Journal of Mahatma Gandhi University of Medical Sciences and Technology

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  7 (2022)
Volume  6 (2021)
Volume  5 (2020)
Volume  4 (2019)
Volume  3 (2018)
Volume  2 (2017)
Volume  1 (2016)
Related articles

VOLUME 3 , ISSUE 1 ( January-April, 2018 ) > List of Articles

Original Article

Spectrum of Conversion Disorders: Clinical Perspective for a Neurologist

Surbhi Chaturvedi

Keywords : Conversion disorder, Neurologist, Psychiatrist

Citation Information : Chaturvedi S. Spectrum of Conversion Disorders: Clinical Perspective for a Neurologist. J Mahatma Gandhi Univ Med Sci Tech 2018; 3 (1):7-16.

DOI: 10.5005/jp-journals-10057-0068

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Conversion disorders are a borderland between psychiatrist and neurologist. These are known from ancient time and witnessed a variety of nomenclature and theories. Manifestations of conversion disorders are widely variable and may range from psychogenic movement disorders, psychogenic sensorimotor deficit to nonepileptic psychogenic seizures. Though advancement in diagnostic techniques helps in diagnosis of a number of neurological disorders, still diagnosis of conversion disorders is mostly clinical. For a neurologist, it is important to know breadth of conversion disorders and salient clinical features to differentiate from organic disorders to avoid fallacious diagnosis and its serious consequences. Treatment options include psychotherapy, hypnotic therapy, pharmacotherapy and recently transcranial magnetic stimulation. All patients of conversion disorders may not have mild course.

PDF Share
  1. Wenegrat B. 2001. Theatre of disorder – patients, doctors and the construction of illness. Oxford: Oxford Univ Pr.
  2. Breuer J, Freud S Studies in Hysteria.1895.
  3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Washington, DC, American Psychiatric Publishing, 2000.
  4. Heruti RJ. Conversion motor paralysis disorder. South Med J 2006;99:327–328.
  5. Lempert T, Dietrich M, Huppert D, Brandt T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 1990;82:335–340.
  6. Putnam FW. Conversion symptoms. Movement disorders in neurology and neuropsychiatry. Boston, Blackwell Scientific Publications 1992. pp.430–437.
  7. Lazare A. Current concepts in psychiatry ; Conversion symptoms. N Engl J Med 1981;05:745–748.
  8. Fahn S, Williams D. Psychogenic dystonia. Adv Neurol 1988;50:431–455.
  9. Shill H, Gerber P. Evaluation of clinical diagnostic criteria for psychogenic movement disorders. Mov Disord. 2006;21:1163–1168.
  10. Gupta A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol 2009; 22(4): 430–436.
  11. Weiner W, Lang A. Idiopathic torsion dystonia. Weiner WJ, Lang A (eds): A comprehensive survey. New York, Futura Publishing Co 1989.pp.221–256.
  12. Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol. 1995;65:231–257.
  13. Mary Ann Thenganatt and Joseph Jankovic; Psychogenic Tremor: A Video Guide to Its Distinguishing Features; Tremor and other hyperkinetic movements; 2014; 4: 253; doi: 10.7916/D8FJ2F0Q.
  14. Kim YJ, Pakiam AS, Lang AE. Historical and Clinical Features of Psychogenic Tremor: a Review of 70 Cases. Can. J. Neurol. Sci 1999;26:190–195.
  15. Monday K, Jankovic J. Psychogenic myoclonus. Neurology 1993;43:349–352.
  16. Lang AE, Koller WC, Fahn S. Psychogenic parkinsonism. Arch Neurol 1995;52:802–810.
  17. Binzer MN, Kullgren G. Psychogenic paralysis: A prospective study. Ugeskr Laeger. 2000;162:5632–5636.
  18. Hill E, Haydel M. Conversion disorder presenting as hemiplegia and hemianesthesia with loss of neurologic reflexes: a case report. South Med J 2006;99:380–382.
  19. Baker JH, Silver JR. Hysterical paraplegia. J Neurol Neurosurg Psychiatry 1987;50:375–382.
  20. Yugue I, Shiba K, Ueta T, Iwamoto Y. A new clinical evaluation for hysterical paralysis. Spine 2004;29:1910–1913.
  21. Okun MS, Koehler PJ. Babinski's clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology. Arch Neurol 2004;61:778–783
  22. Garofalo ML. The diagnosis and treatment of hysterical paralyses by the intravenous administration of pentothal sodium—case reports: 1942. Conn Med 1992;56:159–160.
  23. Andriola MR, Ettinger AB. Pseudoseizures and other nonepileptic paroxysmal disorders in children and adolescents. Neurology 1999;53:S89-S95.
  24. Alper K, Devinsky O, Perrine K, Vazquez B, Luciano D. Non-epileptic seizures and childhood sexual and physical abuse. Neurology 1993;43:1950–1953.
  25. Ronald P. Lesser. Psychogenic Seizures. Neurology. June 01, 1996; 46 (6).
  26. Boddea NMG, Brooksd JL, Bakerd GA, Boonab PAJM, Hendriksena JGM, Muldera OG, AP Aldenkampac. Psychogenic non-epileptic seizures—Definition, etiology, treatment and prognostic issues: A critical review. Volume 18, Issue 8, October 2009, Pages 543–553.
  27. Edwin Peguero, Bassel Abou-Khalil Self-Injury and Incontinence in Psychogenic Seizures. Epilepsia 36(6):586-91. July 1995.
  28. J. Stephen Huff; Najib Murr. Seizure, Pseudoseizures. Treasure Island (FL): Stat Pearls Publishing; 2018 Jan-.
  29. Reuber M, Elger CE. Psychogenic nonepileptic seizures: review and update. Epilepsy Behav. 2003;4(3):205–216. Benbadis SR. Nonepileptic behavioral disorders: diagnosis and treatment. Continuum (Minneap Minn) 2013;19(3 Epilepsy):715–729.
  30. Wesley T. Kerr, Ph.D.,1,2 Emily A. Janio,2 Justine M. Le, B.S.,2 et al. Diagnostic delay in psychogenic seizures and the association with anti-seizure medication trials. Seizure. 2016 Aug; 40: 123–126.
  31. Bromfield EB, Cavazos JE, Sirven JI. Clinical Epilepsy. An Introduction to Epilepsy [Internet]. American Epilepsy Society; 2006.
  32. M. G. Marciani, J. Gotman. Effects of Drug Withdrawal on Location of Seizure Onset. Epilepsia. August 19 https://doi.org/10.1111/j.1528-1157.1986.tb03562.x
  33. Om Shankar Chaurasiya, Parul Gupta, Anil Kaushik, Rajesh Yadav. Usefulness of Serum Prolactin in Differentiating Epileptic and Pseudoseizures in Children. People's Journal of Scientific Research. Vol. 6(1), Jan. 2013.
  34. Abuhuziefa Abubakr, and Ilse Wambacq, Diagnostic value of serum prolactin levels in PNES in the epilepsy monitoring unit.
  35. Oribe E, Amini R, Nissenbaum E, et al. Serum prolactin concentrations are elevated following syncope. Neurology 1996;47:60–62.
  36. Beauchamp TL, Childress JE. Principles of biomedical ethics. New York: Oxford University Press, 1979.
  37. DePaulo JR, Folstein MF. Psychiatric disturbances in neurological patients: detection, recognition and hospital course. Ann Neurol 1978;4:225–228.
  38. Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and “hysteria”. BMJ 2005;331:989.
  39. Carton S, Thompson PJ, Duncan JS. Non-epileptic seizures: patients’ understanding and reaction to the diagnosis and impact on outcome. Seizure 2003; 12:287–294.
  40. Goldstein LH, Chalder T, Chigwedere C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology 2010;74(24):1986–1994.
  41. Zaroff CM, Myers L, Barr WB, Luciano D, Devinsky O: Group psychoeducation as treatment for psychological nonepileptic seizures. Epilepsy Behav 2004; 5:587–592.
  42. Wittenberg D, Michaels J, Ford C, Bullock K, Barry JJ: Group psychotherapy for patients with non-epileptic seizures: a pilot study (abstract). Epilepsia 2004; 45 (suppl 7):57–58.
  43. McDade G, Brown SW: Non-epileptic seizures: management and predictive factors of outcome. Seizure 1992; 1:7–10.
  44. Kim CM, Barry JJ, Zeifert PA: The use of inpatient medical psychiatric treatment for nonepileptic events (abstract). Epilepsia 1998; 39(suppl):242–243.
  45. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R: A randomized controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom 2002; 71:66–76.
  46. Ruddy R, House A. Psychosocial interventions for conversion disorder. Cochrane Database of Systematic Reviews 2009, Issue 1.
  47. Moene FC, Spinhoven P, Hoogduin KA, van Dyck R: A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn 2003; 51:29–50.
  48. LaFrance WC Jr, Devinsky O: The treatment of nonepileptic seizures: historical perspectives and future directions. Epilepsia 2004; 2(45 suppl):15–21.
  49. Voon V, Lang AE: Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry 2005; 66:1529–1534.
  50. LaFrance WC Jr, Keitner GI, Papandonatos GD, Blum AS, Machan JT, Ryan CE, Miller IW. Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizure. Neurology 2010;75(13):1166–1173.
  51. Oto M, Espie CA, Duncan R. An exploratory randomized controlled trial of immediate versus delayed withdrawal of antiepileptic drugs in patients with psychogenic nonepileptic attacks (PNEAs). Epilepsia.2010;51(10):1994–1999.
  52. Drake ME Jr, Pakalnis A, Phillips BB: Neuropsychological and psychiatric correlates of intractable pseudoseizures. Seizure 1992; 1:11–13.
  53. Marazziti D, Dell'Osso B: Effectiveness of risperidone in psychogenic stiff neck. CNS Spect 2005; 10:443–444.
  54. Persinger MA: Seizure suggestibility may not be an exclusive differential indicator between psychogenic and partial complex seizures: the presence of a third factor. Seizure 1994; 3:215–219.
  55. Schonfeldt-Lecuona C, Connemann BJ, Spitzer M, Herwig U: Transcranial magnetic stimulation in the reversal of motor conversion disorder. Psychotherapy Psychosom 2003; 72:286–288.
  56. Grisaru N, Amir M, Cohen H, Kaplan Z: Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study. Biol Psychiatry 1998; 44:52–55.
  57. Hafeiz HB: Hysterical conversion: a prognostic study. Br J Psychiatry 1980; 136:548–551.
  58. Baker JH, Silver JR: Hysterical paraplegia. J Neurol Neurosurg Psychiatry 1987; 50:375–382.
  59. Pestana EM, Foldvary-Schaefer N, Marsillio D, Morris HH III: Quality of life in patients with psychogenic seizures. Neurology 2003; 60 (suppl 1): A355.
  60. Ettinger AB, Devinsky O, Weisbrot DM, Ramakrishna RK, Goyal A: A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia 1999; 40:1292–1298.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.