A Descriptive Study on the Clinical Correlates of Conversion Disorder

Aim: Conversion disorder is defined by the presence of deficits affecting the voluntary motor or sensory functions lacking any known neurological cause. The aim of the study is to describe the sociodemographic profile and clinical characteristics including the frequency distribution of various types of presentations of patients with conversion disorders in a tertiary care psychiatric facility and to assess the presence of depression and anxiety and its level of severity in those patients. Methods: After obtaining informed consent, 50 consecutive patients who had met with the ICD-10 diagnosis criteria for conversion disorder and those who meet the inclusion/exclusion criteria, were enrolled for the study. They were interviewed using a semi-structured Performa and were administered Hospital Anxiety and Depression scale (HADS) and the results were analysed using SPSS software and interpreted. Results: Majority of the study patients were young adolescents (48%), females (76%), rural residents (60%), mostly unmarried (46%). Dissociative motor disorders (30%) were the most common presentation followed by mixed dissociative disorder (26%) and Dissociative convulsions (22%). HAD scale revealed that, both depression and anxiety scores were significantly high in major number of patients. Conclusion: The most common presenting symptom was that of dissociative motor type followed by dissociative convulsions with considerably high rates of depression (48%) and anxiety (54%). This made us to conclude that conversion as a phenomenon emerges to uphold its significance as a non-verbal communication process of the subconscious Mind. Keywords: Conversion, Dissociation, Hysteria, Dissociative Motor Disorder, Dissociative Convulsions, Laterality, Depression, Anxiety.

Frequency of anxiety and depression in dissociative trance (possession) disorder

Background: The possession of a person by God or spirit is an age-old one. The ICD-10 has recorded the presence of a possession and trance disorder before formal featuring it in the 10th edition as a category of dissociative (conversion) disorders. The current study sought to determine the frequency of anxiety and depression among the patients presented in tertiary care hospitals with dissociative trance (possession) disorder, along with gender differences. Patients and methods: This cross-sectional study was conducted at l Department of Psychiatry, Sir Ganga Ram Hospital Lahore over one year: December 2019 till December 2020. A sample of 350 patients, who met the ICD-10 criteria of dissociative trance (Possession) disorder, was recruited in the study through purposive sampling technique. Demographic information sheet and Urdu version of the Hospital Anxiety and Depression (HAD) rating scale were used as assessment measures. The data were stored and analyzed in SPSS version 20. Descriptive analysis i.e., means, standard deviations, percentages, and frequencies, and inferential statistics i.e., independent sample t-test, were performed to explore objectives. Results: The results indicate that 13.2 % of patients with dissociative trance disorder scored in the normal range of depression, 20.7% fall in borderline depression while abnormal, and 66.1% in abnormal cases of depression was found in 66.1% of patients. For anxiety, results demonstrate that 28.2% of patients fall in the category of normal anxiety, 3 31.5% in borderline anxiety, and 40.3% fall in the case of abnormal anxiety. Differences for the gender of patients in depression and anxiety scores were evaluated by independent sample t-test and significant differences were found in depression and anxiety scores of male and female patients with dissociative trance disorder (p-value<0.05). Female patients scored high on depression (19.84±6.68) and anxiety (16.02±5.54) scale than male patients’ scores for depression (27.47±5.06) and anxiety (19.35±4.95). Conclusion: There is a definite frequency of depression and anxiety among patients with, dissociative trance disorder while females are high in the scores. This can help to decrease the comorbidity associated with dissociative trance disorder, reduce the disease burden and ensure a better outcome of treatment

Colour Vision Disorder due to Conversion Disorders in Childhood

Background Non-organic vision loss can manifest in various ways, most commonly in the form of reduced vision and visual field defects. Colour vision disorders in the context of a conversion disorder have only rarely been reported. Materials and Methods This review presents the case of a 9-year-old boy with a colour vision disorder as the isolated symptom of a conversion disorder. The challenging in this case was an additional somatic comorbidity – a congenital red-green deficiency. Consequently it was difficult to make a diagnosis and to convince the parents. Conclusion It is important to rule out organic causes and establish the diagnosis of a conversion disorder. In these cases, multidisciplinary treatment is crucial for a successful outcome. The diagnosis may be especially challenging when the patients have both somatic and psychogenic complaints.

Reversible splenial lesion syndrome with mental disorders as only manifestation

Background Reversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation. Method Total ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed. Result All patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks. Conclusions We found that RESLES might only showed mental symptoms. On the one hand, for the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES caused by physical disease. On the other hand, we suggest that mental disorder might be a precipitating factor of RESLES.

The phenomenology of tics and tic-like behavior in TikTok

Background and Objective Pediatricians and pediatric subspecialists worldwide have reported a marked increase in functional (conversion) disorders with tic-like behaviors during the COVID-19 pandemic. These patients often report frequent viewing of Tourette Syndrome (TS) TikTok videos, suggesting disease modeling. We aimed to evaluate tic phenomenology in videos posted on TikTok. Methods The 100 most-viewed videos under #tourettes in TikTok were randomly assigned to two primary reviewers (n=3; <2 years independent practice), all pediatric neurologists specializing in movement disorders, for extraction and classification of tic phenomenology. Initial disagreements were solved by consensus. If not resolved, a senior reviewer (n=5; >2 years independent pediatric movement-disorder practice) served as tiebreaker. In addition, two primary and one senior reviewer rated each video on a Likert scale from 1= All the tics are typical of TS to 5= None of the tics are typical of TS. Mean scores and Spearman correlation between primary and senior reviewers were calculated. Results Six videos without tic-like behaviors were excluded. Most videos depicted coprophenomena (coprolalia: 53.2%; copropraxia: 20.2%), often with unusual characteristics. Frequently, videos demonstrated atypical phenomenology such as very strong influence by the environment (motor: 54.3%; phonic: 54.3%), aggression (19.1%), throwing objects (22.3%), self-injurious behaviors (27.7%), and long phrases (>3 words; 45.7%). Most videos portrayed atypical, non-tic behaviors (Median [IQR] Likert ratings: Primary 4.5 [4-5]; Senior 5 [3-5]). Primary vs. senior rater scores demonstrated moderate agreement (r = 0.46; p<0.001). Conclusions TS symptoms portrayals on highly-viewed TikTok videos are predominantly not representative or typical of TS.

Subjective experiences of dissociative and conversion disorders among adolescents in India

Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents’ attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents’ appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents’ perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders.

Dimensions of Psychotic and Other Problems of Thought and Affect

A third broad domain of correlated dimensions of frequently serious psychological problems is termed psychotic and related problems of thought and affect in this book, for want of a better term. The adjective “psychotic” refers to beliefs and experiences that essentially all members of a society consider to be baseless or false. Many of the dimensions of problems described in this domain involve psychotic beliefs (delusions), perceptual experiences (hallucinations), and other cognitive disturbances that can be said to put the person “out of touch with reality.” In addition, they often involve emotions and atypical energy levels that can be markedly inconsistent with the situation. Cognition, emotion, and energy levels that are not consistent with reality can sometimes take a very serious toll on people, but recent research strongly suggests that each of these problems lies on a continuum and can be viewed in dimensional terms. The Diagnostic and Statistical Manual of Mental Disorders categorical diagnoses that correspond to high levels of these problems include schizophrenia, schizotypal personality disorder, schizoid personality disorder, bipolar disorder, conversion disorders, and dissociative disorders (derealization and depersonalization). In addition, recent research suggests that obsessive and compulsive problems, compulsive rigidity, and some eating problems share features with this domain. Autistic spectrum problems are discussed in this chapter on the basis of limited current evidence regarding their best placement.

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

Background The off-label use of antipsychotic medications is common in many countries, and the extent of such use in psychiatric inpatients in China has not been sufficiently studied. The purpose of this study was to survey the incidence and examine the correlates of off-label antipsychotic use in a large, nationally–representative sample in China. Methods This study included discharged psychiatric patients between March 19 and 31, 2019 from 41 tertiary psychiatric hospitals across 29 provinces in China. Their socio-demographic and clinical data were collected and analyzed. Results After excluding patients with schizophrenia spectrum disorder or bipolar disorder, 981 patients were included in the analysis. Overall, antipsychotics were prescribed to 63.2% (95%CI 60.2–66.2%) of the sample. Antipsychotics were used in a wide spectrum of psychiatric disorders, with the rate being the highest among patients with dissociative (conversion) disorders (89.9, 95%CI 83.0–94.8%), organic mental disorders (81.7, 95%CI 73.1–88.7%), dementia (79.0,95%CI 67.8–87.9%), obsessive-compulsive disorder (77.8, 95%CI 55.7–92.5%), mental disorders due to psychoactive substances (75.3,95%CI 64.7–84.2%), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (71.4, 95%CI 45.5–90.1%), somatoform disorders (63.2, 95%CI 40.8%–82..2%), major depression disorder (53.7,95%CI 48.8–58.6%), anxiety disorder (38.8,95%CI 30.5–47.7%), and insomnia (25.0, 95%CI 8.5–28.9%). The top three most commonly used antipsychotics were olanzapine (29.1%), quetiapine (20.3%) and risperidone (6.8%), and their corresponding average doses were 9.04 ± 5.80 mg/day, 185.13 ± 174.72 mg/day, and 2.98 ± 1.71 mg/day, respectively. A binary logistic regression showed that younger age, having the Employee Health Insurance or Residents Health Insurance, having psychotic symptoms and requiring restraint during hospitalization were significantly associated with off-label use of antipsychotics. Conclusion Off-label use of antipsychotics is very common in psychiatric inpatients in China, mainly with moderate-dose use of single agents. However, the efficacy and safety of this practice is uncertain for many diagnoses and for the elderly. Clinicians should be cautious about this practice while waiting for more research data.

Reversible Splenial Lesion Syndrome with Mental Disorders as Only Manifestation

Background Reversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation. Method: Total ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed. Result All patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks. Conclusion MRI is an essential tool to identify the RESLES. For the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES. Excluding other possible etiologies, we suggest that different mental disorders might be precipitating factors of RESLES.