Identifiable Organic Cause Research Articles

Reliability and validity of the German version of the Glasgow Edinburgh Throat Scale

Many patients who consult the ENT doctor suffer from globus sensation, as a term for a multifactorial symptom description. It is particularly important during initial consultation to take the often-sensitive patients seriously and to offer a structured diagnostic clarification. Today, there is a lack of a screening tool in everyday clinical practice that can be used to differentiate the globus sensations more closely and assess their severity OBJECTIVES: The reliability and validity of the German version of the Glasgow Edinburgh Throat Scale (GETS) were examined. The original GETS questionnaire was translated into German (GETS-G) and completed by 60 patients with globus sensation (>3 months) in a prospective observational study. All patients received a clinical examination a sonography of the neck. In patients without an identifiable organic cause, a pH monitoring was carried out. A local organic cause for the globus sensation was found in 30 patients (50%). In addition, reflux was detected in 24 patients (40%) using pH monitoring. No cause could be determined in only 6 patients (10%). According to the overall score (Q1-Q12), there was no significant difference between these three groups. The Cronbach's alpha for assessing reliability was 0.88 in the 12-item analysis. Principal component analysis yielded a globus scale, dysphagia scale and a chronic pharyngeal irritation scale. The GETS-G showed high reliability and validity, which justifies its use in patients with globus sensation in German-speaking countries and may lead to a better assessment of the severity of this symptom.

History of Childhood Trauma in Patients Presenting with Conversion Disorder

Background: Conversion disorder, characterized by neurological symptoms without an identifiable organic cause, has historically posed diagnostic and therapeutic challenges. The role of psychosocial factors, especially childhood trauma, in the development of this disorder is increasingly recognized, yet the relationship remains under-explored in diverse populations. Objective: This study aimed to investigate the demographic characteristics, clinical features, and prevalence of childhood trauma among patients diagnosed with conversion disorder at a teaching hospital in Peshawar, enhancing understanding of the disorder's psychosocial dimensions. Methods: This observational study included 55 patients diagnosed with conversion disorder at the Department of Psychiatry, Khyber Teaching Hospital, Peshawar, from May 1, 2022, to April 30, 2023. Participants were diagnosed according to DSM-5 and ICD-10 criteria. Data were collected through detailed reviews of electronic medical records and structured interviews focusing on demographic data, clinical manifestations, and childhood trauma experiences. Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ) and the Adverse Childhood Experiences (ACEs) questionnaire. Statistical analysis was performed using SPSS version 25 to calculate frequencies, means, and standard deviations. Results: Of the participants, 54.5% were female and 45.5% were male, with a significant number having only primary education (56%). The average age was 37.4 years (SD=10.2). Clinically, 81.8% reported motor symptoms, 54.5% had sensory symptoms, and 36.4% experienced seizure-like episodes. The average duration of symptoms was 18.6 months (SD=7.9). Childhood trauma was reported by 36.4% for physical abuse, 27.3% for sexual abuse, and 45.5% for emotional abuse. High CTQ scores indicated substantial trauma levels among participants. Conclusion: The study confirms a high prevalence of childhood trauma among patients with conversion disorder and underscores the need for a comprehensive, trauma-informed approach in managing these patients. The findings highlight the importance of considering psychosocial factors in the diagnosis and treatment of conversion disorder to improve patient outcomes.

Nociplastic pain mechanisms and toll-like receptors as promising targets for its management.

Nociplastic pain, characterized by abnormal pain processing without an identifiable organic cause, affects a significant portion of the global population. Unfortunately, current pharmacological treatments for this condition often prove ineffective, prompting the need to explore new potential targets for inducing analgesic effects in patients with nociplastic pain. In this context, toll-like receptors (TLRs), known for their role in the immune response to infections, represent promising opportunities for pharmacological intervention because they play a relevant role in both the development and maintenance of pain. Although TLRs have been extensively studied in neuropathic and inflammatory pain, their specific contributions to nociplastic pain remain less clear, demanding further investigation. This review consolidates current evidence on the connection between TLRs and nociplastic pain, with a specific focus on prevalent conditions like fibromyalgia, stress-induced pain, sleep deprivation-related pain, and irritable bowel syndrome. In addition, we explore the association between nociplastic pain and psychiatric comorbidities, proposing that modulating TLRs can potentially alleviate both pain syndromes and related psychiatric disorders. Finally, we discuss the potential sex differences in TLR signaling, considering the higher prevalence of nociplastic pain among women. Altogether, this review aims to shed light on nociplastic pain, its underlying mechanisms, and its intriguing relationship with TLR signaling pathways, ultimately framing the potential therapeutic role of TLRs in addressing this challenging condition.

Functional somatic syndromes are associated with inferior outcomes and increased complications after hip and knee arthroplasty: a systematic review

BackgroundFunctional somatic syndromes (FSSs), defined as chronic physical symptoms with no identifiable organic cause, may impact results after hip and knee arthroplasty. The purpose of this study was to perform a systematic review assessing the relationship between FSSs and clinical outcomes after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA).MethodsThe PubMed and Web of Science databases were queried from January 1955 through December 2021 for studies investigating the impact of at least one FSS (fibromyalgia, irritable bowel syndrome (IBS), chronic headaches, and chronic low back pain) on outcomes after primary THA/TKA/UKA. Outcomes of interest included patient-reported outcome measures (PROMs), postoperative opioid use, complications, revisions, and costs of care.ResultsThere were twenty-eight studies, including 768,909 patients, of which 378,384 had an FSS. Five studies reported preoperative PROMs prior to THA/TKA, all of which showed worse PROMs among patients with at least 1 FSS diagnosis. Thirteen studies reported postoperative PROMs after THA/TKA, all of which demonstrated worse PROMs among patients with at least 1 FSS diagnosis. Patients with FSS diagnoses were more likely to continue using opioids at 3, 6, and 12 months following TKA, THA, and UKA. Medical and surgical complications, as well as revision rates, were higher among patients with FSSs.ConclusionPatients with FSSs have inferior PROMs and are at increased risk for prolonged postoperative opioid use, medical and surgical complications, and revision after hip and knee arthroplasty. Improved understanding of the factors influencing the success of hip and knee arthroplasty is critical. Future studies should address the biopsychosocial determinants of health that can impact outcomes after total joint arthroplasty.

New Frontiers in IBS Gut Pain Treatments

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder, characterized by recurrent abdominal pain or discomfort in combination with disturbed bowel habits in the absence of identifiable organic cause. It is considered a functional disorder where complex neuroimmune and brain-gut interactions occur. IBS affects about 10% of the world’s population and shows a similar prevalence in Canada.1 IBS typically is diagnosed by the Rome IV set of diagnostic criteria, which includes abdominal pain associated with defecation (≥1 day per week for ≥3 months) associated with change in bowel habit for at least three months and can be further subtyped by stool consistency. Treatment strategies existing for IBS are largely focused on symptom amelioration and although beneficial, are rarely curative.

Depressive Symptoms Are Related to Poorer Psychological Functioning in Youth with Functional Abdominal Pain Disorders

Functional abdominal pain disorders, recurrent abdominal pain conditions without an identifiable organic cause, impact approximately 10% of children. These youth can experience significant impairment in functioning (e.g., school absences) and are at increased risk for mental health challenges, including the development of depression. This study examines the relationship between depressive symptoms, pain-related impairment, and broader psychological functioning in youth with FAPD. We predict higher levels of depressive symptoms are related to increased pain-related impairment and poorer mental health functioning. Ninety-four participants diagnosed with FAPD per Rome IV criteria between the ages of 9 and 14 (59.6% female, 40.4% male, 91% non-Hispanic white) were recruited from GI clinics as part of a larger psychological treatment study (NCT03134950). Validated questionnaires assessed depressive symptoms (Children's Depression Inventory 2, [CDI2]), anxiety (Screen for Child Anxiety Related Disorders [SCARED]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), pain-related impairment (e.g., functional disability (Functional Disability Inventory, [FDI])), and average pain intensity (0-10 rating via a visual analogue scale). Descriptive data and multiple regressions, controlling for age and sex assigned at birth, were used to examine associations between depressive symptoms and physical (FDI, pain levels) and mental health (SCARED, PCS) functioning. Bonferroni corrections (p<0.05/4=0.0125) were applied to control for multiple analyses. The sample was broadly categorized by moderate levels of pain, functional disability, and mental health symptoms. All study variables were positively correlated with depressive symptoms (all p's<0.05), and females expressed significantly higher depressive symptoms than males (t(92)=2.365, p=0.020). Multiple regressions revealed higher rates of depressive symptoms predicted higher levels of anxiety (F(3, 89)=12.69, p<0.001) and pain catastrophizing (F(3, 90)=15.607, p<0.001), but were not associated with physical health related impairment. Findings suggest the importance of screening youth with FAPD for depressive symptoms to better understand their mental health-related functioning. Grant support from Sharon S. Keller American Pain Society Grant and the Cincinnati Children's Hospital Place Outcomes Award.

Functional somatic syndromes are associated with suboptimal outcomes and high cost after shoulder arthroplasty.

The presence of functional somatic syndromes (chronic physical symptoms with no identifiable organic cause) in patients undergoing elective joint arthroplasty may affect the recovery experience. We explored the prevalence of functional somatic syndromes among shoulder arthroplasty patients, as well as their association with postoperative outcomes and costs. We identified 480 patients undergoing elective total shoulder arthroplasty (anatomic or reverse) between 2015 and 2018 in our institutional registry with minimum 2-year follow-up. Medical records were queried for the presence of 4 well-recognized functional somatic syndromes: fibromyalgia, irritable bowel syndrome, chronic headaches, and chronic low-back pain. Multivariable linear regression modeling was used to determine the independent association of these diagnoses with hospitalization time-driven activity-based costs and 2-year postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain scores. Nearly 1 in 5 patients (17%) reported at least 1 functional somatic syndrome. These patients were more likely to be women, to be chronic opioid users, to report more allergies, to have a diagnosis of anxiety, and to have shoulder pathology other than degenerative joint disease (all P ≤ .001). After multivariable adjustment, the presence of at least 1 functional somatic syndrome was independently predictive of lower 2-year ASES (-9.75 points) and SANE (-7.63 points) scores and greater residual pain (+1.13 points) (all P ≤ .001). When considered cumulatively, each additional functional disorder was linked to a stepwise decrease in ASES and SANE scores and an increase in residual pain (P < .001). These patients also incurred higher hospitalization costs, with a stepwise rise in costs with an increasing number of disorders (P < .001). Functional somatic syndromes are common in patients undergoing shoulder arthroplasty and correlate with suboptimal outcomes and greater resource utilization. Efforts to address the biopsychosocial determinants of health that affect the value proposition of shoulder arthroplasty should be prioritized in the redesign of care pathways and bundling initiatives.

Functional Hypothalamic Amenorrhoea in Adolescent girls as a Result of Stress-Related Conditions in Covid-19 Pandemic Situation

Functional hypothalamic amenorrhoea (FHA) is a form of anovulation due to the suppression of HypothalamicPituitary-Ovarian (HPO) axis, not related to identifiable organic cause. FHA is a state of hormonal imbalance related to stress, exercising too much or consuming too few calories. In the unprecedented Covid-I9 Pandemic, there is an upsurge of FHA in adolescent girls. Being confined to ‘stay at home’, the phobia of gaining weight due to restricted movement is often triggering eating disorders like Anorexia Nervosa(AN);indulging in indoor overexercise, stress associated with routine change, exposure and preoccupations with social media in the changed scenario are causing a disruption of HPO axis manifesting as FHA. But FHA has serious short-term and longterm effects on the physical and mental health of the adolescent individuals. The present article aims at reviewing the causes, effects, evaluation and management of FHA in the present scenario. Adolescent girls with FHA should be carefully diagnosed and properly managed to prevent both short-term and long-term deleterious effects with appropriate and timely intervention.

From hysteria to conversion: A case of stuttering

Introduction Conversion Disorder is a condition defined by the sudden appearance of neurologic symptoms without an identifiable organic cause, often thought to be associated with psychological triggers. This disorder can lead to severe distress and loss of functionality which, without appropriate treatment, can be made permanent.ObjectivesTo raise awareness for this unexplained and often misunderstood disorder using a clinical case as background.MethodsClinical history, organic evaluation, psychological evaluation and literature review.Results28-year-old female, single, with two children, working from home as a call-centre operator. Previously followed and medicated for depression. Presents to the ER due to sudden loss of consciousness while working, after which her speech became hindered by stuttering. Neurologic evaluation was unremarkable and she was referred for Psychiatric assessment, resulting in a diagnosis of Conversion Disorder. Speech was at first understandable but in the following weeks became progressively worse and eventually led to aphonia, while written communication remained normal and was the patient’s method of choice.ConclusionsOnce a favourite of Psychiatrists, little is yet known about the underlying mechanisms behind this disorder. Experts disagree on whether to classify it as a dissociative disorder, a somatoform disorder, or its own category. Patients presenting with this condition are often mistaken for malingering and thus subject to unhelpful or outright discriminatory practices. Broadened awareness is required to ensure patients get early access to the best possible care and thus improve their quality of life.

Anticonvulsants: The Psychotropic and Medically Protective Drugs of the Future

After more than a century of scientific study and philosophical debate, the neurobiology of psychiatric disorders is still unclear. However, an emerging hypothesis contends that psychiatric and related functional symptoms are rooted in an inherent hyperexcitability of the neurological system. Particularly under the influence of stress, too many neurons fire for too long, resulting in circuit-specific psychiatric symptoms such as anxiety, depression, irritability, insomnia, inattention, and obsessional thinking as well as various physical symptoms that have no identifiable organic cause, such as migraine headache, fibromyalgia, irritable bowel, and chronic pain. Based on this hypothesis, anticonvulsant drugs, which could more aptly be called “Neuroregulators” because of their proposed mechanism of action, should have emerged as the drugs of choice for most of these disorders. Yet the use of anticonvulsants, at least for psychiatric disorders, dwindles in comparison to antidepressants, antipsychotics, psychostimulants, and sedative hypnotics. This article addresses the dearth of anticonvulsant drug use and the hypothetical reasons that several other classes of drugs continue to be used ahead of anticonvulsants despite the expanding base of evidence in support of the neuronal hyperexcitability hypothesis. The article will also propose new ways that anticonvulsants could be used to optimize their effectiveness for the wide range of disorders they should be able to treat, and it will discuss the means by which anticonvulsants could, in theory, be used prophylactically to prevent the development of an equally wide range of general medical conditions, including diabetes, high blood pressure, cardiovascular disease, autoimmune disease, dementia, and cancer.

Surgical Interventions for Functional Constipation: An Update.

Chronic idiopathic constipation, also known as functional constipation, is defined as difficult and infrequent defecation without an identifiable organic cause. Medical management with laxatives is effective for the majority of constipated children. However there is a subset of patients who may need evaluation by a surgeon. As constipation progresses, it can lead to fecal retention and rectal and sigmoid distension, which impairs normal colorectal motility. Surgical interventions are influenced by the results of: a rectal biopsy, transit studies, the presence of megacolon/megarectum on contrast enema, the degree of soiling/incontinence, anorectal manometry findings, and colonic motility evaluation. In this review, we describe the different surgical options available (intestinal diversion, antegrade enemas, sacral nerve stimulation, colonic resections, and Botulinum toxin injection) and provide guidance on how to choose the best procedure for a given patient.

Irritable Bowel Syndrome in a Population of a Developing Country: Prevalence and Association.

Introduction: Irritable bowel syndrome (IBS) is included as one of the functional gastrointestinal (GI) related disorders presenting with pain in abdomen of chronic duration in the absence of any identifiable organic cause. Bloating, distension of abdomen, and defecation in disordered manner are other features commonly associated with IBS. It is a complex disorder with mixed physiological, psychological, and social interactions. The present study was carried out with the aim to determine the frequency of IBS in patients presenting with abdominal pain in a population of a developing country.Materials and methods: A descriptive cross-sectional study was undertaken at the outpatient department of a large tertiary care hospital. Patients of either gender aged between 20 and 50 years presenting with abdominal pain were included. The diagnosis of IBS was established using Rome III criteria. Prevalence of IBS was calculated and confounding factors such as age, gender, marital status, duration of abdominal pain, and economic status were stratified to see their effect on outcome variable by applying chi-square test and taking p-value of <0.05 as significant.Results: A total of 186 patients were included in this study. Some 100 (53.76%) were male and 86 (46.24%) were female. Mean age of the patients was 33.67 ± 7.08 years. Some 58.6% were married and 41.4% were single. Some 61.83% had mild abdominal pain and 38.17% had moderate pain. Out of the total 186 patients, the frequency of IBS was found to be 35.48%. There was no significant effect of confounding variables such as age, gender, duration of abdominal pain, marital status, and economic status on IBS.Conclusion: In our study the frequency of IBS in patients with abdominal pain is high with no significant effect of gender, marital status, economic status, and duration of abdominal pain on IBS.

Evolution of ‘Dementia Infantilis to Childhood Disintegrative Disorder, or Autism Spectrum Disorder’: A case report

Childhood disintegrative disorder (CDD), rare clinical syndrome characterized by at least two years of normal development, followed by distinct regression of developmental and behavioral functioning before ten years of age. CDD is a condition that no longer officially exists, been eliminated and absorbed into the larger category of autism spectrum disorder with the release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Here we report the case of 12 years old male who presented normal development till 4 years of age followed by gradual deterioration in his communication, motor and social skills with behavioral disturbances. The aim of our case report is to increase awareness of this rare illness, due to diagnostic dilemma, especially when no identifiable organic cause is elicited so early diagnosis and prompt treatment required.

Functional hypothalamic and drug-induced amenorrhea: an overview.

Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation not due to identifiable organic causes and with adverse health consequences. The identification of women with this disorder or the precocious identification of women at risk is based on the knowledge of lifestyle risk factors or behaviors such as stress, weight loss, and excessive physical exercise that are known to negatively impact gonadal axis activity. In this overview, we described the most common forms of FHA, in particular stress-induced amenorrhea and overtraining-induced amenorrhea. In addition, although its mechanisms can differ from those involved in FHA, we reviewed the available literature on drug-induced amenorrhea, highlighting the clear connection between this condition and psychoactive drugs such as antipsychotics, antidepressants and anti-epilectics thus raising concern about the role that the abuse of substances such as opioids or alcohol can possibly have on the growing unexplained infertility of the female population.

Usefulness of Psychiatric Intervention in a Joint Consultation for the Treatment of Burning Mouth Syndrome: A Monocentric Retrospective Study.

Primary burning mouth syndrome is a term used for chronic oral mucosal pain with no identifiable organic cause. The aim of the study was to evaluate the usefulness of a psychiatric intervention for treating burning mouth syndrome based on a joint consultation with a psychiatrist and a dermatologist. The study was proposed to all patients who visited this consultation group between 2001 and 2017 for the treatment of primary burning mouth syndrome. The patients answered a questionnaire that was administered via mail. Of the 57 patients diagnosed with primary burning mouth syndrome, 38 were included. Seven patients (18.4%) no longer had pain; 8 (21.1%) estimated that the pain had decreased by greater than 50%; 11 (28.9%) estimated the decrease at between 30 and 50%, and 12 (31.6%) estimated a less than 30% decrease. Only 14 patients (36.8%) remained under treatment with antidepressants, as compared to 63.2% before the psychiatric intervention. This psychiatric intervention could be considered a valuable tool in the global burning mouth syndrome treatment strategy.

Intractable hiccups (Singultus) of psychogenic origin- a case report.

Hiccups are repeated involuntary, intermittent spasmodic contractions of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration followed by a sudden closure of the glottis. It is naturally benign, self-limited but may be most of the time organic in nature and in some cases chronic, debilitating and psychogenic. Here we report a case of a 16 year old female student who developed hiccups of a psychogenic origin started by stress, which lasted for more than weeks sometime for a month and is successfully treated by antipsychotics haloperidol and psychological interventions. Physicians always face a diagnostic challenge, especially when no identifiable organic cause is elicited. However, such cases are invariably referred for psychiatric evaluation and treatment.

Probiotics, Stress, and Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional, gastrointestinal disease characterized by a combination of chronic or recurrent symptoms such as abdominal pain and abnormal bowel habit. Most of the IBS features occur without identifiable organic cause and are strongly influenced by stress and anxiety suggesting the involvement of brain–gut interactions in this disease. Microbiota changes have also been reported such as decreased abundance of the genera Bifidobacterium and Lactobacillus and increased firmicutes: bacteroidetes ratio but there is no consensus on a specific IBS microbiota signature. Psychological stress in rodents impacts intestinal epithelial barrier integrity as well as the composition of microbial communities and induces visceral pain, providing an interesting model for IBS pathophysiology investigation. Modulation of the intestinal microbiota using probiotics in preclinical trials prevents stress-induced visceral hypersensitivity directly through probiotic metabolites production or indirectly through prevention of the intestinal barrier function impairment. The clinical efficacy of probiotic treatments has also been suggested but the use of different scales to analyze the mean differences of symptoms in various studies has limited the ability of all existing meta-analyses in IBS to confirm the effectiveness of probiotics on major IBS symptoms and patient quality of life.

A treatment algorithm for healthy young men with erectile dysfunction.

To assess baseline characteristics of a cohort of young men with erectile dysfunction (ED) but no identifiable organic cause and to evaluate the efficacy of our treatment algorithm. We retrospectively reviewed the charts of men aged <40 years referred to our tertiary care centre for evaluation and treatment of their ED between March 2010 and August 2016. Of 185 men reviewed, we included 73 men who were identified as having no identifiable organic cause for their ED and had successfully completed a detailed questionnaire regarding their medical and sexual history at the initial consultation. The questionnaire was used to obtain baseline patient characteristics and identify comorbid conditions which may predispose to ED. For these men, our standard treatment comprised a daily low-dose phosphodiesterase type 5-inhibitor along with a referral for psychosexual therapy, with the option of more invasive treatment if this initial approach failed. After a minimum of 6 months of treatment, patients were asked to complete a follow-up questionnaire via phone or e-mail. Thirty-three men successfully completed the follow-up questionnaire. Pre- and post-treatment questionnaires were compared to determine treatment adherence and efficacy. The mean (range) age of the study cohort was 31.9 (22-39) years. At the initial consultation, 85% of men (n = 62) reported problems obtaining an erection. After a minimum of 6 months of treatment, only 42% reported the same problem (n = 14), with 58% (n = 19) satisfied with their erectile function. Post-treatment International Index of Erectile Function (IIEF) scores showed a significant improvement in erectile function (18.8 vs 13.3; P < 0.01), orgasmic function (7.7 vs 6.2; P = 0.01) and overall satisfaction (6.1 vs 4.5; P < 0.01). No statistically significant improvement was noted in sexual desire or intercourse satisfaction. Our proposed treatment approach for men with ED aged < 40 years without an identifiable organic aetiology appears to be a reasonable and effective first-line approach, as demonstrated by significantly improved post-treatment IIEF scores and patient-reported outcomes. This algorithm can provide urologists with a useful framework for managing these potentially challenging patients.

Suicide risk in somatoform disorders

The somatoform disorders include agroup of complex disorders consist of somatic symptoms for which there are no identifiable organic cause or pathogenetic mechanisms. Given the importance of these disorders and the need to clarify the diagnosis of somatoform disorder affecting the suicide risk, we took into consideration the scientific literature to investigate the correlation between the two conditions. We performed abibliographic search through Medline, Embase, PsycINFO, Scopus, SciELO, ORCID, Google Scholar, DOAJ using the following terms: somatoform, somatization disorder, pain disorder AND psychological factor, suicide, parasuicide, suicidality. In all studies reported in our review, the suicidal behavior risk is high. But in the majority, the data are relatively unreliable because it takes into account the category nosographic "Neurotic, stress-related and somatoform disorders", too wide to be able to identify the clinical characteristics of patients at risk of only somatoform disorder. Several studies conclude that psychiatric comorbidity increases the suicide risk: patients with two or more psychiatric disorders are more likely to commit asuicide attempt; in particular if there is aaxisI diagnosis, the risk reduplicate. The somatization disorder seems to have asignificant psychiatric comorbidity in particular with anxious and affective disorders spectrum.

Non-organic Vision Loss in the Afghanistan and Iraq Conflicts

ABSTRACTNon-organic visual loss (NOVL), defined as a decrease in visual acuity or field without an identifiable organic cause, can be challenging to diagnose, especially in patients whose NOVL is superimposed on some component of true organic pathology. Exposure to combat puts soldiers at risk of emotional distress and physical trauma, which can contribute to the development of NOVL with conversion disorder or malingering. This case series describes six patients with NOVL who sustained ocular or non-ocular injuries while serving in combat operations in Iraq and Afghanistan, and highlights diagnostic pearls and components of inter-disciplinary management in the unique military context.