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Morning Report. October 4, 2010. Conversion Disorder. Suspect when symptoms do not fit Known medical illness Physical exam findings Subconscious plea for help with coping mechanisms School Family disharmony Abuse . Conversion Disorder. 65% CNS symptoms Episodic loss of awareness

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morning report

Morning Report

October 4, 2010

conversion disorder
Conversion Disorder
  • Suspect when symptoms do not fit
    • Known medical illness
    • Physical exam findings
  • Subconscious plea for help with coping mechanisms
    • School
    • Family disharmony
    • Abuse
conversion disorder1
Conversion Disorder
  • 65% CNS symptoms
    • Episodic loss of awareness
      • Pseudoseizures or syncope
    • Motor dysfunction
      • Gait disturbances or paresis
    • Sensory abnormalities
      • Pain and/or numbness
      • Special senses
conversion disorder2
Conversion Disorder
  • Diagnosis
    • Must rule out medically treatable causes
    • Testing is important
  • Psychiatric evaluation
    • Levels of stress or anxiety in child and family
    • Predisposing vulnerabilities
      • Learning disabilities
      • Peer pressure
      • Body image
      • Chronic illness
      • Family disharmony or conflict
conversion disorder3
Conversion Disorder
  • Psychiatric Evaluation
    • Temporal relationship between stress and onset of symptoms
    • Role models
    • Evidence of primary or secondary gain
conversion disorder4
Conversion Disorder
  • Differential
    • Familial periodic paralysis
      • Hypokalemic or normokalemic
    • Metabolic myopathies
    • Muscular dystrophy
    • Myasthenia gravis
    • Endocrinopathies
      • Thyroid and adrenal
conversion disorder5
Conversion Disorder
  • Treatment
    • Explanation to parents
      • Symptom is real
      • No organic disease
      • Anxiety or stress needs to be relieved
    • Tailored to problem
      • Set goals
      • Positive feedback
    • Physical Therapy
      • More likely accepted
conversion disorder6
Conversion Disorder
  • Treatment
    • Remove secondary gain
      • Missed school
      • Parental attention
    • Give some control to the child
    • Continued psychotherapy
      • Give up sick role
      • Coping
        • “to help you cope with the stress of being ill”
conversion disorder7
Conversion Disorder
  • Prognosis
    • Usually no underlying mood disorder
      • Pseudoseizures – 32%
    • History of sexual abuse is common
    • Histrionic Personality Disorder
      • As adults if no treatment for coping