the most frequently reported symptoms across conditions. Regardless of whether symptoms are connected to an underlying medical diagnosis or not, they are often associated with an increased experience of psychological distress by both the ill child and their parents. While pain and embarrassing symptoms can induce increased distress, evidence is also accumulating in support of a reciprocal relationship between pain and distress. This reciprocal relationship is nicely illustrated in the fear avoidance model of pain, which has recently been found to be applicable to childhood pain experiences. The purpose of this article is to illustrate how mind (i.e., emotions) and body (i.e., physical symptoms) interact using chronic pain and gastrointestinal disorders as key examples. Despite the evidence for the connection between mind and body, the mind-body split is still a dominant position for families and health care systems, as evidenced by the artificial split between physical and mental health care. In a mission to overcome this gap, this article will conclude by providing tools on how the highlighted evidence can help to close this gap between mind and body.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling FK9 4LA, UK.
| | - Alex Orchard
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
| | - Deborah Christie
- UCLH NHS Foundation Trust, Child and Adolescent Psychological Services, London NW1 2PQ, UK.
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Bouras G, Michopoulos I, Theofanopoulou N, Giannopoulou I, Christodoulou C, Dinopoulos A. Conversion disorder in a preschool age girl. J Health Psychol 2016; 21:2668-2672. [DOI: 10.1177/1359105315583368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article reports a case of a 5-year-old girl with clinical manifestations of a conversion disorder. Children presenting with a conversion disorder very often have multiple investigations and more than two-thirds of them are admitted to the hospital. This case illustrates the necessity of adapting, from the outset, a multidisciplinary approach to diagnosis and management, which helps in providing an explanatory model that takes into account stressors, factors within the child and the family, and aids in planning an appropriate psychotherapeutic intervention based on the child’s and family’s needs.
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Roelofs K, pasman J. Stress, childhood trauma, and cognitive functions in functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:139-155. [DOI: 10.1016/b978-0-12-801772-2.00013-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abstract
Functional neurologic disorders (FND) of children have many similarities to those of adults, and there is a potential to learn much from the study of FND in children. In this chapter we discuss multiple aspects of pediatric FND. These include their frequency, historic features, the diagnosis, and controversies over the nature of FND and the "correct" name that should be used. We also discuss methods of informing the child and family of the diagnosis, treatment, and prognosis. FND of children typically affect girls in the 10-14-years age range. The presentation is often polysymptomatic, with pain and lethargy accompanying loss of motor function. A common situation is a perfectionistic child who has taken on too much in her academic, sporting, cultural, and social life. Some children respond readily to treatment, but others have a prolonged illness.
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Affiliation(s)
- P J Grattan-Smith
- Department of Neurology, Westmead Children's Hospital, Sydney, Australia.
| | - R C Dale
- Department of Neurology, Westmead Children's Hospital, Sydney, Australia
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Duque PA, Vásquez R, Cote M. [Conversion Disorder in Children and Adolescents]. ACTA ACUST UNITED AC 2015; 44:237-42. [PMID: 26578475 DOI: 10.1016/j.rcp.2015.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 05/18/2015] [Accepted: 06/17/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Conversion disorder is diagnosed late, by exclusion and with a high risk of complications. There is a wide experience in adults that is not extrapolated to paediatric patients. According to the literature, the prognosis is better in children, but this changes when other variables such are included, such as comorbidities, late diagnosis and a very convincing social image of the neurological disease. OBJECTIVE To review the medical literature on the clinical features, diagnosis, comorbidities and treatment of this disorder. METHODS A literature research was performed on Medline and Pubmed, the terms used were "conversion disorder", pseudoseizures, treatment, clinic, children ("conversion disorder" OR hysteria OR hysterical) (child OR children OR childhood OR pediatric OR paediatric). The most relevant material found is included in this review. CONCLUSIONS Conversion disorder is often an imprecise diagnosis in high complexity paediatric services. No consensus was found in the literature search on how to treat patients after the initial diagnosis. The evidence that it becomes chronic is not strong enough, just as the evidence is not convincing enough to argue that comorbidity factors are those maintained over time. Clearly, there is no medical experience of the natural history of this disorder in children and adolescents. It is only known is that it is a complex condition, on which there is experience only in the diagnosis and treatment of the acute state, but not so in the long-term care. It is proposed that each patient is studied in detail in order to define the psychiatric diagnosis and its treatment.
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Affiliation(s)
| | - Rafael Vásquez
- Universidad Nacional de Colombia y Universidad del Bosque, Bogotá, Colombia.
| | - Miguel Cote
- Universidad Nacional de Colombia, Bogotá, Colombia
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Ouss L, Tordjman E. Conversive disorders among children and adolescents: towards new "complementarist" paradigms? Neurophysiol Clin 2014; 44:411-6. [PMID: 25306081 DOI: 10.1016/j.neucli.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 07/27/2014] [Indexed: 11/30/2022] Open
Abstract
This paper aims to describe current questions concerning conversive disorders among children and adolescents. We first describe prevalence and clinical characteristics of these. Many unresolved questions remain. Why do patients show excess, or loss of function? Attachment theory offers a relevant framework to answer this question. Does neurobiology of conversion disorders shed light on conversive processes? Current neurobiological research paradigms focus on the symptom, trying to infer processes, instead of proposing paradigms that test theoretical hypotheses. The most convincing theoretical framework that has already proposed a coherent theory of conversion is a psychodynamic one, which has not yet been tested with neurobiological paradigms. The interest of studying child and adolescent conversive disorders is to provide a means to more deeply investigate the two challenges we face: theoretical, and clinical ones. It provides the opportunity to access a pathopsychological process at its roots, not yet hidden by many defensive, rationalizing attitudes, and to better explore environmental features. We propose a "complementarist" model, which allows the combination of different approaches (neural, cognitive, environmental, attachment, intra-psychic) and permits proposal of different levels of therapeutic targets and means.
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Affiliation(s)
- L Ouss
- Necker hospital, 149, rue de Sèvres, 75015 Paris, France.
| | - E Tordjman
- Necker hospital, 149, rue de Sèvres, 75015 Paris, France.
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23
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de Gusmão CM, Guerriero RM, Bernson-Leung ME, Pier D, Ibeziako PI, Bujoreanu S, Maski KP, Urion DK, Waugh JL. Functional neurological symptom disorders in a pediatric emergency room: diagnostic accuracy, features, and outcome. Pediatr Neurol 2014; 51:233-8. [PMID: 25079572 DOI: 10.1016/j.pediatrneurol.2014.04.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND In children, functional neurological symptom disorders are frequently the basis for presentation for emergency care. Pediatric epidemiological and outcome data remain scarce. OBJECTIVE Assess diagnostic accuracy of trainee's first impression in our pediatric emergency room; describe manner of presentation, demographic data, socioeconomic impact, and clinical outcomes, including parental satisfaction. METHODS (1) More than 1 year, psychiatry consultations for neurology patients with a functional neurological symptom disorder were retrospectively reviewed. (2) For 3 months, all children whose emergency room presentation suggested the diagnosis were prospectively collected. (3) Three to six months after prospective collection, families completed a structured telephone interview on outcome measures. RESULTS Twenty-seven patients were retrospectively assessed; 31 patients were prospectively collected. Trainees' accurately predicted the diagnosis in 93% (retrospective) and 94% (prospective) cohorts. Mixed presentations were most common (usually sensory-motor changes, e.g. weakness and/or paresthesias). Associated stressors were mundane and ubiquitous, rarely severe. Families were substantially affected, reporting mean symptom duration 7.4 (standard error of the mean ± 1.33) weeks, missing 22.4 (standard error of the mean ± 5.47) days of school, and 8.3 (standard error of the mean ± 2.88) of parental workdays (prospective cohort). At follow-up, 78% were symptom free. Parental dissatisfaction was rare, attributed to poor rapport and/or insufficient information conveyed. CONCLUSIONS Trainees' clinical impression was accurate in predicting a later diagnosis of functional neurological symptom disorder. Extraordinary life stressors are not required to trigger the disorder in children. Although prognosis is favorable, families incur substantial economic burden and negative educational impact. Improving recognition and appropriately communicating the diagnosis may speed access to treatment and potentially reduce the disability and cost of this disorder.
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Affiliation(s)
- Claudio M de Gusmão
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts.
| | - Réjean M Guerriero
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Danielle Pier
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Simona Bujoreanu
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - Kiran P Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - David K Urion
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Jeff L Waugh
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts; Department of Neurology, Pediatric Movement Disorders Clinic, Massachusetts General Hospital, Boston Massachusetts
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Fernández Carbonell C, Benson L, Rintell D, Prince J, Chitnis T. Functional relapses in pediatric multiple sclerosis. J Child Neurol 2014; 29:943-6. [PMID: 24065582 DOI: 10.1177/0883073813501873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/23/2013] [Indexed: 11/15/2022]
Abstract
Multiple sclerosis in children is characterized by more frequent relapses than in adult patients. Diagnosing and treating youth with multiple sclerosis present a number of challenges including differentiating organic relapses from functional symptoms. However, there is no literature describing coexistence of functionality in pediatric multiple sclerosis. Here, we report 2 cases in which inconsistency between clinical history, physical examination, imaging, and atypical disease progression led to suspicion of functional relapses. The purpose of this study is to raise awareness of functional relapses, as prompt recognition can prevent overtreatment and iatrogenic risks in children and adolescents with multiple sclerosis. Underlying psychiatric issues also need to be addressed.
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Affiliation(s)
- Cristina Fernández Carbonell
- Partners Pediatric Multiple Sclerosis Center, Department of Child Neurology Massachusetts General Hospital, Boston, MA, USA
| | - Leslie Benson
- Partners Pediatric Multiple Sclerosis Center, Department of Child Neurology Massachusetts General Hospital, Boston, MA, USA
| | - David Rintell
- Partners Pediatric Multiple Sclerosis Center, Department of Child Neurology Massachusetts General Hospital, Boston, MA, USA Department of Child Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jefferson Prince
- Department of Child Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Pediatric Multiple Sclerosis Center, Department of Child Neurology Massachusetts General Hospital, Boston, MA, USA
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Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, Williams LM. Conversion disorder in children and adolescents: A disorder of cognitive control. J Neuropsychol 2014; 9:87-108. [DOI: 10.1111/jnp.12037] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
- Disciplines of Psychiatry and of Paediatrics and Child Health; University of Sydney Medical School; New South Wales Australia
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
| | - Donna M. Palmer
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
| | - Kerri J. Brown
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
- NSW Institute of Psychiatry; Parramatta BC New South Wales Australia
| | - Stephen Scher
- Department of Psychiatry; Harvard Medical School; McLean Hospital; Belmont Massachusetts USA
| | - Catherine Chudleigh
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
| | - Fiona Davies
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
| | - Leanne M. Williams
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
- Psychiatry and Behavioral Sciences; Stanford University; California USA
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Akdemir D, Uzun O, Pehlivantürk Özsungur B, Topçu M. Health-related quality of life in adolescents with psychogenic nonepileptic seizures. Epilepsy Behav 2013; 29:516-20. [PMID: 24126028 DOI: 10.1016/j.yebeh.2013.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/30/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the health-related quality of life (HRQoL) in adolescents with psychogenic nonepileptic seizures (PNESs) and to identify factors affecting the quality of life in these patients. Thirty-four adolescents with PNESs were compared to 30 adolescents without any psychiatric disorder. The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version (K-SADS-PL) was applied to determine comorbid psychiatric disorders in the study group and to rule out any psychiatric disorder in the control group. The Pediatric Quality-of-Life Inventory (PedsQL) was used to assess the HRQoL. Physical HRQoL and psychosocial HRQoL, including emotional and school functioning, were found to be significantly lower in adolescents with PNESs. In the group with PNESs, the physical HRQoL and total HRQoL of adolescents with somatoform disorders other than PNESs and the emotional functioning of adolescents with major depressive disorder were worse than those of the adolescents without these comorbid psychiatric disorders. Seizure frequency and the duration of symptoms were not correlated with HRQoL scores. Treatment strategies in adolescents with PNESs should regard comorbid unexplained somatic symptoms and psychiatric disorders in addition to the reduction or cessation of seizures.
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Affiliation(s)
- Devrim Akdemir
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Rofé Y, Rofé Y. Conversion Disorder: A Review Through the Prism of the Rational-Choice Theory of Neurosis. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i4.621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ani C, Reading R, Lynn R, Forlee S, Garralda E. Incidence and 12-month outcome of non-transient childhood conversion disorder in the U.K. and Ireland. Br J Psychiatry 2013; 202:413-8. [PMID: 23620449 DOI: 10.1192/bjp.bp.112.116707] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Little is known about conversion disorder in childhood. AIMS To document clinical incidence, features, management and 12-month outcome of non-transient conversion disorder in under 16-year-olds in the U.K. and Ireland. METHOD Surveillance through the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System. RESULTS In total, 204 cases (age range 7-15 years) were reported, giving a 12-month incidence of 1.30/100 000 (95% CI 1.11-1.52). The most common symptoms were motor weakness and abnormal movements. Presentation with multiple symptoms was the norm. Antecedent stressors were reported for 80.8%, most commonly bullying in school. Most children required in-patient admission with frequent medical investigations. Follow-up at 12 months was available for 147 children, when all conversion disorder symptoms were reported as improved. Most families (91%) accepted a non-medical explanation of the symptoms either fully or partially. CONCLUSIONS Childhood conversion disorder represents an infrequent but significant clinical burden in the UK and Ireland.
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Affiliation(s)
- Cornelius Ani
- Academic Unit of Child and Adolescent Psychiatry, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
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St. Martin A, Alcantara J. The chiropractic care of an 11-year-old with a medical diagnosis of conversion disorder. Eur J Integr Med 2012. [DOI: 10.1016/j.eujim.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Affiliation(s)
- Mary Lynn Dell
- Division of Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
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Chinta SS, Malhi P, Singhi P, Prabhakar S. Clinical and psychosocial characteristics of children with nonepileptic seizures. Ann Indian Acad Neurol 2011; 11:159-63. [PMID: 19893662 PMCID: PMC2771977 DOI: 10.4103/0972-2327.42935] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 05/26/2008] [Accepted: 07/05/2008] [Indexed: 11/28/2022] Open
Abstract
Objective: The aim of this study is to present a comprehensive profile of clinical and psychosocial characteristics of children with psychogenic nonepileptic seizures and to assess the short-term outcome of these patients. Materials and Methods: The subjects were consecutive cases of children with a diagnosis of nonepileptic seizures (N=17, mean age = 10.7 years, S.D. = 1.26) and two groups of control groups matched on age and sex: true seizure group and healthy controls. All the children were recruited from the out-patient services of the Department of Pediatrics of a tertiary care teaching hospital in North India. Detailed history taking and clinical examination was done in the case of every child. A standard 18 channel EEG was done in all the children and a video EEG was done in 12 cases of children with nonepileptic seizures. The Childhood Psychopathology Measurement Schedule (CPMS) and Life Events Scale for Indian Children (LESIC) were used to measure the children's emotional and behavioral functioning at home, and the number of life events and the stress associated with these events in the preceding year and the year before that. Short-term outcome was examined three to six months after the diagnosis of nonepileptic seizures was made. Results: Unresponsiveness without marked motor manifestations was the most common “ictal” characteristic of the nonepileptic seizures. Pelvic thrusting, upper and lower limb movements, head movements, and vocalization were observed in less than one-third of the patients. Increased psychosocial stress and significantly higher number of life events in the preceding year were found to characterize children with nonepileptic seizures, as compared to the two control groups. The nonepileptic seizures and true seizures groups had a higher proportion of children with psychopathology scores in the clinically significant maladjustment range, as compared to those in the healthy control group. A majority of the patients (82.4%) either recovered completely or had more than 50% reduction in the frequency of their symptoms, after three to six months of initiation of therapy. Conclusions: Psychosocial stress is common among children with nonepileptic seizures. Confirmatory diagnosis by video EEG, along with prompt psychosocial intervention, often results in a favorable outcome for most children with nonepileptic seizures.
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Abstract
Zu den dissoziativen Störungen vom Bewusstseinstyp werden psychogene Syndrome mit Amnesie, Stupor, Fugue, Trance- und Besessenheit, Identitätsdiffusion sowie Depersonalisation und Derealisation gerechnet. Dissoziative Symptome treten nicht nur im Rahmen dieser dissoziativen Störungen auf, sondern auch bei anderen, vor allem posttraumatischen Störungen. Dass behandlungsbedürftige dissoziative Syndrome bereits im Kindesalter vorkommen, ist unbestritten. Allerdings fehlen adaptierte diagnostische Kriterien für diese Altersgruppe. Stark ergänzungsbedürftig sind auch die Erkenntnisse zu Auftretenshäufigkeit, Komorbidität und Verlauf des Störungsbildes. Behandlungsstrategien sind nicht hinreichend evidenzbasiert. Vor diesem Hintergrund wird ein kurzer Überblick zu Symptomatik, Diagnostik, Komorbidität, Verlauf und Behandlung psychoformer dissoziativer Störungen im Kindes- und Jugendalter gegeben.
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Affiliation(s)
- Thomas Jans
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg
| | - Andreas Warnke
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg
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Flett GL, Panico T, Hewitt PL. Perfectionism, Type A Behavior, and Self-Efficacy in Depression and Health Symptoms among Adolescents. CURRENT PSYCHOLOGY 2011. [DOI: 10.1007/s12144-011-9103-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stone J, Warlow C, Sharpe M. The symptom of functional weakness: a controlled study of 107 patients. ACTA ACUST UNITED AC 2010; 133:1537-51. [PMID: 20395262 DOI: 10.1093/brain/awq068] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Functional weakness describes weakness which is both internally inconsistent and incongruent with any recognizable neurological disease. It may be diagnosed as a manifestation of conversion disorder or dissociative motor disorder. Other names include psychogenic or 'non-organic' paralysis. We aimed to describe the incidence, demographic and clinical characteristics of cases with functional weakness of less than 2 years duration, and to compare these with controls with weakness attributable to neurological disease. Both cases and controls were recruited from consultant neurologists in South East Scotland. Participating patients underwent detailed assessments which included: physical examination, structured psychiatric interview (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders), measures of symptoms, disability and distress [Short Form (36) Health Survey, Hospital and Anxiety Depression Scale], and assessment of their illness beliefs using an augmented version of the Illness Perception Questionnaire. In total, 107 cases (79% female, mean age 39 years, median duration of illness 9 months) were recruited. This number suggests a minimum annual incidence of 3.9/100 000. Forty-six controls (83% female, median age 39 years, duration 11 months) were also recruited. Compared to controls, cases had similar levels of disability but more physical symptoms, especially pain. They had a higher frequency of psychiatric disorders, especially current major depression (32 versus 7%, P < 0.0001), generalized anxiety disorder (21 versus 2%, P < 0.005), panic disorder (36 versus 13%, P < 0.001) and somatization disorder (27 versus 0%, P < 0001). There was no difference in median self-rated anxiety and depression scores. Paradoxically, they were less likely than controls to agree that stress was a possible cause of their illness (24 versus 56%, P < 0.001). Cases were twice as likely as controls to report that they were not working because of their symptoms (65 versus 33%, P < 0.0005). Functional weakness is a commonly encountered clinical problem. Patients with this symptom are as disabled as patients with weakness of similar duration due to neurological disease. There is a paradox between the frequency of depression and anxiety diagnoses and the patient's willingness to accept these as potentially relevant to their symptoms. We discuss the theoretical and practical implications of these findings for the concept of conversion disorder.
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Affiliation(s)
- Jon Stone
- Department Clinical Neurosciences, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK.
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36
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[Astasia-abasia: psychogenic and non-psychogenic causes]. Rev Neurol (Paris) 2009; 166:221-8. [PMID: 19819508 DOI: 10.1016/j.neurol.2009.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/23/2009] [Accepted: 08/19/2009] [Indexed: 11/20/2022]
Abstract
Astasia-abasia is defined as the inability to stand and to walk, despite sparing of motor function underlying the required balance and gestures. Initially, astasia-abasia was considered a psychogenic gait disorder, but later on, the description of "high-order" gait disorders mimicking this pure functional deficit led authors to refer to "astasia-abasia" as a pure descriptive term, without a presupposed etiological or anatomical substrate. In this paper, the main clinical characteristics of both psychogenic and non-psychogenic astasia-abasia are presented and discussed.
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Huang KL, Su TP, Lee YC, Bai YM, Hsu JW, Yang CH, Chen YS. Sex distribution and psychiatric features of child and adolescent conversion disorder across 2 decades. J Chin Med Assoc 2009; 72:471-7. [PMID: 19762315 DOI: 10.1016/s1726-4901(09)70410-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Earlier research suggested female predominance in adult conversion disorder, and the strong association between conversion disorder and experiences of being abused is well known. However, the data for child and adolescent populations are limited. In Taiwan, the dramatic increase in child abuse may have some impact on the features of child and adolescent conversion disorder. This study aimed to compare the demographic characteristics, psychiatric comorbidity, and experiences of being abused in Taiwanese children and adolescents diagnosed with conversion disorder in psychiatric consultations across 2 decades. METHODS Retrospective and consecutive chart reviews were conducted for child and adolescent patients (< 20 years old) who were newly diagnosed with conversion disorder in psychiatric consultations at Taipei Veterans General Hospital from 1987 to 2006. The first group included patients who were diagnosed between 1987 and 1996 (the first decade), and the second group included patients who were diagnosed between 1997 and 2006 (the second decade). RESULTS A total of 42 patients diagnosed with conversion disorder were included in this study. Nineteen of the 42 subjects were diagnosed in the first decade (from 1987 to 1996), and 23 in the second decade (from 1997 to 2006). There existed among patients a tendency toward an increasing number of male subjects (p < 0.05), suffering more abuse (p < 0.05), and higher prevalence rates of depression and dysthymia comorbidity (p < 0.05) in the second decade compared to the first. CONCLUSION The sex distribution in conversion disorder might have significantly changed over the past 2 decades. There is an increasing need for screening and interventions for psychiatric comorbidity and experiences of being abused in children and adolescents with conversion disorder. Because of the small sample size of our study, further studies that include multiple study sites and a larger number of patients are needed before a firm conclusion can be drawn.
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Affiliation(s)
- Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Abstract
Psychogenic movement disorders (PMDs) are well characterized in adults, but childhood-onset PMDs have not been extensively studied. We reviewed the medical records of children who were diagnosed in our clinic with PMDs since 1988 and identified 54 patients with PMDs, representing 3.1% of our pediatric movement disorder population and 5.7% of all PMD cases. The mean age at symptom onset was 14.2 years (+/-2.11, range 7.6-17.7). Similar to published data in adults, two-thirds of children exhibited multiple PMD phenotypes, the most common being tremor followed by dystonia and myoclonus. Most PMDs were abrupt in onset, paroxysmal and triggered by identifiable physical or psychological trauma. As in adults, childhood PMDs were more likely to affect females, but there was no female predominance in children less than 13 years old. Although prior studies suggest that medically unexplained symptoms beginning in childhood often follow a benign course, this cohort of children experienced marked disability and morbidity related to PMDs, including prolonged school absences and unnecessary surgical procedures in more than one-fifth of patients.
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Affiliation(s)
- Joseph Ferrara
- Parkinson's Disease Center, Department of Neurology, Baylor College of Medicine, Houston, Texas 77030, USA
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Griffin A, Christie D. Taking the psycho out of psychosomatic: using systemic approaches in a paediatric setting for the treatment of adolescents with unexplained physical symptoms. Clin Child Psychol Psychiatry 2008; 13:531-42. [PMID: 18927139 DOI: 10.1177/1359104508096769] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Difficulty expressing emotional distress verbally is widely thought to underlie the presentation of physical symptoms which cannot be explained in medical terms. Children presenting with so called psychosomatic symptoms therefore bridge both the medical and psychological domains and create a conundrum for professionals from either field if working with them alone. A multidisciplinary rehabilitative approach has long been considered the treatment of choice for children exhibiting chronic physical problems. However, there has been little focus on the use of this approach with children diagnosed as suffering from nonorganic physical symptoms, or on the nuts and bolts of the psychological interventions which have been found beneficial. This article outlines a psychological model which has been integrated into a multidisciplinary team approach with good outcomes. The unique features of each case means that evidence for treatment is limited and relies upon such examples of good practice.
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Jans T, Schneck-Seif S, Weigand T, Schneider W, Ellgring H, Wewetzer C, Warnke A. Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence. Child Adolesc Psychiatry Ment Health 2008; 2:19. [PMID: 18651951 PMCID: PMC2517058 DOI: 10.1186/1753-2000-2-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 07/23/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up. METHODS The total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (N = 62). Two of these former patients committed suicide during the follow-up period (3%). We got information on the clinical course of 27 former patients (44%). 17 out of these 27 former patients were female (63%). The mean age of onset of dissociative disorder was 11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23) at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II). Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale - Self Report, SAS-SR). Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years). RESULTS At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially anxiety, dissociative and somatoform disorders). Personality disorders were seen in 47.8% (especially borderline, obsessive-compulsive and negativistic personality disorders). More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood. CONCLUSION Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. Limitations of the study refer to the small sample size and the low rate of former patients taking part in the follow-up investigation.
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Affiliation(s)
- Thomas Jans
- University of Wuerzburg, University Hospital, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Wuerzburg, Germany.
| | - Stefanie Schneck-Seif
- University of Wuerzburg, University Hospital, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fuechsleinstr.15, D-97080 Wuerzburg, Germany
| | - Tobias Weigand
- University of Wuerzburg, University Hospital, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fuechsleinstr.15, D-97080 Wuerzburg, Germany
| | - Wolfgang Schneider
- University of Wuerzburg, Department of Psychology – Educational Psychology, Roentgenring 10, D-97070 Wuerzburg, Germany
| | - Heiner Ellgring
- University of Wuerzburg, Department of Psychology – Psychological Intervention, Behavior Analysis and Regulation of Behavior, Marcusstraße 9-11, D-97070 Wuerzburg, Germany
| | - Christoph Wewetzer
- Municipal Hospitals of Cologne, Clinic for Child and Adolescent Psychiatry and Psychotherapy, Florentine-Eichler-Str. 1, D-51067 Koeln, Germany
| | - Andreas Warnke
- University of Wuerzburg, University Hospital, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Fuechsleinstr.15, D-97080 Wuerzburg, Germany
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Abstract
The Greek term astasia-abasia literally translates to mean inability to stand and to walk. Although today we would classify the syndrome as a conversion disorder, it was considered a separate disease by Paul Blocq (1860-1896), who described this phenomenon as the inability to maintain an upright posture, despite normal function of the legs in the bed. Paul Blocq's original 1888 articles on astasia abasia were read, partly translated from French to English, and the cases were summarized. A review of a selection of the literature following Blocq's description on astasia abasia was performed. Present day literature was consulted as well. Blocq reviewed what was known about astasia abasia in two papers. Although he was the first to use the combined term astasia abasia, he referred to similar descriptions of Charcot, Richer, Mitchell, Jaccoud, Roméi, and Erlenmeyer. Blocq's contribution was in compiling the experiences and observations of preeminent 19th century neurologists. He recognized that paralysis, jumping, fits, tremor, and bizarre behavior could all be associated with the syndrome. He distinguished the disorder from hysteria. Moreover, he presented a formal delineation of the gait disorder and provided a pathophysiologic concept. Prognosis was considered favorable. Paul Blocq directed attention to psychogenic gait disorders by publishing a small case series on astasia abasia. Today, these case descriptions would be likely considered cases of conversion or psychogenic gait disorder, with or without other conversion/psychogenic movement disorders.
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Affiliation(s)
- Michael S Okun
- Departments of Neurology and Neurosurgery, Movement Disorders Center, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Peter J Koehler
- Department of Neurology, Atrium Medical Center, Heerlen, The Netherlands
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Eminson DM. Medically unexplained symptoms in children and adolescents. Clin Psychol Rev 2007; 27:855-71. [PMID: 17804131 DOI: 10.1016/j.cpr.2007.07.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 06/04/2006] [Accepted: 02/07/2007] [Indexed: 01/30/2023]
Abstract
A review is presented of the range of medically unexplained symptoms (MUS) in children and adolescents, with an account of the main presentations that are recognised in clinical settings in paediatric and children's mental health services. A summary of both epidemiological and clinical studies of symptoms and their associations is given, followed by a brief overview of aetiological theories and of management interventions.
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Affiliation(s)
- D Mary Eminson
- Bolton Hospitals NHS Trust, Child and Adolescent Mental Health Services, Royal Bolton Hospital, Minerva Road, Farnworth, Bolton BL4 OJR, UK.
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Okun MS, Rodriguez RL, Foote KD, Fernandez HH. The "chair test" to aid in the diagnosis of psychogenic gait disorders. Neurologist 2007; 13:87-91. [PMID: 17351529 DOI: 10.1097/01.nrl.0000256358.52613.cc] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the chair test for diagnosis of psychogenic gait disorders. BACKGROUND The diagnosis of psychogenic gait disorders can be difficult. Contained in Paul Blocq's original descriptions of hysterical gait disorders in 1888 are 11 case descriptions of patients with astasia abasia. One description was of a patient who had a "hysterical" gait disorder but could propel a chair while seated normally. METHODS Based on Blocq's paper, we describe 9 consecutive patients who presented with a psychogenic gait disorder who underwent "chair testing." Each patient was asked to walk 20-30 feet forward and backward toward the examiner. Patients were then asked to sit in a swivel chair with wheels and to propel the chair forward and backward. These trials were compared with a control group of 9 consecutive movement disorder patients with nonpsychogenic gait problems. RESULTS Compared with their walking, 8 of the 9 patients in the psychogenic group performed well on the chair test, showing improved ability to propel a chair forward when seated. By contrast, all 9 control patients performed equally when walking or propelling utilizing the chair. CONCLUSION Although it will need more prospective study with better quantitative measurements to determine its true sensitivity and specificity, we believe many practitioners faced with differentiating psychogenic gait disorders from neurologic dysfunction will find the chair test, as well as the observation of a difference in leg function (sitting versus standing), useful diagnostic information.
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Affiliation(s)
- Michael S Okun
- Department of Neurology, University of Florida, McKnight Brain Institute, Gainesville, Florida 32610, USA.
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Kozlowska K, Nunn KP, Rose D, Morris A, Ouvrier RA, Varghese J. Conversion disorder in Australian pediatric practice. J Am Acad Child Adolesc Psychiatry 2007; 46:68-75. [PMID: 17195731 DOI: 10.1097/01.chi.0000242235.83140.1f] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Kasia Kozlowska
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia..
| | - Kenneth P Nunn
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia
| | - Donna Rose
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia
| | - Anne Morris
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia
| | - Robert A Ouvrier
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia
| | - John Varghese
- Dr. Kozlowska and Ms. Rose are with the Department of Psychological Medicine, The Children Hospital at Westmead, Sydney, Australia; Professor Nunn is with Nexus, John Hunter Hospital, Newcastle, Australia; Dr. Morris and Professor Ouvrier are with the Department of Paediatrics and Child Health, The Children Hospital at Westmead and University of Sydney; and Dr. Varghese is with the Child and Family Therapy Unit, Royal Children's Hospital, Brisbane, Australia
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Abstract
Habit cough is a condition that is often misdiagnosed as asthma. The cough is bizarre in nature, troublesome to those around the person coughing and clearly a waking phenomenon. Often, relatives will have considered the possibility of a habit cough by the time that they present to the respiratory or general paediatrician. In the majority of cases, simple explanation of the nature of likely stressors and reassurance form the basis of effective therapy. In young people with more entrenched symptoms, the provision of coping strategies and increasing the subjective sense of control is an intervention in itself and will improve the likelihood of a good outcome. In more extreme cases, the role of rehabilitation programmes involving negotiation with schools and community organisations may prove useful in remediation of the cough and normalisation of social and peer supports.
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Abstract
BACKGROUND Conversion disorder is an alteration or loss of physical functioning suggestive of a physical disorder that is thought to be due to a psychological stressor or conflict. The fact that many theories about the cause of conversion disorder focus on psychological and social factors would suggest that a psychosocial intervention might be of most benefit. OBJECTIVES To investigate the efficacy of psychosocial interventions on people diagnosed with conversion disorder compared with standard care, a biological intervention or another psychosocial intervention. SEARCH STRATEGY We searched the Cochrane Depression, Anxiety and Neurosis Group Trials Register (May 2004), various databases on OVID (February 2004), handsearched reference lists and textbooks on conversion disorder and contacted relevant authors. SELECTION CRITERIA We included all randomised controlled trials that compared psychosocial interventions for conversion disorder with standard care or other interventions (biological or psychosocial). DATA COLLECTION AND ANALYSIS We reliably selected, quality assessed and extracted data from the studies. For dichotomous outcomes we calculated a relative risk with its associated 95% confidence interval and a number needed to treat. For continuous data we calculated a weighted mean difference. MAIN RESULTS The search identified 260 references, 217 were clearly not relevant to this review and excluded on the basis of their titles and abstracts, 40 more were excluded after reading the full papers (the reasons are given in the excluded studies tables) and only three studies (total n =119) met the inclusion criteria. One study was concerned with paradoxical injunction therapy and the other two studied the value of hypnosis. The three studies had different interventions and control groups so the results could not be combined. All of the studies were of poor methodological quality and it is therefore difficult to place much value on the results of the studies. We were unable to include some data because of poor reporting. AUTHORS' CONCLUSIONS Randomised studies are possible in this field. The use of psychosocial interventions for conversion disorder requires more research and it is not possible to draw any conclusions about their potential benefits or harms from the included studies.
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Affiliation(s)
- R Ruddy
- University of Leeds,Academic Unit of Psychiatry & Behavioural Sciences,15 Hyde Terrace,Leeds,UK LS2 9LT.
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Malhotra S, Singh G, Mohan A. Somatoform and dissociative disorders in children and adolescents: A comparative study. Indian J Psychiatry 2005. [PMCID: PMC2918316 DOI: 10.4103/0019-5545.46073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Somatoform and dissociative (conversion) disorders in adults have been reported to have a close relationship because of a diagnostic overlap and comparable aetiological models. The literature on these disorders in children and adolescents is scarce. Aim: The present study attempted to compare these two disorders in children and adolescents since antecedents of these disorders are said to be laid in childhood. Methods: Case files of 118 patients (69 of somatoform disorders and 49 of dissociative disorders) were reviewed and the two groups were compared with respect to sociodemographic profile, clinical profile, neurotic traits, behavioural problems, temperament, intelligence and family dysfunction. Results: Age at presentation and intelligence were significantly higher in those with somatoform disorders than in those with dissociative disorders. Patients with dissociative disorders had a significantly higher number of co-morbid somatoform symptoms. Conclusion: Somatoform and dissociative disorders are closely linked.
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Affiliation(s)
- Savita Malhotra
- Professor
- Correspondence to:Savita Malhotra, Professor, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012; e-mail:
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Ozekmekçi S, Apaydin H, Ekinci B, Yalçinkaya C. Psychogenic movement disorders in two children. Mov Disord 2003; 18:1395-7. [PMID: 14639692 DOI: 10.1002/mds.10539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two schoolboys with diagnostic criteria for psychogenic movement disorder (PMD) are described: one with bizarre tremor of the right hand and a very slow and cautious gait, another with exaggerated trunk sway and collapses during standing and walking.
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Affiliation(s)
- Sibel Ozekmekçi
- Department of Neurology, Istanbul University, Cerrahpaşa Medical School, Istanbul, Turkey.
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Nowak M. Psychogene Lähmungen im Kindes- und Jugendalter. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2002. [DOI: 10.1024//1422-4917.30.3.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Am Beispiel vorliegender klinischer Studien aus der Literatur werden die Charakteristika der psychogenen Lähmung im Kindes- und Jugendalter erarbeitet. Anhand einer Übersicht wird zunächst der Wandel in der diagnostischen Einordnung der psychogenen Lähmung von der ICD-6 bis zur ICD-10 dargestellt. Weiterhin werden die epidemiologischen Daten aus der Literatur referiert. Die psychogene Lähmung bei Kindern und Jugendlichen zeigt innerhalb der dissoziativen Störungen in dieser Altersgruppe eine charakteristische Alters- und Geschlechtsverteilung, sowie eine gute Prognose. Eine besondere Rolle für die Genese der psychogenen Lähmungen und Gangstörungen spielen invasive iatrogene diagnostische und therapeutische Eingriffe, körperliche Traumata, Infekterkrankungen und Modellerkrankungen.
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Affiliation(s)
- M. Nowak
- Abteilung für Kinder- und Jugendpsychiatrie der Psychiatrischen Klinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg (Leiter: Prof. Dr. R. Castell)
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Abstract
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.
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Affiliation(s)
- Berna Pehlivantürk
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Hacettepe University, PK 67 Samanpazari 06242, Ankara, Turkey.
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