While on my neurology placement I came across approx 4 patients with a ‘conversion disorder’ otherwise known as Hysterical neurosis. Apparently that it is post grad stuff but I found it very interesting. For those of you who are unsure here are some facts:
- essentially a conversion disorder is when psychological symptoms manifest as physical symptoms (although there is no evidence of organic cause of the symptoms)
- It is a psychiatric condition
- Common signs and symptoms may include paralysis in an arm or leg, difficulties swallowing, sudden blindness/deafness, or nonepileptic seizures
- Symptoms usually appear suddenly and may follow a stressful experience
- Conversion disorder is rare
- affects women more than men
- most commonly people between age 10 and 35 years of age
Case study: One of my patients who was only young had been assaulted and had presented to the hospital with L sided weakness. The doctors did all the CT/MRI scans and found no organic cause of his weakness and so gave him the dx of a conversion disorder secondary to the stress of the assault. Initially I found it really hard to get my head around this diagnosis as his symptoms were very real i.e. he was unable to stand on his L leg with out it collapsing and shaking like mad. But then when my CCT saw him, the first thing she said was that he had a conversion disorder- just by looking at him. I guess looking back, that his presentation didn’t really fit. He would
- hop on his right leg to get around- which is very strange as it takes a lot of strength in both legs to hop
- he had 2-3 falls (which apparently is a sign of conversion)
- he had pain the whole way down his (L) side which was not dermatomal and had no apparent cause
- when testing sensation and proprioception his results were inconsistent and it appeared as though he was trying to get them wrong
I guess essentially we need to be mindful of this condition and that it exists. Even though it is rare (I saw 4 patients on 4 weeks with it…)
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2 comments:
Hi Jess,
Got me curious, what's the recommended treatment / strategy for this type of disorder? Do u refer this type patient to other health prof i.e. psychologist?
with coincidence, I had a pt who was diagnosed with conversion disorder last week on a gen. med. ward. Just to add a few more facts about this type disorder to Jess's list:
- normally occured in carer who has cared for their sick relatives.
- if you put them on a lie detector, it would show that the pt is telling the 'truth'
- the 'signs & symptoms' are usually more severe when the pt knows that he/she is being observed (i.e. Quads showed G2 in MMT but able to ambulate to toilet!)
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