conversion disorder

CONVERSION DISORDER

ByDr. Hena Jawaid

Definition

Term refers to a condition in which there are isolated neurological symptoms that can not be explained in terms of known mechanism of pathology and in which there has been a significant pathological stressor.

Derivation

Hysterikos (Greek)- ‘suffering in the uterus’ hystericus (Latin) Hysteric (Latin) hysteria

Background Upto 17th CE – Hysteria is due to abnormal

position/function of Uterus Charcot (1825-’93) identified it as functional

disorder of brain that enhances hypnotic ability, existing symptoms can be modified and symptoms can be induced

Pierre Janet (1859-1947) – tendency to dissociation – loss normal integration

Frued in 1893-95 wrote a paper ‘Studies on Hysteria’ – adopted word ‘Conversion’.

(Unexpressed emotions to physical symptoms)

DSM IV Criteria deficits suggest a neurological or other general

medical condition deficit is preceded by conflicts or other stressors deficit is not intentionally produced or feigned deficit can not be fully explained deficit causes significant distress deficit is not limited to pain or sexual

dysfunction, somatization dis.

DSM IV Criteria (cont.) With Motor Deficit With Sensory Deficit With Seizures or Convulsions With Mixed Presentation

ICD - 10

Clinical features as specified for the individual disorders

No evidence of a physical disorder that might explain the symptoms

Evidence for psychological causation, in the form of clear association in time with stressful events and problems or disturbed relationships

ICD – 10 • D. Amnesia• D. Fugue• Multiple Personality disorder• D./Conversion NOS• D. Stupor• Trance and Possession disorder• Ganser’s Syndrome

Classification DSM – IV1. D. Amnesia2. D. Fugue3. D. Identity disorder4. Depersonalization

dis.5. D. Disorder NOS

ICD -101. D. Amnesia2. D. Fugue3. Multiple Personality

disorder4. D./Conversion NOS5. D. Stupor6. Trance and

Possession disorder7. Ganser’s Syndrome

Epidemiology

Incidence – 5-12/ 100,000 Prevalence – 50/100,000

Reference-Shorter Oxford textbook of Psychiatry – 5th edn.

Epidemiology (Cont.) In India, 31% among IP, 6-11% in OP setting In Turkey among OP 27.2% In Pakistan -12.4% in OP and 4.8% of the

admissions in IP psychiatric units  Females as compared to males (60% vs. 4.20%),

middle income group, less education  

References – Malik P, Singh P. Characteristics and outcome of children and adolescent with

conversion disorder. Indian J Pediatr 2002;39:747-52. Wig NN. A follow up study of hysteria. Indian J Psychiatry 1982;3:50-5. Pehlivanturk B, Unal F. Conversion disorder in children and adolescents: clinical

features and co morbidity with depressive and anxiety disorders. Turk J Pediatr 2000;42:132-7.

Malik SB, Bokhari IZ. Psychiatric admissions in a teaching hospital: a profile of 177 patients. J Coll Physicians Surg Pak 1995;9:159-61

Epidemiology (Cont.) The commonest symptoms among the patient

population in Pakistan may be extremely rare in West, unresponsiveness and jerky body movements (pseudo-seizures) – 53%

RefrencesConversion Disorder: Difficulties in Diagnosis using DSM-IV/ ICD-10 by

Syed EU et al

Etiology Psychodynamic theories Social factors Neuro-physiological mechanisms Cognitive explanations Cultural explanations

Neuro-physiological mechanisms SPECT using (99m)Tc-ECD- decrease RCBF in

thalamus & basal ganglia opposite to the deficit. Lower activation in contralateral caudate during

hysterical conversion symptoms predicted poor recovery at follow-up. hysterical conversion deficits may involve a functional disorder in striatothalamocortical circuits controlling sensorimotor function and voluntary motor behavior

References -“Functional neuroanatomical correlates of hysterical sensorimotor loss” Brain. 2001 Jun

by Vuilleumier P

Treatment

Reassurance Immediate efforts to resolve any

stressful conflict or event Should provide healthy alternatives for

return to normal functioning Attention should be directed away from

symptoms to resolution of problems Offer continuing help

Treatment (Cont.) Medication has no direct play in the

treatment If conversion is secondary – Depression If conversion is secondary – Anxiety

Prognosis Good

Short history Young age

Bad

Long history Personality disorder Receipt of disability

benefit

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