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Conversion disorder
From WikEM
Contents
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
- 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
- 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
