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CONVERSION DISORDER

CONVERSION DISORDER. By Dr. 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.

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CONVERSION DISORDER

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  1. CONVERSION DISORDER By Dr. Hena Jawaid

  2. 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.

  3. Derivation Hysterikos (Greek)- ‘suffering in the uterus’ hystericus(Latin)  Hysteric (Latin)  hysteria

  4. 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)

  5. 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.

  6. DSM IV Criteria (cont.) • With Motor Deficit • With Sensory Deficit • With Seizures or Convulsions • With Mixed Presentation

  7. 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

  8. ICD – 10 • D. Amnesia • D. Fugue • Multiple Personality disorder • D./Conversion NOS • D. Stupor • Trance and Possession disorder • Ganser’s Syndrome

  9. Classification DSM – IV • D. Amnesia • D. Fugue • D. Identity disorder • Depersonalization dis. • D. Disorder NOS ICD -10 • D. Amnesia • D. Fugue • Multiple Personality disorder • D./Conversion NOS • D. Stupor • Trance and Possession disorder • Ganser’s Syndrome

  10. Epidemiology • Incidence – 5-12/ 100,000 • Prevalence – 50/100,000 Reference- Shorter Oxford textbook of Psychiatry – 5th edn.

  11. 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

  12. 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% Refrences Conversion Disorder: Difficulties in Diagnosis using DSM-IV/ ICD-10 by Syed EU et al

  13. Etiology • Psychodynamic theories • Social factors • Neuro-physiological mechanisms • Cognitive explanations • Cultural explanations

  14. 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

  15. 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

  16. Treatment (Cont.) • Medication has no direct play in the treatment • If conversion is secondary – Depression • If conversion is secondary – Anxiety

  17. Prognosis Good • Short history • Young age Bad • Long history • Personality disorder • Receipt of disability benefit

  18. THANK YOU THANK YOU

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