Conversion Disorder

Question 1

“Conversion disorder” is effectively equivalent to. . .

Answer 1

. . . “Functional neurologic disorder”

Question 2

La belle Indifference

Answer 2

Inappropriate lack of concern about one’s disability

Characteristic of Conversion disorder when in the presence of an apparently functional neurologic disorder.

Question 3

It is not unheard of for patients with ___ to be misdiagnosed as Conversion disorder

Answer 3

It is not unheard of for patients with Multiple Sclerosis to be misdiagnosed as Conversion disorder

Question 4

Illness anxiety disorder

Answer 4

Formerly hypochondriasis

Chronic reoccupation with having or acquiring a serious illness, coupled with anxiety about health and performing excessive health-related behaviors.

Question 5

Factitious disorder vs malingering

Answer 5

Factitious disorder: Involve the intentional production or falsification of physical or psychological signs or symptoms in order to present as ill or impared (assume the sick role)

Malingering: Not a mental illness, but involves the intentional production or exaggeration of symptoms motivated by external incentives (financial compensation, avoiding jail sentence, militray duty, or work).

The main difference is in the motivation. Someone who is malingering wants to obtain something, someone who has a factitious disorder wants to assume the sick role.

Question 6

Diagnostic criteria for Conversion Disorder

Answer 6

• One or more symptoms of altered voluntray motor or sensory function
• Evidence of incompatibility between symptoms and recognized neurologic or medical conditions
• The symptom or deficit is not better explained by another medical or mental disorder
• The symptom or deficit causes significant distress or impairment in functioning or warrants medical attention

Question 7

Treatment of Conversion Disorder

Answer 7

In most cases, symptoms resolve on their own without treatment. However, it is not unusual for the same or similar problems to recur in the presence of a new stressor or conflict.

Reassurance and education can result in quick resolution of symptoms and should ALWAYS be first-line. (“Under stress, the body can react in unusual ways; however this will likely get better soon on its own without our intervention.”)

CBT or PT may also be helpful. Hospitalization is usually unnecessary unless ADLs are impaired.

Question 8

Conversion symptoms in patients with factitious disorder

Answer 8

Patients with factitious disorders may present with conversion symptoms, but with factitious disorder there is usually evidence that the loss of function is being deliberately feigned (eg, present during the examination but not at home)

Question 9

___ is a form of conversion disorder

Answer 9

PNES is a form of conversion disorder

Question 10

Characteristics of a functional tremor

Answer 10

• Abrupt onset
• Changes in amplitude, frequency, and distribution over time
• Worsens under direct observation, improves with distraction
• Seen in the setting of:
  
  • Conversion disorder
  • Anxiety
  • Depression