Conversion disorder

(Redirected from Conversion reaction)

Background

  • Neurologic symptoms believed to be related to a psychiatric condition[1]
  • Symptoms are not intentionally produced
  • Patient is often unconcerned or neutral to the neural deficit
  • Recurrence is common, but good prognosis with single episode
    • Likelihood of recovery exceeds that of other somatoform disorders
    • Good prognostic indicators include
      • good premorbid health
      • absence of organic illness or concomitant major psychiatric syndromes
      • acute and recent onset
      • definite precipitation by a stressful event
      • presenting symptoms of paralysis, aphonia, or blindness.
  • Diagnosis of exclusion

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.

Authors:

Ross Donaldson