Conversion disorder

Background

• One or more symptoms that involve motor or sensory neurologic function believed to be related to a psychiatric condition.
• The symptoms are not intentionally produced
• Diagnosis of exclusion
• Often associated with patient who is unconcerned or neutral to the loss of motor/sensory function

Clinical Features

• A. One or more symptoms of altered voluntary motor or sensory function.
• 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
  • Delirium
  • Dementia
  • Overdose
• Psychiatric causes
  • Depression
  • Anxiety
  • Conversion disorder
  • Bipolar disorder
  • Acute psychosis
  • Panic attack
  • Schizophrenia

Evaluation

• All test will be negative: should consider CT, CBC, CHEM 10, LP, Possible MRI if concerned for spinal pathology
• See here for Optokinetic drum

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