CONVERSION DISORDER By Dr. Hena Jawaid
Jan 26, 2016
CONVERSION DISORDER
ByDr. Hena Jawaid
Definition
Term refers to a condition in which there are isolated neurological symptoms that can not be explained in terms of known mechanism of pathology and in which there has been a significant pathological stressor.
Derivation
Hysterikos (Greek)- ‘suffering in the uterus’ hystericus (Latin) Hysteric (Latin) hysteria
Background Upto 17th CE – Hysteria is due to abnormal
position/function of Uterus Charcot (1825-’93) identified it as functional
disorder of brain that enhances hypnotic ability, existing symptoms can be modified and symptoms can be induced
Pierre Janet (1859-1947) – tendency to dissociation – loss normal integration
Frued in 1893-95 wrote a paper ‘Studies on Hysteria’ – adopted word ‘Conversion’.
(Unexpressed emotions to physical symptoms)
DSM IV Criteria deficits suggest a neurological or other general
medical condition deficit is preceded by conflicts or other stressors deficit is not intentionally produced or feigned deficit can not be fully explained deficit causes significant distress deficit is not limited to pain or sexual
dysfunction, somatization dis.
DSM IV Criteria (cont.) With Motor Deficit With Sensory Deficit With Seizures or Convulsions With Mixed Presentation
ICD - 10
Clinical features as specified for the individual disorders
No evidence of a physical disorder that might explain the symptoms
Evidence for psychological causation, in the form of clear association in time with stressful events and problems or disturbed relationships
ICD – 10 • D. Amnesia• D. Fugue• Multiple Personality disorder• D./Conversion NOS• D. Stupor• Trance and Possession disorder• Ganser’s Syndrome
Classification DSM – IV1. D. Amnesia2. D. Fugue3. D. Identity disorder4. Depersonalization
dis.5. D. Disorder NOS
ICD -101. D. Amnesia2. D. Fugue3. Multiple Personality
disorder4. D./Conversion NOS5. D. Stupor6. Trance and
Possession disorder7. Ganser’s Syndrome
Epidemiology
Incidence – 5-12/ 100,000 Prevalence – 50/100,000
Reference-Shorter Oxford textbook of Psychiatry – 5th edn.
Epidemiology (Cont.) In India, 31% among IP, 6-11% in OP setting In Turkey among OP 27.2% In Pakistan -12.4% in OP and 4.8% of the
admissions in IP psychiatric units Females as compared to males (60% vs. 4.20%),
middle income group, less education
References – Malik P, Singh P. Characteristics and outcome of children and adolescent with
conversion disorder. Indian J Pediatr 2002;39:747-52. Wig NN. A follow up study of hysteria. Indian J Psychiatry 1982;3:50-5. Pehlivanturk B, Unal F. Conversion disorder in children and adolescents: clinical
features and co morbidity with depressive and anxiety disorders. Turk J Pediatr 2000;42:132-7.
Malik SB, Bokhari IZ. Psychiatric admissions in a teaching hospital: a profile of 177 patients. J Coll Physicians Surg Pak 1995;9:159-61
Epidemiology (Cont.) The commonest symptoms among the patient
population in Pakistan may be extremely rare in West, unresponsiveness and jerky body movements (pseudo-seizures) – 53%
RefrencesConversion Disorder: Difficulties in Diagnosis using DSM-IV/ ICD-10 by
Syed EU et al
Etiology Psychodynamic theories Social factors Neuro-physiological mechanisms Cognitive explanations Cultural explanations
Neuro-physiological mechanisms SPECT using (99m)Tc-ECD- decrease RCBF in
thalamus & basal ganglia opposite to the deficit. Lower activation in contralateral caudate during
hysterical conversion symptoms predicted poor recovery at follow-up. hysterical conversion deficits may involve a functional disorder in striatothalamocortical circuits controlling sensorimotor function and voluntary motor behavior
References -“Functional neuroanatomical correlates of hysterical sensorimotor loss” Brain. 2001 Jun
by Vuilleumier P
Treatment
Reassurance Immediate efforts to resolve any
stressful conflict or event Should provide healthy alternatives for
return to normal functioning Attention should be directed away from
symptoms to resolution of problems Offer continuing help
Treatment (Cont.) Medication has no direct play in the
treatment If conversion is secondary – Depression If conversion is secondary – Anxiety
Prognosis Good
Short history Young age
Bad
Long history Personality disorder Receipt of disability
benefit
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