Conversion disorder: Difference between revisions
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==Background== | ==Background== | ||
* | *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> | ||
* | *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''' | *'''Diagnosis of exclusion''' | ||
* | |||
==Clinical Features== | |||
*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> | |||
*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== | ==Differential Diagnosis== | ||
*Malingering | *Malingering | ||
*[[Hypokalemic_periodic_paralysis|Hypokalemic Periodic Paralysis]] | *[[Hypokalemic_periodic_paralysis|Hypokalemic Periodic Paralysis]] | ||
*[[Complex regional pain syndrome]] | |||
*[[Multiple_Sclerosis|Multiple Sclerosis]] | *[[Multiple_Sclerosis|Multiple Sclerosis]] | ||
*[[Myasthenia_Gravis|Myasthenia Gravis]] | *[[Myasthenia_Gravis|Myasthenia Gravis]] | ||
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{{Psych DDX}} | {{Psych DDX}} | ||
== | ==Evaluation== | ||
*All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology | *All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology | ||
* | *[https://www.youtube.com/watch?v=CG5n516PCXM Optokinetic drum] in situations of factitious blindness | ||
==Management== | ==Management== | ||
*No current treatment, often symptoms will resolve if psychiatric connection is made to patient | *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 | *Co-treatment of associated psychiatric syndromes | ||
==Disposition== | ==Disposition== | ||
*Can often be discharged from ED if good support system, consider admission for psychiatric evaluation | *Can often be discharged from ED if good support system, consider admission for psychiatric evaluation | ||
*Set up close psychiatric or neurology follow up | *Set up close psychiatric or neurology follow up | ||
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
- Malingering
- Hypokalemic Periodic Paralysis
- Complex regional pain syndrome
- Multiple Sclerosis
- Myasthenia Gravis
- Stroke
- Guillain-Barre Syndrome
- Spinal Impingement/Epidural Abscess
General Psychiatric
- Organic causes
- Psychiatric causes
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