Illness behavior in the acute phase of motor disability in neurological disease and in conversion disorder

1998 ◽  
Vol 44 (6) ◽  
pp. 657-666 ◽  
Author(s):  
Michael Binzer ◽  
Martin Eisemann ◽  
Gunnar Kullgren
Keyword(s):  
Acute Phase ◽  
Neurological Disease ◽  
Conversion Disorder ◽  
Illness Behavior ◽  
Motor Disability

scholarly journals Conversion Disorder: Early Diagnosis and Personalized Therapy Plan Is the Key

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Lauren Miller ◽  
Robert L. Archer ◽  
Nidhi Kapoor
Keyword(s):  
Physical Therapy ◽  
Group Therapy ◽  
Early Diagnosis ◽  
Neurological Disease ◽  
Financial Burden ◽  
Recovery Process ◽  
Conversion Disorder ◽  
White Female ◽  
Speed Up ◽  
Sensory Functions

Conversion disorder is characterized by one or more symptoms of altered voluntary motor or sensory functions that cannot be explained by a neurological disease (Keynejad, 2019; Samuels et al., 2019). We present a patient with conversion disorder and discuss her process in overcoming this disorder. Additionally, we review the literature about this specific disorder. A 15-year-old white female was diagnosed with conversion disorder and has shown significant recovery with physical therapy and group therapy since. It is essential to recognize this disorder early to lessen the financial burden on families and to speed up the recovery process for these patients.

Proinflammatory cytokine levels in patients with conversion disorder

2013 ◽  
Vol 25 (3) ◽  
pp. 137-143 ◽  
Author(s):  
Utkan Tiyekli ◽  
Okan Çalıyurt ◽  
Nimet Dilek Tiyekli
Keyword(s):  
Acute Phase ◽  
Proinflammatory Cytokine ◽  
Interleukin 1 ◽  
Conversion Disorder ◽  
Enzyme Linked Immunosorbent Assay ◽  
Necrosis Factor Alpha ◽  
Tnf Α ◽  
Significant Difference ◽  
Cytokine Levels ◽  
As Stress

ObjectiveIt was aimed to evaluate the relationship between proinflammatory cytokine levels and conversion disorder both commonly known as stress regulated.MethodBaseline proinflammatory cytokine levels–[Tumour necrosis factor alpha (TNF‐α), Interleukin‐1 beta (IL‐1β), Interleukin‐6 (IL‐6)]–were evaluated with enzyme‐linked immunosorbent assay in 35 conversion disorder patients and 30 healthy controls. Possible changes in proinflammatory cytokine levels were evaluated again, after their acute phase in conversion disorder patients.ResultsStatistically significant decreased serum TNF‐α levels were obtained in acute phase of conversion disorder. Those levels increased after acute conversion phase. There were no statistically significant difference observed between groups in serum IL‐1β and (IL‐6) levels.ConclusionsStress associated with conversion disorder may suppress immune function in acute conversion phase and may have diagnostic and therapeutic value.

Ten-Year Prognosis of Conversion Disorder

1996 ◽  
Vol 169 (3) ◽  
pp. 282-288 ◽  
Author(s):  
C. J. Mace ◽  
M. R. Trimble
Keyword(s):  
Neurological Disease ◽  
Conversion Disorder ◽  
Structured Interview ◽  
Community Services ◽  
Screening Criteria ◽  
Somatisation Disorder ◽  
Use Of Services ◽  
Poor Outcomes ◽  
Hospital Contact

BackgroundPrevious work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected.MethodClinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services.ResultsThirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up.ConclusionsThe prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.

Functional neurological symptom disorder (conversion disorder)

2020 ◽  
pp. 1350-1360
Author(s):  
Jon Stone ◽  
Michael Sharpe
Keyword(s):  
Neurological Symptom ◽  
Neurological Disease ◽  
Visual Loss ◽  
Psychological Treatment ◽  
Initial Step ◽  
Conversion Disorder ◽  
Physical Symptom ◽  
Limb Weakness ◽  
Depression Disorders ◽  
Functional Neurological Symptom Disorder

Conversion disorder (now also called functional neurological symptom disorder) describes symptoms (of motor and sensory dysfunction such as limb weakness, tremor, visual loss, with or without ‘blackouts’), which can be positively identified as being inconsistent with neurological disease. The disorder is common in neurological services and frequently seen by psychiatrists working in such settings. It is often associated with chronic severe disability. The diagnosis previously hinged on the neurologist’s demonstration of the lack of disease and the psychiatrist’s hypothesis of a ‘conversion’ of stress into a physical symptom. It is now based on positive findings on neurological assessment supplemented by a psychiatric assessment to confirm the diagnosis. Comorbid anxiety and depression disorders are common. Treatment is multi-disciplinary. Explanation of the condition to the patient is a crucial initial step supplemented, where necessary, by psychological treatment (especially for dissociative or non-epileptic attacks) and physiotherapy for functional motor symptoms. The prognosis without treatment is poor once the disability is established.

Patterns of dissociative (conversion) disorder cases in private psychiatric facility and the effectiveness of an indigene model of psychotherapy

2017 ◽  
Vol 41 (S1) ◽  
pp. S410-S410
Author(s):  
M.I. Hussain
Keyword(s):  
Family Environment ◽  
Family Members ◽  
Care Facility ◽  
Health Care Facility ◽  
Conversion Disorder ◽  
Illness Behavior ◽  
Psychiatric Facility ◽  
Supportive Psychotherapy ◽  
The Family ◽  
Competing Interest

This is descriptive study was carried out on newly diagnosed dissociative (conversion) disorder patients admitted in private health care facility, Iftikhar Psychiatric Hospital Peshawar.The studied was carried out from January 2012 to December 2012. Cases were diagnosed according to international classification of disease (ICD-10) diagnostic criteria. Subjects were selected through purposive sampling. A total of 139 patients were included in this study. Patterns of and disorder and demographic will be presented in presentation.Due to sociocultural sensitivity of applying dialectical and CBT an indigenes model of psychotherapy was applied.Stage 1: admission of conversion disorder cases for four days admission with informed consent, supportive psychotherapy, and brief psycho-education of attendants to avoid reinforcement of the patient's behavior. Parental single dose medication to break the cycle of fits.Stage 2: it involves exploratory session with the patient and her/his family members focusing on what is the problem with the patient nature of stressors, and the family environment. Meanwhile, we involve the patient in the recreational and occupational therapy to avoid sick role and illness behavior.Stage 3: psychotherapy session with the patient to give psycho-education and insight of her/his mental problem. Discussing different options, and facilitating the patient to come up with the best possible desirable option. Psychotherapy of the family members involved psycho-education about the patient's mental illness, its association with the prevailing stressors, and avoiding reinforcement. Responses have been 85% improvement in conversion disorder, 90% in sensory symptoms, 98% in motor symptoms, 95% in mixed symptoms.Disclosure of interestThe author has not supplied his declaration of competing interest.

Quick Reference: Chapter 1: The Musculoskeletal System: The Hand and Upper Extremity

2000 ◽  
Vol 5 (5) ◽  
pp. 4-5
Keyword(s):  
Dorsal Column ◽  
Persistent Pain ◽  
Illness Behavior ◽  
Abnormal Illness Behavior ◽  
Organ Systems ◽  
Spinal Cord Dorsal ◽  
Objective Basis ◽  
Dorsal Column Stimulation ◽  
Underlying Pathology

Abstract Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians prescribe these treatments in cancer pain or noncancer-related neuropathic pain settings. A survey of academic centers showed that 87% of responding centers use SCS and 84% use ISO. These treatments are performed frequently in nonacademic settings, so evaluators likely will encounter patients who were treated with SCS and ISO. Does SCS or ISO change the impairment associated with the underlying conditions for which these treatments are performed? Although the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address this question, the answer follows directly from the principles on which the AMA Guides impairment rating methodology is based. Specifically, “the impairment percents shown in the chapters that consider the various organ systems make allowance for the pain that may accompany the impairing condition.” Thus, impairment is neither increased due to persistent pain nor is it decreased in the absence of pain. In summary, in the absence of complications, the evaluator should rate the underlying pathology or injury without making an adjustment in the impairment for SCS or ISO.

Behavioral Factors Impact Impairment and Disability Evaluation

2011 ◽  
Vol 16 (5) ◽  
pp. 5-7
Author(s):  
Lee Ensalada
Keyword(s):  
Social History ◽  
Standardized Test ◽  
Somatoform Disorders ◽  
Disability Evaluation ◽  
Body Part ◽  
Emotional Reactions ◽  
Illness Behavior ◽  
Validity Testing ◽  
Symptom Validity Testing ◽  
Disease Pattern

Abstract Illness behavior refers to the ways in which symptoms are perceived, understood, acted upon, and communicated and include facial grimacing, holding or supporting the affected body part, limping, using a cane, and stooping while walking. Illness behavior can be unconscious or conscious: In the former, the person is unaware of the mental processes and content that are significant in determining behavior; conscious illness behavior may be voluntary and conscious (the two are not necessarily associated). The first broad category of inappropriate illness behavior is defensiveness, which is characterized by denial or minimization of symptoms. The second category includes somatoform disorders, factitious disorders, and malingering and is characterized by exaggerating, fabricating, or denying symptoms; minimizing capabilities or positive traits; or misattributing actual deficits to a false cause. Evaluators can detect the presence of inappropriate illness behaviors based on evidence of consistency in the history or examination; the likelihood that the reported symptoms make medical sense and fit a reasonable disease pattern; understanding of the patient's current situation, personal and social history, and emotional predispositions; emotional reactions to symptoms; evaluation of nonphysiological findings; results obtained using standardized test instruments; and tests of dissimulation, such as symptom validity testing. Unsupported and insupportable conclusions regarding inappropriate illness behavior represent substandard practice in view of the importance of these conclusions for the assessment of impairment or disability.

Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

2003 ◽  
Vol 8 (5) ◽  
pp. 4-12
Author(s):  
Lorne Direnfeld ◽  
James Talmage ◽  
Christopher Brigham
Keyword(s):  
Upper Extremity ◽  
Radicular Pain ◽  
Illness Behavior ◽  
Orthopedic Surgeon ◽  
First Case ◽  
Clinical Presentations ◽  
Whole Person ◽  
Physical Examinations ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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