Conversion disorder: Unexplained symptoms of silenced emotions?

2017 ◽  
Vol 41 (S1) ◽  
pp. S413-S413
Author(s):  
C.P. Martins ◽  
S. Carvalho ◽  
F. Silva ◽  
H.S. Almeida
Keyword(s):  
Neurological Diseases ◽  
Conversion Disorder ◽  
Clinical Findings ◽  
Sensory Function ◽  
Lower Limbs ◽  
Medical Conditions ◽  
Mesh Terms ◽  
Psychological Conflict ◽  
Competing Interest ◽  
Psychological Stressor

IntroductionConversion disorder is a condition defined by the presence of symptoms of altered voluntary motor or sensory function, not intentionally produced or feigned, presumed to be the expression of a psychological conflict or stressor, but mimicking neurological diseases or other medical conditions, that must be excluded before this diagnosis is made. The suspicion of conversion disorder arises when clinical findings are incompatible with the suggested neurological or medical conditions and there is a temporal relation between the onset of the symptoms and a psychological stressor. However, when these hints are absent, diagnosis may not be clear and require wider workup.Objectives/aimsTo make a brief review on conversion disorder and present an illustrative clinical-vignette.MethodsWe collected information from medical records and interview with the patient and made a research on PubMed with the MeSH terms “conversion disorder”.ResultsWe present a 51-years-old female outpatient with episodes of paralysis of left upper and lower limbs. Some months before the onset of these symptoms, her daughter came to live with her. Their relationship became very conflictual. Electroencephalogram, laboratory and imaging studies were normal. She did not tolerate the antidepressants tried (SSRI, SNRI and trazodone), but reported to feel better with amisulpride and alprazolam.ConclusionsWidely discussed in the past as “hysteria”, conversion disorder is still intriguing, because little is known about the link between body and mind, making the management of patients with this disorder challenging and highlighting the need for more studies on the topic.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Somatoform and conversion disorders as psychological defences

2021 ◽  
Vol 11 (73) (1) ◽  
pp. 217-225
Author(s):  
Elena Andreea Mut ◽  
Cristina Pălădoiu ◽  
Monica Stănescu
Keyword(s):  
Defense Mechanism ◽  
Conversion Disorder ◽  
Clinical Situation ◽  
Sensory Function ◽  
Conversion Disorders ◽  
Psychological Conflict ◽  
Organic Condition ◽  
Substance Consumption ◽  
Intrapsychic Conflicts

Conversion disorder is the clinical situation in which one or more symptoms can present deficits that affect motor or sensory function and suggest a neurological or organic condition. Psychological factors are decisive, and they usually include a major anxiety generated by intrapsychic conflicts, which are converted by unconscious defense mechanism into symptoms. The symptoms are not intentionally provoked or simulated nor are explained by organic suffering or substance consumption. They affect the quality of life of the person who presents significant deficits such as motor, sensory, convulsive or mixed. It may also occur a lack of coordination, ataxia, paralysis, tremor, aphonia, difficulties at swallowing, loss of sensitivity, anesthesia that does not follow anatomical nervous trajectories, blindness or mental deafness. Consciousness is not altered, but a condition of "la belle indifference" appears which is rather associated with histrionic personality disorders and what the patients imagine about their own illness or suffering. This condition is unstable and changing. The primary gain is the expression of an unconscious psychological conflict through a somatic symptom by reducing anxiety and keeping conflict out of consciousness. The secondary gain is external and includes attention and care from caregivers or others.

Comparison of standardised lymphoscintigraphic function test and high resolution sonography of the lymphoedema of legs

Phlebologie ◽  
2008 ◽  
Vol 37 (05) ◽  
pp. 247-252 ◽  
Author(s):  
V. S. Brauer ◽  
W. J. Brauer
Keyword(s):  
Lower Leg ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Fatty Tissue ◽  
Qualitative And Quantitative ◽  
Function Test ◽  
Unreliable Method ◽  
Negative Conclusion ◽  
Fine Disperse

SummaryPurpose: Comparison of qualitative and quantitative sonography with the lymphoscintigraphic function test and clinical findings in legs. Patients, methods: In 33 patients a lymphoscintigraphic function test of legs combined with measurement of lymph node uptake was performed and subsequently compared with sonography. Sonographic criteria were: Thickness of cutis, thickness of subcutanean fatty tissue and presence of liquid structures or fine disperse tissue structure of lower limbs, foots and toes. Results: In 51 legs uptake values lie in the pathologic area, in four legs in the grey area and in ten legs in the normal area. The cutis thickness in the lower leg shows no significant correlation with the uptake. The determination of the thickness of the subcutanean fatty tissue of the lower leg and of the cutis thickness of the feet turned out to be an unreliable method. In 47% of the medial lower legs and in 57% of the lateral lower legs with clinical lymphoedema sonography is falsely negative. Conclusion: Early lymphoedema is only detectable with the lymphoscintigraphic function test. In the case of clinical lymphoedema clinical examination is more reliable than sonography.

scholarly journals Acute myelitis after SARS-CoV-2 infection: a case report

2020 ◽  
Author(s):  
Kang Zhao ◽  
Jucun Huang ◽  
Dan Dai ◽  
Yuwei Feng ◽  
Liming Liu ◽  
...  
Keyword(s):  
Acute Flaccid Paralysis ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Nasopharyngeal Swab ◽  
Comprehensive Treatment ◽  
Nucleic Acid Testing ◽  
Test Results ◽  
Microbiological Test ◽  
Novel Coronavirus ◽  
Post Infectious

AbstractWe report a case of acute myelitis in a patient infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A 66-year-old man with coronavirus disease 2019 was admitted with acute flaccid paralysis of the bilateral lower limbs and urinary and bowel incontinence. All serum microbiological test results were negative, except for SARS-CoV-2 nucleic acid testing. Clinical findings indicated post-infectious acute myelitis. He received treatment containing ganciclovir, lopinavir/ritonavir, moxifloxacin, dexamethasone, human immunoglobulin, and mecobalamin. With a diagnosis of post-infectious acute myelitis and comprehensive treatment, paralysis of the bilateral lower extremities ameliorated. After two negative novel coronavirus RNA nasopharyngeal swab tests, he was discharged and transferred to a designated hospital for isolation and rehabilitation therapy.

Bone Scintigraphic Findings of Os Trigonum: A Prospective Study of 100 Soldiers on Active Duty

2000 ◽  
Vol 21 (10) ◽  
pp. 822-824 ◽  
Author(s):  
Vladimir Sopov ◽  
Aharon Liberson ◽  
David Groshar
Keyword(s):  
Active Duty ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Whole Body ◽  
X Rays ◽  
Stress Injury ◽  
Os Trigonum ◽  
Frequent Finding ◽  
The Right ◽  
A Prospective Study

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty. PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated. RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum. CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.

scholarly journals Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia

2020 ◽  
Vol 8 ◽  
pp. 232470962093164
Author(s):  
Aditi Vian Varma-Doyle ◽  
Kristen Garvie ◽  
Seema Walvekar ◽  
Mae Igi ◽  
Radha Mayuri Garikepati
Keyword(s):  
Bipolar Disorder ◽  
Respiratory Failure ◽  
Aspiration Pneumonia ◽  
Ivig Therapy ◽  
Conversion Disorder ◽  
Clinical Findings ◽  
Symptom Improvement ◽  
Csf Analysis ◽  
Life Threatening ◽  
High Index Of Suspicion

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy affecting both motor and sensory peripheral nerves. Typically presenting after a gastrointestinal or a respiratory tract infection, it manifests as ascending paralysis with concomitant areflexia in patients. Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in treatment can occur, and consequently, GBS can become life threatening due to respiratory failure. We report ascending paralysis in a 36-year-old woman with known history of bipolar disorder who recently recovered from aspiration pneumonia following a drug overdose event. Given her psychiatric history, she was initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) therapy was initiated at our hospital due to strong suspicion of GBS, based on history and physical examination findings consistent with flaccid quadriparesis and impending respiratory failure. CSF analysis and radiological findings subsequently supported our clinical suspicion and clinical findings. Concurrent IVIG therapy, pain management, aggressive physical and respiratory therapy, and monitoring resulted in symptom improvement. One must have a high index of suspicion for GBS when presented with acute inflammatory demyelinating neuropathies in patients who present with ascending paralysis. Early initiation of therapy is key and can prevent life-threatening complications.

scholarly journals Candidate Genes Associated with Delayed Neuropsychomotor Development and Seizures in a Patient with Ring Chromosome 20

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Thiago Corrêa ◽  
Amanda Cristina Venâncio ◽  
Marcial Francis Galera ◽  
Mariluce Riegel
Keyword(s):  
Candidate Genes ◽  
Protein Interactions ◽  
Neurological Diseases ◽  
Ring Chromosome ◽  
Molecular Data ◽  
Clinical Findings ◽  
Chromosomal Microarray ◽  
Chromosomal Microarray Analysis ◽  
Nucleosome Assembly ◽  
Chromosome 20

Ring chromosome 20 (r20) is characterized by intellectual impairment, behavioral disorders, and refractory epilepsy. We report a patient presenting nonmosaic ring chromosome 20 followed by duplication and deletion in 20q13.33 with seizures, delayed neuropsychomotor development and language, mild hypotonia, low weight gain, and cognitive deficit. Chromosomal microarray analysis (CMA) enabled us to restrict a chromosomal segment and thus integrate clinical and molecular data with systems biology. With this approach, we were able to identify candidate genes that may help to explain the consequences of deletions in 20q13.33. In our analysis, we observed five hubs (ARFGAP1, HELZ2, COL9A3, PTK6, and EEF1A2), seven bottlenecks (CHRNA4, ARFRP1, GID8, COL9A3, PTK6, ZBTB46, and SRMS), and two H-B nodes (PTK6 and COL9A3). The candidate genes may play an important role in the developmental delay and seizures observed in r20 patients. Gene ontology included microtubule-based movement, nucleosome assembly, DNA repair, and cholinergic synaptic transmission. Defects in these bioprocesses are associated with the development of neurological diseases, intellectual disability, neuropathies, and seizures. Therefore, in this study, we can explore molecular cytogenetic data, identify proteins through network analysis of protein-protein interactions, and identify new candidate genes associated with the main clinical findings in patients with 20q13.33 deletions.

scholarly journals Primary Aneurysm of the Medial Marginal Vein of the Foot

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
D. Casian ◽  
V. Culiuc
Keyword(s):  
Duplex Ultrasound ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Venous Aneurysm ◽  
Marginal Vein ◽  
Second Trimester ◽  
Surgical Department ◽  
Previous Trauma ◽  
History Of ◽  
One Year

The primary superficial venous aneurysms of the foot are very rare. A 34-year-old female patient developed a dorsal foot mass during the second trimester of pregnancy with no history of previous trauma, puncture, or infection. One year later, she was referred to the surgical department for excision of “foot hygroma.” Based on the clinical findings, the venous aneurysm was suspected and duplex ultrasound confirmed the diagnosis of the aneurysm of the medial marginal vein of the foot. Excision of aneurysm with bipolar ligation of marginal vein was performed under local anesthesia. The postoperative evolution was uneventful. The authors hope that the presented case report will increase the awareness of general practitioners, dermatologists, and surgeons regarding the superficial venous aneurysms of lower limbs.

Pseudoakathisia in a patient with clotiapine abuse: Report of a case

2016 ◽  
Vol 33 (S1) ◽  
pp. S550-S550 ◽  
Author(s):  
P. Quandt ◽  
M.D.R. Cejas Méndez
Keyword(s):  
Rating Scale ◽  
Beta Blockers ◽  
Lower Limbs ◽  
Antipsychotic Treatment ◽  
Clinical Progression ◽  
Drug History ◽  
Competing Interest ◽  
Confusional States ◽  
Subjective Discomfort

IntroductionObjective symptoms of akathisia in the absence of subjective symptoms is known as pseudoakathisia, more often diagnosed in older patients with long-term antipsychotic treatment.ObjectiveTo describe a case of pseudoakathisia in a patient with clotiapine abuse.AimsPseudoakathisia management.MethodsX is a 47-year-old male with chronic insomnia treated with clotiapine 40 mg/day for four years. He admits abusive neuroleptic consumption in the past eight months (160 mg/day), without any psychiatric control for years. In recent months he has experienced different organic complications, requiring multiple hospitalizations. During psychiatric examinations due to confusional states, repeated lower limbs movements were objectified. X reported he presented these movements for at least six months, without complaints of inner restlessness feeling. Neurological examination showed normal DAT-SCAN result. Clinical progression was evaluated using BARS scale (Barnes Akathisia Rating Scale).ResultsFollowing the results of tests and statements of drug history, X was diagnosed with clotiapine-induced pseudoakathisia. Neuroleptic treatment was suspended, and clonazepam 6 mg/day and propranolol in ascending doses up to 80 mg/day were initiated. In subsequent evaluations, progressive decrease in movement intensity was observed. However, complete remission after four months from clotiapine suspension was not achieved.ConclusionsPseudoakathisia is a concept not well defined at this moment and different hypotheses about its nature are considered. It has been suggested that it is a form of delayed dyskinesia, or a clinical progression from akathisia, with acquired subjective discomfort tolerance. The most widely used treatment includes benzodiazepines, beta-blockers and anticholinergics, although their effectiveness is limited.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Magnetic Resonance Imaging versus Electrophysiologic Tests in Clinical Diagnosis of Lower Extremity Radicular Pain

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
E. G. Hasankhani ◽  
F. Omidi-Kashani
Keyword(s):  
Lower Extremity ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Radicular Pain ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Medical Problems ◽  
Cross Sectional ◽  
Physical Examinations ◽  
Comprehensive History

Introduction. Radicular low back pain is one of the most common medical problems. The aim of this study was to evaluate the diagnostic accuracy of MRI and electrodiagnosis in lower extremity radicular pain in relation to history and clinical findings. Methods. In this cross-sectional study, we studied 165 sciatalgic subjects. A comprehensive history and physical examinations were taken from the subjects and recorded, and then MRI scanning and electrodiagnostic (nerve conduction velocity and electromyography) tests were performed. Results. From 152 subjects who remained in the study, 67 cases (44.1%) had radicular pain in left lower limb, 46 (30.3%) in right, and 39 (25.6%) in both lower limbs. 104 cases (68.4%) had shown some type of abnormalities in both MRI and electrodiagnosis, 30 (19.7%) had shown this abnormality only in MRI, and 21 (13.8%) only in electrodiagnosis, while 10 cases (6.5%) had both normal MRI and electrodiagnostic studies. Coordination rates of MRI and electrodiagnosis with clinical findings were 58.6% and 89.5%, respectively. Conclusion. In many MRI negative but symptomatic subjects, electrodiagnosis has an important diagnostic value.

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