Conversion Disorder Research Articles

AGR - 3 Socially Responsible Neuropsychology (SRN) in Action: Navigating Relevant Socio-Cultural and Educational Factors in Frontotemporal Dementia

Abstract Objective Socio-cultural factors obscure diagnostic specificity for neurodegenerative disorders, particularly among minority or foreign-born patients with limited access to education. Our objective with the following case presentation is to illustrate the utility of a Socially Responsible Neuropsychology (SRN) model in guiding clinical practice through the comprehensive incorporation of significant, yet common, socio-cultural factors throughout the neuropsychological assessment. Method The present case involved a 79-year-old Spanish-speaking Mexican woman with two years of education, who underwent two serial neuropsychological assessments, as well as, structural/functional neuroimaging to monitor acute onset of telegraphic speech following the kidnapping of her husband. The SRN model guided clinical decision-making in understanding the onset and progression of symptoms within the context of medical-psychiatric comorbidities intertwined with socio-cultural and educational factors. Results Mild vascular neurocognitive disorder and complicated grief were the initial diagnostic impressions as supported by structural neuroimaging. Neuropsychological assessment over time, however, revealed progressive global cognitive decline whereas psychiatric symptomatology remained stable. In the presence of equivocal converging evidence from available neuroimaging studies (PET vs MRI), strong suspicion for the language variant of frontotemporal neurocognitive disorder was considered given the onset and progressive decline of expressive/receptive language, executive and memory abilities, and qualitative evidence for progressive behavioral disihibition. Conclusion Telegraphic speech in an elderly Latina woman that initially appeared most consistent with vascular neurocognitive disorder in the context of complex trauma with possible conversion disorder, was deemed most consistent with a neurodegenerative process after careful consideration of the time course and evolution of the neurocognitive profile over time within an SRN model.

Hallucinations, somatic-functional disorders of PD-DLB as expressions of thalamic dysfunction.

Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD-dementia with Lewy bodies psychosis. We propose that PD-dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast-theta or pre-alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self-referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society.

Hysterical and comorbid mental disorders in outpatient neurological practice

Introduction. Particular problems in diagnosing hysteria are determined by its inordinate changeability, which explains the traditional ambiguity of ideas concerning its essence and the specific diagnostic problems. As we know, a significant number of patients with conversion and dissociative disorders present at neurological clinics, thus constituting the distinct cohort of “difficult patients”.Study aim. Identifying the current clinical-dynamic regular patterns of hysterical disorders (taking into account the temporal pathological morphosis) for purposes of providing substantiation for their psychopathological essence and the optimal therapeutic-diagnostic tactics in respect of the pertinent cohort of patients.Materials and methods. Between 2016 and 2018 at the “Practical Neurology” Medical Center we have examined 80 patients (71 women and 9 men) aged between 17 and 72. The criteria for inclusion into this group were the presence of hysterical symptoms as the main disorder in the clinical picture, and meeting the criteria for being the so-called «difficult patient», which are well-known in clinical practice. After having excluded the presence of organic neurological pathology, and taking into account the specifics of their current complaints (which correspond to conversion and somatoform disorders), the patients have been seen by a psychiatrist on condition of having obtained their informed consent. The examination was carried out by means of collecting anamnestic data from patients and people closely involved with them. Disorders were diagnosed in accordance with the ICD-10 criteria and with the use of the brief scale for assessing the mental status of MMSE (Mini-mental State Examination). Statistical processing of obtained data has been carried out with the use of Statistica 10. rus software. Comparative study of frequencies has been carried out with the F-test – φ* criterion; differences with р <0.05 were seen as reliable.Results. Hysterical disorders in the examined patients have been differentiated within four clusters: 1) motor disorder (n = 24 (30 %)); 2) sensory disorders (n = 29 (36.2 %)); 3) somatoform disorders (n =5 (6.3 %)); and 4) dissociative disorders (n = 22 (27.5 %)). Comorbid mental disorders in the examinees were represented by: 1) affective disorders F30–39 (n = 42 (52.5 %)); 2) schizophrenia spectrum disorders F20–29 (n = 20 (25 %)); 3) personality disorders F60–69 (n = 14 (17.5 %)); 4) organic mental disorders F00–09 (n = 3 (3.75 %)); 5) posttraumatic stress disorder F43 (n = 1 (1.3 %)). Hysterical disorders manifest high comorbidity with other mental disorders, above all, – the affective ones, schizophrenia spectrum disorders, and the pathology of personality. The nature of comorbid pathology determines the clinical-dynamic regular patterns of hysterical syndromes, the diagnostic problems of prime concern, and the tactics of therapy. Conclusion. Interdisciplinary approach contributes to improving the effectiveness of therapeutic-diagnostic assistance provided to patients with hysterical and comorbid mental disorders.

Clinically isolating syndrome: when neurology hits a neurologist

I could not make a fist. There I sat in the middle of a typical Wednesday afternoon lecture, staring at my hand in disbelief. The fingers of my right hand...

Characteristics of Conversion Disorder in an Urban Academic Children's Medical Center.

Background. Literature on childhood conversion disorder (CD) is sparse and is mostly limited to the outpatient population. Method. Our study retrospectively examines the characteristics of childhood CD in 42 children and adolescents seen by the psychiatric consultation-liaison service in an urban academic medical center with a large minority population. Results. CD accounted for 11% of our consultations. The majority of patients were female adolescents, but in the younger cohort, the male-to-female ratio equalized. Other somatic symptoms and additional psychiatric diagnoses were common, anxiety disorders in particular. Antecedent stressors were identified in 95% of patients, most commonly related to family stressors. Recent or remote history of abuse was rare. Neurological presentations were complex, with almost half of the patients presenting with multiple distinct neurological symptoms. Hyperkinetic symptoms were more common than hypokinetic symptoms, and paroxysmal symptoms were more common than non-paroxysmal. No distress (la belle indifference) was found in only 25% of patients and about half of patients had no socio-academic impairment. High resource utilization was noted based on multiple specialist consultants, diagnostic studies, and length of stay. Conclusion. Much of our data confirms previous findings and contributes to what is becoming a more robust characterization of this population.

Prevalence of psychiatric disorder in Bangladesh

The prevalence of psychiatric disorders is on rising trend in the country. This two stage nationwide multicentric community based cross sectional study was conducted by National Institute of Mental Health (NIMH), Dhaka during the period of September 2017 to July 2018 to determine the prevalence of psychiatric disordes and to identify common types of psychiatric disorders as well as to find out the physical illness in Bngladesh. In the first stage 19800 respondents in 140 clusters aged between 7 years and above were approached by the trained data collectors with standard printed questinnaires to collect information. Among them 19692 respondents were finally interviewed. Diagnoses of psychiatric disorders were made in the second stage of interview by research psychiatrists following DSM 5 diagnostic criteria of psychiatric disorders. The results showed that, the prevalence of psychiatric disorders was found 13.7% among population 18 years and above and 17.3% below 18 years of age. Division wise prevalence of adult psychiatric disorders were 15.5% in Rajshahi, 14.8% in Rangpur, 14.7% in Khulna, 14.2% in Dhaka, 13.8% in Chittagong, 13.6% in Sylhet and 13.0% in Barishal. Among total diagnosis of psychiatric disorders major depressive disorder were 24.8%, somatic symptom disorder 15.9%, generalized anxiety disorder 13.9%, neurodevelopmental disorders were 10.5%, schizophrenia spectrum and other psychotic disorders 4.7%, conduct disorder 4.7%, bipolar and related disorders 3.7%, obsessive compulsive disorder 3.1%, conversion disorder 1.8%, eneuresis 1.3% and dementia 1%. Data of this community survey will be used for planning of mental health services in Bangladesh. Bang J Psychiatry 2019; 33(1): 1-6

Personality and Psychopathology in Patients With Mixed Sensory-Motor Functional Neurological Disorder (Conversion Disorder): A Pilot Study.

The purpose of this pilot study was to explore differences in the level of personality functioning, symptom severity, and personality pathology in patients with mixed sensory-motor functional neurological disorder (conversion disorder). Individuals with psychogenic nonepileptic seizures were not included. We recruited 15 patients, mean age of 33.5 years (SD, 11.4 years), 13 females and 2 males, from an outpatient clinic for psychotherapeutic treatment. We assessed the patients using the Structured Clinical Interview for DSM-4 Axis II Personality Disorders, the SCL-90-R, the Karolinska Psychodynamic Profile, and the Defense Style Questionnaire. We were able to distinguish two levels of difficulty in relation to personality functioning as distinct subgroups: 1) "neurotic" with less severe or moderate personality psychopathology and 2) "borderline" with severe personality psychopathology. Furthermore, we concluded that all patients showed severe deficits in personality functioning. The study points out the clinical relevance of identifying personality functioning as part of an assessment in the preparation of a treatment strategy.

Conversion Disorder (Functional Neurological Symptom Disorder) Masquerading as Multiple Sclerosis: A Case Report

Conversion disorder, also referred to as functional neurological symptom disorder, is a DSM-5 identified somatic disorder that presents with one or more neurological symptoms that does not clinically correlate with recognized neurological or medical conditions brought on by intense stress, emotions, or an associated psychiatric disorder. Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system and usually presents in young adults with clinical manifestations that range from cognitive abnormalities, eye movement problems, motor and sensory impairments such as weakness and numbness, bowel/bladder dysfunction, fatigue, and/or pain. This case report presents a patient with functional neurological symptom disorder presenting with clinical signs associated with MS.

Using ESSENCE to Meet Local Needs for Mental Health Data: Query & Results

Using ESSENCE to Meet Local Needs for Mental Health Data: Query & Results

Ecological association between chronic hepatitis C virus infection and psychosis: A study in Colombia, 2009–2016

This study tests psychometric properties of the Polish Dissociative Experiences Scale (DESR-PL) with a revised scoring system and its capacity, alongside its short form (DESR-T), to screen for dissociative disorders. Both pen-and-paper (p&p) and online forms were tested.Validity and reliability were examined in a sample of 540 participants in non-clinical (n = 289) and clinical (n = 251) groups, who completed the tests p&p (n = 60) or online (n = 480). The clinical group included 21 patients with dissociative (conversion) disorders, and people with other disorders. The Exploratory Factor Analysis with Principal Component Analysis method of parameter estimation without rotation confirmed unidimensionality of p&p and online versions of DESR-PL and DESR-T.Reliability of both versions was corroborated by a Cronbach's alpha coefficient (DESR-PL: online > .931 p&p > .937; DESR-T: online > .783 p&p > .797). The cutoff score maximising sensitivity and specificity for dissociative (conversion) disorders was 71.5 in DESR-PL (sensitivity of 71.43% and specificity of 91.82%) and 16.5 in DESR-T (sensitivity of 76.19% and specificity of 92.73%). People with dissociative disorders had significantly (p < .001) higher scores in DESR-PL and DESR-T than patients with other disorders and non-clinical participants (criterion validity). Both DESR-PL and DESR-T strongly correlated with SDQ-20 and PSDQ-5.DESR-PL administrated p&p or online proved to be reliable tools for measuring the levels of dissociation as a continuum between normal experiences and pathological symptoms. DESR-T has similar psychometric properties and can be used effectively for the screening of dissociative disorders.

The four-cluster spectrum of mind-body interrelationships: An integrative model

Despite the shift toward a biopsychosocial paradigm of medicine, many physicians and mental health professionals (MHPs) find it difficult to treat patients with psycho-somatic disorders. This situation is particularly troublesome due to the high prevalence of these conditions. Although progress has been made over the last few decades in understanding mechanisms underlying the mind-body relationship, disparities remain between research and its clinical implementation. One possible reason for this is the lack of a comprehensive, agreed-upon model that incorporates a biopsychosocial framework and is rooted in an understanding of the various psychobiological pathways. Such a model would enable better communication between physicians and MHPs, allowing them to provide coordinated, stratified treatment. In this paper, four archetypal case studies, together with standard care options are presented to illustrate the current state of affairs. A four-tiered conceptual model of mind-body interrelationships based on pathophysiological and psychopathological mechanisms is suggested to help optimize the treatment of somatic complaints. This Four-Cluster model consists of: (1) Organic Conditions: Structural, or degenerative processes that can affect mood and psychological responses but are not clearly exacerbated by stress. (2) Stress Exacerbated Diseases: Biological disorders with a distinct pathophysiology, such as inflammatory or autoimmune diseases, whose progression is clearly exacerbated by stress. (3) Functional Somatic Syndromes: Conditions wherein heightened sensitivity to stimuli together with hyper-reactivity of the autonomic system form a vicious cycle of mutually enhancing learning processes. These processes involve biological mechanisms, such as central sensitization and psychological mechanisms such as catastrophization and selective attention. (4) Conversion Disorder: Physical manifestations of psychological distress, expressed somatically. Symptoms are solely an expression of problems in patients' psychic functioning and are not caused by biological pathology. Finally, suggested management of the aforementioned case studies is presented through the lens of the Four-Cluster model and a proposed integration of our model with existing theories is discussed. As it is rooted in an understanding of psychobiological pathways of illness, the proposed model enables a new way to discern which form of mind-body interaction is manifesting in different diseases and proposes a way to coordinate treatment plans accordingly, to enhance the accuracy and efficacy of care.

Conversion disorder in a child with Pentasomy X: A rare presentation of a rare genetic syndrome

Conversion disorder in a child with Pentasomy X: A rare presentation of a rare genetic syndrome

Conversion Disorders in Mental Health Care-A Basic Review of Literature

Conversion Disorders in Mental Health Care-A Basic Review of Literature

High cervical meningioma: a patient case report and literature review

Cervical spine meningiomas are uncommon. They present with motor, sensory and other nonspecific symptoms like pain. We present a first case at our hospital. A 33yr old female presented with 5months history of spastic quadriparesis, gait ataxia and pain and forceful contractions of the left upper limb. She had been seen in different health centres and diagnosed as conversion disorder. Brain CT was normal, C-spine CT showed a 2*3cm homogenous lesion at C2-C3.Simpsons 2 resection was done with no complications. Post-operative physical rehabilitation with physiotherapy was instituted with good recovery. By 6 weeks' post-operative, she was ambulating without support.

Conversion Disorder Manifesting as Functional Visual Loss.

Children with conversion disorder experience neurological symptoms without a definable organic cause. Clinical presentation of conversion disorders is uncommon in the emergency department (ED). An 11-year-old previously healthy girl presented to the ED for management of lobar pneumonia. She developed acute visual loss subsequent to accidental placement of an intra-arterial cannula in her arm. Clinical assessments by the emergency physician, neurology, ophthalmology, and psychiatry services, and negative neuroimaging studies established the diagnosis of functional visual loss as a manifestation of conversion disorder. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Conversion disorder symptoms are often without any specific markers and do not fit standard clinical guidelines. A comprehensive and step-wise evaluation of unusual clinical presentation by multiple specialties and ancillary test results should be considered to rule out organic causes and establish the diagnosis of conversion disorder, as seen in our patient.

The Fainting Assessment Inventory: A 10-Item Instrument Developed to Screen for Psychogenic Nonsyncopal Collapse Among Youth Referred for Syncope.

The conversion disorder that appears like syncope is common but poorly recognized. The study aimed to develop and validate a brief, clinician-administered screening tool to discriminate psychogenic nonsyncopal collapse (PNSC) among young patients referred for fainting. Consecutive patients with PNSC and with syncope (15.4 ± 2.2 years) completed a 92-item inventory highlighting features typical of PNSC and neurally mediated syncope (n = 35, each cohort). Fourteen items were retained and revised and then administered to new cohorts ultimately diagnosed with PNSC or syncope (n = 40, each cohort). Further revision led to a 10-item Fainting Assessment Inventory (FAI-10). Scoring the syncope ratings positively and the PNSC ratings negatively, median scores differed between cohorts with PNSC and with syncope (-6 vs. 7; p < 0.001). Diagnostic sensitivity (0.95), specificity (0.875), positive predictive value (0.889), negative predictive value (0.93), and area under the curve (0.973) were calculated. The FAI-10 furthers clinicians' ability to distinguish various forms of transient loss of consciousness.

Hashimoto thyroiditis, therapeutic options and extrathyroidal options - an up-to-date overview

Hashimoto's thyroiditis is one of the most common organspecific autoimune diseases and the most frequent cause of hypothyroidism in areas with sufficient iodine supply. Excessively stimulated Tcells CD4+ and their differentiated cells are known to play akey role in the pathogenesis. It is currently accepted that on the one hand genetic susceptibility, environmental factors, existential factors (gender difference) play an important role, on the other hand gut and intestinal microbiota seem to contribute to its development too. Diagnosis requires adetailed medical history, sonography, and blood analysis of thyroid function and thyroid antibodies. In case of an overt or subclinical hypothyroidism long-term or lifelong levothyroxine replacement may be needed, with aspecial focus on phases with an additional demand like during pregnancy. There are multifactorial reasons for poor response to therapy despite normal TSH levels in blood sampling like co-morbidities (other organspecific autoimmune diseases, psychiatric diseases), lack of vitamin and trace elements. Pharmacogenomic and pharmacokinetic factors may impact on levothyroxine bioavailability, also thyroid hormone resistance and transport- or conversion disorder due to insulin resistance or adrenal insufficiency for example. The relations between thyroid function, mental status and psychiatric disorders seem to be complex and the mechanisms underlying the interactions remain to be clarified. Continuing research in biochemical, genetic and neuroimaging fields are needed.

Predicting psychiatric symptoms by personality types for gifted students

ABSTRACT This study examined if personality types of gifted students predicted their psychiatric symptoms and if the type of giftedness and gender moderated the relationship between the personality and psychiatric manifestations. The Murphy-Meisgeir Type Indicator for Children and the Minnesota Multiphasic Personality Inventory-Adolescent were used to measure the personality types and psychiatric symptoms of 232 gifted middle-school students in South Korea. Results found that introversion predicted all of the symptoms but hypomania. Intuition predicted the symptoms of psychopathic deviance and schizophrenia and feeling predicted those of depression and conversion hysteria. Other predictive relationships were found between perceiving and hypomania and between judging and depression and social introversion. Creatively gifted students with introverted and intuitive personality types exhibited several symptoms than were academically gifted students of the same personality. Regarding gender, introverted males were more vulnerable to psychiatric symptoms compared to introverted females, and perceptive females had a higher chance to show hypomania than perceptive males. This study supported that personality characteristics partly accounted for the indications of psychological distress among gifted students. Further studies need to examine causal relationships between the two and to corroborate the current results involving adolescents.

Corticolimbic fast-tracking: enhanced multimodal integration in functional neurological disorder

ObjectiveSome individuals with functional neurological disorder (FND) exhibit motor and affective disturbances, along with limbic hyper-reactivity and enhanced motor-limbic connectivity. Given that the multimodal integration network (insula, dorsal cingulate, temporoparietal...

Neurological disease or conversion disorder? Important aspects of differential diagnosis - psychiatric and psychotherapeutic perspective. Case report

Introduction: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease with undetermined etiology. Due to diverse symptomatology, it requires a thorough differential diagnosis, with consideration of conversion disorders. The presented thesis describes a case of a young man hospitalized in the Department of Psychiatry in order to verify the possible psychogenic basis of his symptoms, which previously were considered to be a manifestation of neurological disease with an unfavorable prognosis. Aim: The aim of the thesis is to raise the issue of a multidisciplinary approach to diagnostic process in medicine, as well as taking into account the legitimacy of including psychiatrists, psychologists, and psychotherapists in diagnostic teams. Case study: We present a case report of a man who has been experiencing progressive feeling and walking problems for the past several years, which originally suggested a neurological or rheumatological disease. Earlier observations and medical tests had led to a diagnosis of amyotrophic lateral sclerosis. After several years, the diagnosis was excluded, and the patient was referred to the Department of Psychiatry to determine the possible psychogenic basis of his symptoms. Diagnostic methods used during the patient’s hospitalization confirmed the conversational nature of his symptoms, and both pharmacological and psychotherapeutic treatment caused reduction of severity of his symptoms and allowed him for a gradual return to independent functioning. Conclusion: Analysis of the collected data, including patient’s life history and a course of his treatment, indicates the validity of a holistic approach to medical problems, which implies the inclusion of specialists in the field of psychiatry, psychology, as well as psychotherapists in diagnostic teams. Such a multidimensional view of the patient and the source of his symptoms may allow for faster diagnosis and may also contribute to reducing the risk of making mistakes such as an incorrect assessment of factors triggering the disease process. Keywords: conversion disorders, amyotrophic lateral sclerosis, differential diagnosis