Functional Neurological Disorder
Original Editors - Abby Naville and Alex Piedmonte from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Alexandria Piedmonte, Jessica Hetzer, Abby Naville, Melissa Borst, Elaine Lonnemann, Naomi O'Reilly, Simisola Ajeyalemi, Kim Jackson, Mason Trauger, Wendy Walker, Adam Vallely Farrell, 127.0.0.1, Evan Thomas, WikiSysop and Vidya Acharya
Definition/Description[edit | edit source]
Conversion disorder is a rare psychodynamic occurrence that consists if the physical expression of an unconscious conflict or stress in a person’s life [1]. This physical expression is characterized by the presentation of signs and symptoms that are inconsistent or cannot be explained by known anatomy or physiology (DSM IV).
Patients that fall under this presentation, however, should not be confused with malingerers or categorized as someone feigning an illness. This population is not intentionally simulating symptoms but is genuinely experiencing them. Symptom presentation consists of the patient’s conception of a particular disease process therefore their presentation will not follow typical or expected patterns, such as dermatome or myotome changes. The physical therapist should carefully document these changes in order to recognize these indescrepencies. [1]( DSM IV)
Conversion disorder is also known as “hysterical neurosis” , “conversion type”. ( DSM IV), or “functional neurological symptom disorder” [2].
Prevalence[edit | edit source]
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Characteristics/Clinical Presentation [3][4][5] (DSM IV)[edit | edit source]
The onset of conversion symptoms usually occurs abruptly during adolescence or early adulthood, often following a stressful life evenyt. Symptoms often appear neurologic encompassing sensory and/or motor presentations. Generally, patients present with one symptom at any given time and the severity of symptoms may vary under certain circumstances. Often symptoms will be present within an exam but are absent during functional movement or reflex reactions. The most common symptoms include:
• Anesthesia
• Paralysis
• Ataxia
• Tremor
• Tonic-clonic pseudoseizures
• Deafness
• Blindness
• Aphonia
• Globus hystericus
• Parkinsonism
• Syncope
• Coma
• Anosmia
• Nystagmus
• Convergence spasm
• Facial weakness
• Ageusia
Prognosis is best for patients that have acute onset of symptoms or have symptoms immediately following an acute stressor. These patients stand the best chance of recovery and will do so in a matter of a few weeks. Symptoms of tremor or seizure are more persistent while aphoina, blindness, and paralysis tend to improve. A minority of patients experience symptoms chronically, which has a correlation with an associated personality disorder.
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Alternative/Holistic Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 Goodman C, Fuller K. Chapter 3: Pain Types and Viscerogenic Pain Patterns. In:Differential Diagnosis for Physical Therapists: Screening for Referral. 5th Edition. St. Louis, Missouri: Saunders Elsevier; 2013:144-145
- ↑ Conversion Disorder: Definition. Mayo Clinic Website. http://www.mayoclinic.org/diseases-conditions/conversion-disorder/basics/definition/con-20029533. Accessed on March 14,2014
- ↑ Conversion Disorder: Symptoms. Mayo Clinic Website. http://www.mayoclinic.org/diseases-conditions/conversion-disorder/basics/symptoms/con-20029533. Accessed on March 14, 2014
- ↑ Roffman J, Stern T. Conversion disorder presenting with neurologic and respiratory symptoms. Primary Care Companion To The Journal Of Clinical Psychiatry [serial online]. 2005;7(6):304-306. Available from: MEDLINE, Ipswich, MA. Accessed March 14, 2014.
- ↑ Mace C, Trimble M. Ten-year prognosis of conversion disorder. The British Journal Of Psychiatry: The Journal Of Mental Science [serial online]. September 1996;169(3):282-288. Available from: MEDLINE, Ipswich, MA. Accessed March 14, 2014.
