Conversion disorder: Difference between revisions

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'''<big>Background</big>'''
==Background==
      * One or more symptoms that involve motor or sensory neurologic function believed to be related to a psychiatric condition.
*Neurologic symptoms believed to be related to a psychiatric condition<ref>Allin M, Streeruwitz A, Curtis V. Progress in understanding conversion disorder. Neuropsychiatr Dis Treat. Sep 2005;1(3):205-9</ref>
      * The symptoms are not intentionally produced
*Symptoms are not intentionally produced
      * '''Diagnosis of exclusion'''
*Patient is often unconcerned or neutral to the neural deficit
      * Often associated with patient who is unconcerned or neutral to the loss of motor/sensory function
*Recurrence is common, but good prognosis with single episode
**Likelihood of recovery exceeds that of other somatoform disorders
**Good prognostic indicators include
***good premorbid health
***absence of organic illness or concomitant major psychiatric syndromes
***acute and recent onset
***definite precipitation by a stressful event
***presenting symptoms of paralysis, aphonia, or blindness.
*'''Diagnosis of exclusion'''


'''<big>Differential Diagnosis</big>'''
==Clinical Features==
      * Malingering
*A. One or more symptoms of altered voluntary motor or sensory function<ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>
      * [[Hypokalemic_periodic_paralysis|Hypokalemic Periodic Paralysis]]
*B. Clinical findings provide evidence of incompatibility between the symptom and recog­nized neurological or medical conditions
      * [[Multiple_Sclerosis|Multiple Sclerosis]]
*C. The symptom or deficit is not better explained by another medical or mental disorder
      * [[Myasthenia_Gravis|Myasthenia Gravis]]
*D. The symptom or deficit causes clinically significant distress or impairment in social, oc­cupational, or other important areas of functioning or warrants medical evaluation
      * [[CVA|Stroke]]
      * [[Guillain-Barre_Syndrome|Guillain-Barre Syndrome]]
      * Spinal Impingement/Epidural Abscess


'''<big>Diagnostic Studies</big>'''
==Differential Diagnosis==
      * All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology
*Malingering
*[[Hypokalemic_periodic_paralysis|Hypokalemic Periodic Paralysis]]
*[[Complex regional pain syndrome]]
*[[Multiple_Sclerosis|Multiple Sclerosis]]
*[[Myasthenia_Gravis|Myasthenia Gravis]]
*[[CVA|Stroke]]
*[[Guillain-Barre_Syndrome|Guillain-Barre Syndrome]]
*Spinal Impingement/Epidural Abscess


'''<big>Treatment</big>'''
{{Psych DDX}}
      * No current treatment, often symptoms will resolve if psychiatric connection is made to patient.
      * Co-treatment of associated psychiatric syndromes


'''<big>Disposition</big>'''
==Evaluation==
      * Can often be discharged from ED if good support system, consider admission for psychiatric evaluation.
*All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology
      * Set up close psychiatric or neurology follow up
*[https://www.youtube.com/watch?v=CG5n516PCXM Optokinetic drum] in situations of factitious blindness


'''<big>Authors</big>'''
==Management==
*No current treatment, often symptoms will resolve if psychiatric connection is made to patient
*Psych will sometimes recommend acute rehab as outpatient to work on specific presenting symptoms
*Co-treatment of associated psychiatric syndromes


[[User:Dx316gol|Babak Missaghi]]
==Disposition==
*Can often be discharged from ED if good support system, consider admission for psychiatric evaluation
*Set up close psychiatric or neurology follow up
 
==References==
<references/>
 
[[Category:Psychiatry]]

Latest revision as of 01:12, 24 July 2017

Background

  • Neurologic symptoms believed to be related to a psychiatric condition[1]
  • Symptoms are not intentionally produced
  • Patient is often unconcerned or neutral to the neural deficit
  • Recurrence is common, but good prognosis with single episode
    • Likelihood of recovery exceeds that of other somatoform disorders
    • Good prognostic indicators include
      • good premorbid health
      • absence of organic illness or concomitant major psychiatric syndromes
      • acute and recent onset
      • definite precipitation by a stressful event
      • presenting symptoms of paralysis, aphonia, or blindness.
  • Diagnosis of exclusion

Clinical Features

  • A. One or more symptoms of altered voluntary motor or sensory function[2]
  • B. Clinical findings provide evidence of incompatibility between the symptom and recog­nized neurological or medical conditions
  • C. The symptom or deficit is not better explained by another medical or mental disorder
  • D. The symptom or deficit causes clinically significant distress or impairment in social, oc­cupational, or other important areas of functioning or warrants medical evaluation

Differential Diagnosis

General Psychiatric

Evaluation

  • All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology
  • Optokinetic drum in situations of factitious blindness

Management

  • No current treatment, often symptoms will resolve if psychiatric connection is made to patient
  • Psych will sometimes recommend acute rehab as outpatient to work on specific presenting symptoms
  • Co-treatment of associated psychiatric syndromes

Disposition

  • Can often be discharged from ED if good support system, consider admission for psychiatric evaluation
  • Set up close psychiatric or neurology follow up

References

  1. ↑ Allin M, Streeruwitz A, Curtis V. Progress in understanding conversion disorder. Neuropsychiatr Dis Treat. Sep 2005;1(3):205-9
  2. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
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