Conversion disorder

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Background

  • One or more symptoms that involve motor or sensory neurologic function believed to be related to a psychiatric condition[1]
  • The symptoms are not intentionally produced
  • Diagnosis of exclusion
  • Often associated with patient who is unconcerned or neutral to the loss of motor/sensory function

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

General Psychiatric

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

References

  1. Allin M, Streeruwitz A, Curtis V. Progress in understanding conversion disorder. Neuropsychiatr Dis Treat. Sep 2005;1(3):205-9
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.