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Conversion Disorders Across Psychiatry and Neurology

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Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

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Abstract

The term conversion disorders refers to a variety of neurological symptoms genuinely experienced by the patient but inconsistent with an underlying identifiable neurologic cause. Conversion disorders have a high prevalence among population, leading to frequent hospitalization and causing significant distress and disability in patients. In the last years, a better understanding of the possible phenotypes and underlying psychopathologic mechanisms in conversion disorders has been provided. A complete neurologic examination represents the main part of the clinical assessment in patients with conversion disorders and the main tool to differentiate them from organic neurological conditions. The diagnosis of conversion disorders is based on the demonstration of positive functional signs, together with the exclusion of signs of disease. Management of conversion disorders is difficult, and many patients are reluctant to accept their diagnosis. Neurologists, psychiatrists, psychologists, and physiotherapists need to work together in order to help the patients to understand their symptoms and to heal. The following chapter provides a detailed explanation about clinical assessment, psychopathologic mechanisms, and current treatment of conversion disorders, with the aim of helping physician in the diagnosis and differential diagnosis with organic diseases. A clinical case is also presented to supply a concrete example of how insidious can be the management of a conversion disorder.

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Author information

Authors and Affiliations

  1. Neurodegenerative Disease Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Tiziana Carandini, Andrea Arighi & Elio Scarpini

Authors
  1. Tiziana Carandini
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  2. Andrea Arighi
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  3. Elio Scarpini
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Corresponding author

Correspondence to Andrea Arighi .

Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment Questionnaire

Self-Assessment Questionnaire

  1. 1.

    In DSM-V and ICD-11 classifications, conversion disorders are considered:

    1. (A)

      A field of psychiatry

    2. (B)

      A field of neurology

    3. (C)

      A field in which both neurology and psychiatry are equally important

    4. (D)

      A field of psychology

  2. 2.

    The most common phenotype of conversion disorders is:

    1. (A)

      Swallowing alteration

    2. (B)

      Non-epileptic seizure

    3. (C)

      Complete blindness

    4. (D)

      Word-finding difficulty

  3. 3.

    In Daum’s proposed classification of clinical positive signs in conversion disorders, Hoover’s sign is considered:

    1. (A)

      Highly reliable

    2. (B)

      Reliable

    3. (C)

      Suggestive

    4. (D)

      Not suggestive

  4. 4.

    Poor activation at electromyography can’t be:

    1. (A)

      Related to pain

    2. (B)

      Related to poor cooperation possibly due to a functional disorder

    3. (C)

      Related to upper motor neuron lesion

    4. (D)

      A normal finding

  5. 5.

    The best therapeutic approach to functional symptoms is:

    1. (A)

      Antidepressants

    2. (B)

      Neuroleptics

    3. (C)

      Electroconvulsive therapy

    4. (D)

      A good explanation to the patient of the nature of his functional symptoms and the sharing of physical signs

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Carandini, T., Arighi, A., Scarpini, E. (2019). Conversion Disorders Across Psychiatry and Neurology. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_13

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  • DOI: https://doi.org/10.1007/978-3-319-91557-9_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91556-2

  • Online ISBN: 978-3-319-91557-9

  • eBook Packages: MedicineMedicine (R0)

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