Conversion Disorders Flashcards
What are conversion disorders?
- When patients present with motor and/or sensory dysfunction not explained by known physical disorders or pathophysiological mechanisms
- No organic cause
What are the characteristics of conversion disorders?
- Occurs most often at 10 -35yo
- Usually lasts a few weeks or months
- Many have medical problems as well
- 20-50% of people diagnosed with a functional disorder are eventually found to have a physical cause for their symptoms
What are the risk factors of conversion disorders?
- Having a family member with the disorder
- Having been sexually abused as a child
- Having a very stressful home or work life
- Being a woman
- Belonging to a lower socioeconomic class
What is the DSM-IV diagnostic criteria?
- One or more symptoms/deficits present that affect voluntary motor/sensory function that suggest a neurological or other general medical condition
- Psychological factors are judged to be associated
- Cannot be explained fully by a general medical condition, direct effects of a substance, or as a culturally sanctioned behaviour/experience.
- Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.
- Not limited to pain or sexual dysfunction, & is not better accounted for by another mental disorder
What is the presentation of conversion disorders?
- Weakness/paralysis of a limb or the entire body
- Impaired hearing or vision
- Loss/disturbance of sensation
- Impairment or loss of speech
- Psuedoseizures
- Fixed dystonia
- Tremor, myoclonus or other movement disorders
- Gait problems
- Syncope
What is the presentation of weakness in conversion disorders?
- Involves whole movements rather than muscle groups
- Simultaneous contraction of agonists & antagonists during testing
- Discontinuous resistance during testing or give-way weakness may exist
- Muscle wasting is absent
- Reflexes are normal
- Level of weakness may not be consistent with level of function
What is the presentation of sensory symptoms in conversion disorders?
- Sensory loss is inconsistent when tested on more than one occasion & is incompatible with peripheral nerve or root distribution.
- Discrete patches of anesthesia or hemisensory loss that stop in the midline may be present
What is the presentation of visual symptoms in conversion disorders?
- Includes monocular diplopia, triplopia, field defects, tunnel vision, & bilateral blindness associated with intact pupillary reflexes.
- Nystagmus may be observed in patients with apparent blindness when exposed to a rotating striped drum
What is the presentation of motor performance in conversion disorders?
- Inability to stand despite normal ability to move legs when lying down or sitting OR inability to move legs in lying or sitting, but able to stand up
- Jerky, exaggerated movements
- Unexplained/inconsistent tremor
- Bizarre gait patterns with unusual co-ordination yet
no falls - May use affected side spontaneously without realising it
What are the rehab approaches for conversion disorders?
- Behavioural management
- Psychotherapeutic approach
- Physical therapy approach
What should physiotherapy treatment be based on?
- Long & short term goals should encourage rapid achievement of normal activities
- Collaboration with family members
- Using positive suggestion
What does physio management often involve?
- Training usual tasks (e.g. standing up, standing balance, walking)
- Giving patients permission to relinquish their symptoms
How should progress be measured in conversion disorders?
- Avoid prolonged documentation of outcome measures
- Use outcome measures judiciously to demonstrate improvement and normal performance
What are the factors associated with favourable prognosis?
- Sudden onset
- Presence of stress during onset
- Short interval between diagnosis and
treatment
- High level of intelligence
- Absence of psychiatric disorder
- Aphonia and blindness as presentation
What are the factors associated with poor prognosis?
- Presentation with severe disability of long duration
- Over 40 years of age
- Convulsions & paralysis as presentation
