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.

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 Demographic and clinical characteristics of patients presenting with conversion disorder in a tertiary care hospital in north India

2021 ◽  
Vol 9 (2) ◽  
pp. 535
Author(s):  
Haamid Ismail ◽  
Sabreena Qadri ◽  
Arshad Hussain ◽  
Nadia Ismail
Keyword(s):  
Clinical Characteristics ◽  
Tertiary Care ◽  
Conversion Disorder ◽  
Sensory Function ◽  
North India ◽  
Care Hospital ◽  
Rural Background ◽  
Medical College ◽  
Conversion Disorders ◽  
Study Population

 Background: Conversion (functional neurological symptom) disorder refers to patients who have neurological symptoms in the absence of neurological disease, encompassing one or more symptoms of altered voluntary motor or sensory function. Aim of the study was to study the demographic and clinical characteristics of patients with conversion disorder.Methods: The study population comprised all the patients (both inpatients and outpatients) of conversion disorder attending department of psychiatry, government medical college Srinagar over a period of 6 months who fulfilled the inclusion criteria of the study were evaluated on a semi-structured proforma for demographic variables and clinical characteristics.Results: A total of 76 patients of conversion disorder were included in our study. Conversion disorder is more common in age group of 20-29 years (52.6%), females (93.4%) and among students (71.1%) belonging to rural background. Motor symptoms were the predominant presentation with pseudo seizure (69.7%) being the commonest. A majority of the patients had an obvious psychosocial stressor, of which family-related (36.8%) and relationship- related (15.8%) problems accounted for the major types.Conclusions: Conversion disorders are commonly seen in young adult females, students and in those from rural background. They are mostly preceded by psychosocial stressors.

scholarly journals Characteristics and outcomes of children with dissociative (conversion) disorders in western China: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhixu Fang ◽  
Yuhang Li ◽  
Lingling Xie ◽  
Min Cheng ◽  
Jiannan Ma ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Environmental Variables ◽  
Binary Logistic Regression ◽  
Junior College ◽  
Conversion Disorder ◽  
Psychological Characteristics ◽  
Western China ◽  
Left Behind ◽  
Conversion Disorders ◽  
Close Relationship

Abstract Background Dissociative (conversion) disorder in children is a complex biopsychosocial disorder with high rates of medical and psychiatric comorbidities. We sought to identify the characteristics and outcomes of children with dissociative (conversion) disorders in western China. Methods We conducted a retrospective cohort study of 66 children admitted with dissociative (conversion) disorders from January 2017 to July 2019, and analyzed their clinical characteristics, socio-cultural environmental variables, and personality and psychiatric/psychological characteristics. Binary logistic regression was used to analyze the variables associated with clinical efficacy. Results Of these 66 patients, 38 (57.6%) were male and 28 (42.4%) were female, 46 (69.7%) had an antecedent stressor, 30 (45.5%) were left-behind adolescents, and 16 (24.2%) were from single-parent families. In addition, 30 patients (45.5%) were not close to their parents, 38 patients (59.4%) had an introverted personality, and 34 (53.1%) had unstable emotions. Thirteen families (19.7%) were uncooperative with the treatment. Patients who had cormorbid anxiety or depression exhibited significantly lower cognitive ability (P < 0.01). Logistic regression found that better treatment outcomes were positively associated with having a close relationship with parents, parental cooperation with treatment, and having a father with a lower level of education (i.e., less than junior college or higher). Conclusions The characteristics and outcomes of children with dissociative (conversion) disorders are related to socio-cultural environmental variables and psychiatric/psychological factors. Timely recognition and effective treatment of dissociative (conversion) disorders are important.

scholarly journals Improvement in staff compliance with a safety standard checklist in endoscopy in a tertiary centre

2018 ◽  
Vol 7 (3) ◽  
pp. e000294
Author(s):  
Matthew Charles Mason ◽  
Rebecca Katie Griggs ◽  
Rachel Withecombe ◽  
Eunice Yun Xing ◽  
Charlotte Sandberg ◽  
...  
Keyword(s):  
Clinical Situation ◽  
Invasive Procedures ◽  
Independent Observer ◽  
Safety Standards ◽  
Tertiary Centre ◽  
Time Out ◽  
Score Analysis ◽  
Ensure Patient Safety ◽  
Local Safety

National Health Service England published the National Safety Standards for Invasive Procedures (NatSSIP) in 2015. They mandated that individual trusts produce Local Safety Standards for Invasive Procedures (LocSSIPs), a set of safety standards drawn from the NatSSIP that apply to a particular clinical situation in a given department, for all invasive procedures.The project goal was to design and implement the LocSSIP within the endoscopy department. A draft LocSSIP was produced, and a pilot study conducted to gain initial feedback on its use. Version 1 of the checklist was produced and after approval, rolled out for use within the endoscopy department at ‘time out’ and ‘sign out’. A scoring system was developed that allowed the quality of the performance of LocSSIPs to be assessed and recorded as a ‘compliance score’.After 2 months, an independent observer spent a week assessing use of the checklist, recording completion and a compliance score. Analysis of this data led to a number of changes in performing the checklist, wider multidisciplinary team education and integration of the checklist into existing documentation, before reassessing at 12 months.In 2016, ‘time out’ checks were completed in 100% of cases, but full completion was only observed in 68%. ‘Sign out’ checks were completed in 91% of cases, with full completion in 71%. In 2017, ‘time out’ checks were completed in 100% of cases, with full completion in 85%. ‘Sign out’ checks were completed in 100% of cases, with full completion in 91%.The composite score for compliance in 2016 was 57% increasing to 90% in 2017.In conclusion, stronger departmental leadership, broadening education and integration of the checklist into routine documentation to reduce duplication led to significant improvements in compliance with use of the checklist. Ongoing education and assessment is imperative to ensure that compliance is maintained to ensure patient safety.

scholarly journals Dynamic monitoring of HbA1c in Russian regions: data comparison of mobile medical center (Diamodul) and national diabetes register of Russian Federation

2020 ◽  
Vol 23 (2) ◽  
pp. 104-112
Author(s):  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Alexey A. Serkov ◽  
Marina V. Shestakova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Center ◽  
Clinical Situation ◽  
Dynamic Monitoring ◽  
Random Group ◽  
Glucose Lowering ◽  
Lowering Therapy ◽  
Glucose Lowering Therapy ◽  
Diabetes Register

BACKGROUND: Glikogemoglobin (HbA1c) is a key clinical marker for evaluating the effectiveness of glucose-lowering therapy for patients with diabetes mellitus (DM) and the quality of diabetic care. AIMS: to conduct dynamic monitoring of the quality of glycemic control in DM patients based on a comprehensive examination in mobile medical center (Diamodul) during repeated visits to the regions in 2019 compared with visits of Based Federal program Diabetes Mellitus (20052010) and data of the National diabetes register (NDR). MATERIALS AND METHODS: The object of the study: patients with T1DM and T2DM examined in Diamodul in 2019 in Voronezh region (Vr), Krasnodar region (Kr) (n = 600), there were dynamic group of re-examined (Vr n = 224; Kr n = 113), random group of new patients (Vr n = 72; Kr n = 191); group of adult patients from NDR with indicated HbA1c in 2019 (n = 2410067). RESULTS: According to Diamodul, the HbA1c levels are significantly worse than they were reported to NDR: the proportion of patients achieved HbA1c 7% for T1DM is 13.3% and 11.7%; T2DM 25.1% and 28.6%, in Kr and Vr, respectively; in NDR: T1DM 37.4%, T2DM 52.2%. The average HbA1c values in the Diamodul are higher than in NDR by 0.95% for T1DM, 1.41% for T2DM patients. The proportion of patients with HbA1c9% decrease in dynamic of examinations through years in T1: in Vr from 53.1% in 2005 and 55.8% in 2010 to 42.9% in 2019, in Kr from 53.2% in 2006 to 43.8% in 2019; also there were decreases in the average HbA1c values in Vr from 9.3% in 2005 and 9.4% in 2010 to 8.8% in 2019; in Kr from 9.1% in 2006 to 8.7% in 2019. In T2DM patients with the best parameters of DM control in a whole, the positive trends were less pronounced and are assessed as non-deterioration: the proportion of HbA1c9 % in Vr: 34.7%34.7%36.4%, in Kr 40.1%28.4%; average values of HbA1c: 8.2%8.4%8.5% and 8.6%8.4%, respectively. CONCLUSIONS: The data of the research clearly indicates the need for 100% inclusion of HbA1c in the examination standards in all DM patients at the primary level at least 1 time per year, in order to monitor the real clinical situation, the effectiveness of glucose-lowering therapy and its timely intensification to prevent development of complications.

scholarly journals Chronic Inflammatory Demyelinating Polyradiculoneuropathy 101—Pitfalls and Pearls of Diagnosis and Treatment

US Neurology ◽  
2017 ◽  
Vol 13 (01) ◽  
pp. 18 ◽  
Author(s):  
Said R Beydoun ◽  
Thomas H Brannagan III ◽  
Peter Donofrio ◽  
Carol Lee Koski ◽  
Eric Lancaster ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Ivig Therapy ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Sensory Function ◽  
Therapeutic Interventions ◽  
First Line ◽  
Chronic Disability ◽  
Treatable Condition ◽  
Progressive Weakness

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which is caused by demyelination of the peripheral nerves, is characterized by progressive weakness and impaired sensory function in the arms and legs. CIDP is a treatable condition in which early diagnosis is crucial to limit chronic disability. CIDP can mimic other neuropathies and it is important to identify these in order to ensure prompt treatment. Patients with other causes of neuropathy should be suspected of having CIDP if there is rapid progress or proximal weakness. Intravenous immunoglobulin (IVIG), corticosteroids, and plasma exchange are first-line therapies. The IVIG CIDP Efficacy (ICE) trial, the largest trial reported of any CIDP treatment, demonstrated that IVIG therapy reduced disability and functional impairment, as well as improved quality of life. Autoantibodies against membrane proteins of the peripheral nerve axons or the myelin sheath have been reported recently, and an improved understanding of antibody responses in CIDP may enable the development of future targeted therapeutic interventions.

scholarly journals Audit of compliance with WHO surgical safety checklist (modified for electroconvulsive therapy including NPSA advice)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S64-S64
Author(s):  
Faisal Alam ◽  
Rizwan Ashraf ◽  
Kyaw Sein ◽  
Terri Feeney
Keyword(s):  
Patient Safety ◽  
Electroconvulsive Therapy ◽  
Time Pressure ◽  
Clinical Situation ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
National Patient ◽  
Service Standards ◽  
Therapy Treatment

AimsThis audit aims to evaluate the compliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment in ECT clinic at Greater Manchester Mental Health Bolton Directorate. The audit is based on WHO surgical safety checklist modified for ECT including National Patient Safety Agency advice. The goal is to improve the compliance and in turn improve clinical outcomes.BackgroundThe WHO surgical safety checklist (modified for Electroconvulsive therapy including NPSA advice) is devised to promote patient safety, improve teamwork, reduce errors/adverse events and improve overall quality of care. An audit was completed regarding the compliance with the safety checklist at the Bolton ECT clinic and to assess how this could be improved.MethodFollowing approval from the clinical audit department, GMMH NHS Foundation Trust, 20 checklists from randomly selected patient ECT files were included in this audit. We looked at whether the checklists were completed, signed and dated. Our current WHO surgical safety checklist is as per the Electroconvulsive therapy accreditation service standards.ResultA total of 20 WHO surgical safety checklists were reviewed. 95% of the checklists (19/20) were completed by the duty Psychiatrist. 1 form was not completed. 25% (5/20) were not signed rendering them invalid. A total of 75% checklists were complete and valid. Checklists were present in all the case notes.ConclusionCompliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment can be challenging due to various reasons ranging from time pressure to difficult clinical situation. This audit has highlighted that the overall compliance with the set standards (100% completion) was not achieved. A repeat audit will be important to further improve the compliance and overall clinical outcome.

scholarly journals Regarding operative treatment of thoracoabdominal injuries

2019 ◽  
Vol 36 (1) ◽  
pp. 14-20
Author(s):  
Dmitriy G. Amarantov ◽  
Mikhail F. Zarivchatsky ◽  
Andrey A. Kholodar ◽  
Andrey S. Nagaev ◽  
Oleg S. Gudkov
Keyword(s):  
Operative Treatment ◽  
Clinical Situation ◽  
Rational Approach ◽  
Quality Of Treatment ◽  
Results Of Treatment ◽  
Group I ◽  
Thoracoabdominal Injuries ◽  
Group Ii

Aim. To improve the results of treatment in patients with thoracoabdominal injuries (TAI) by means of creating the method of determining indications for the use of classical or endoscopic surgeries in respect of this pathology. Materials and methods. Seventy-six sufferers from TAI were divided into 2 groups. Results. The method of successive determination of indications for the use of classical or endoscopic surgeries in patients with TAI was created on the basis of treatment of 41 (53.95 %) patients of group II. This method was used to treat 35 (46.05 %) patients of group I. Conclusions. Rational approach to the choice between the use of advantages of classical and endoscopic surgeries depending on characteristics of clinical situation permitted to elevate the quality of treatment in patients with TAI.

Management of Somatic Symptoms

2014 ◽  
Author(s):  
Andreas Schröder ◽  
Joel E Dimsdale
Keyword(s):  
Clinical Presentation ◽  
Health Anxiety ◽  
Management Strategies ◽  
Somatic Symptoms ◽  
Conversion Disorder ◽  
Effective Management ◽  
Patient Interaction ◽  
Step Care ◽  
Physician Patient

Somatic symptoms that cannot be attributed to organic disease account for 15 to 20% of primary care consultations and up to 50% in specialized settings. About 6% of the general population has chronic somatic symptoms that affect functioning and quality of life. This chapter focuses on the recognition and effective management of patients with excessive and disabling somatic symptoms. The clinical presentation of somatic symptoms is categorized into three groups of patients: those with multiple somatic symptoms, those with health anxiety, and those with conversion disorder. The chapter provides information to assist with making a diagnosis and differential diagnosis. Management includes ways to improve the physician–patient interaction that will benefit the patient, a step-care model based on illness severity and complexity, and psychological and pharmacologic treatment. The chapter is enhanced by figures and tables that summarize health anxiety, symptoms, differential diagnoses, and management strategies, as well as by case studies and examples. This review contains  5 highly rendered figures, 10 tables, and 235 references.

Management of Somatic Symptoms

2018 ◽  
Author(s):  
Andreas Schröder ◽  
Joel E Dimsdale
Keyword(s):  
Clinical Presentation ◽  
Health Anxiety ◽  
Management Strategies ◽  
Somatic Symptoms ◽  
Conversion Disorder ◽  
Effective Management ◽  
Patient Interaction ◽  
Step Care ◽  
Physician Patient

Somatic symptoms that cannot be attributed to organic disease account for 15 to 20% of primary care consultations and up to 50% in specialized settings. About 6% of the general population has chronic somatic symptoms that affect functioning and quality of life. This chapter focuses on the recognition and effective management of patients with excessive and disabling somatic symptoms. The clinical presentation of somatic symptoms is categorized into three groups of patients: those with multiple somatic symptoms, those with health anxiety, and those with conversion disorder. The chapter provides information to assist with making a diagnosis and differential diagnosis. Management includes ways to improve the physician–patient interaction that will benefit the patient, a step-care model based on illness severity and complexity, and psychological and pharmacologic treatment. The chapter is enhanced by figures and tables that summarize health anxiety, symptoms, differential diagnoses, and management strategies, as well as by case studies and examples. This review contains  5 highly rendered figures, 10 tables, and 235 references.

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