Transcript conversion disorder

CONVERSION
DISORDER
By
Dr. 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
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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
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D. Amnesia
D. Fugue
Multiple Personality disorder
D./Conversion NOS
D. Stupor
Trance and Possession disorder
Ganser’s Syndrome
Classification
1.
2.
3.
4.
5.
DSM – IV
D. Amnesia
D. Fugue
D. Identity disorder
Depersonalization dis.
D. Disorder NOS
ICD -10
1. D. Amnesia
2. D. Fugue
3. Multiple Personality
disorder
4. D./Conversion NOS
5. D. Stupor
6. Trance and Possession
disorder
7. Ganser’s Syndrome
Epidemiology
 Incidence
– 5-12/ 100,000
 Prevalence – 50/100,000
ReferenceShorter 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%
Refrences
Conversion Disorder: Difficulties in Diagnosis using DSM-IV/ ICD-10 by Syed
EU et al
Etiology
 Psychodynamic
 Social
theories
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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