جستجوی مقالات مرتبط با کلیدواژه « conversion disorder » در نشریات گروه « پزشکی »

The conversion disorder (CD) or functional neurological symptom disorder is a diagnostic category used in some psychiatric classification systems, which often refers to the patients presenting with neurological symptoms. Parkinson’s disease (PD) essentially affects non-motor and motor functions. The chronic use of levodopa, which is the primary treatment in this regard, has been reported to cause complications such as the wearing-off phenomenon. This problem may also increase the disease symptoms, as well as the patients’ need to receive higher doses of the drug to remain symptom-free for a longer period. This case study aimed to describe a 47-year-old male patient with PD and psychotic features, the symptoms of which had progressed in a conversional setup relating to particular visitation times. According to the examinations, CD was the main problem, which simulated the features of PD.

The frequency of bipolar spectrum in patients with conversion disorder is not well known, while it is important to be aware of comorbid bipolarity in the management of conversion disorder.

The study aimed to identify the frequency of bipolar spectrum disorder among people with conversion disorder and the factors associated with this comorbidity.

The participants were 96 consecutive patients aged 18 - 65 years, referring to the emergency department or admitted to the psychiatric wards of two university general hospitals in Tehran, Iran, in 2019. Patients fulfilled the DSM-IV criteria for conversion disorder based on the structured clinical interview (SCID). The Mood Disorder questionnaire (MDQ) was used to identify bipolar spectrum disorder. Demographic characteristics and other relevant correlated factors were also recorded using a checklist. Data were analyzed using Pearson chi-square/Fisher’s exact test and logistic regression model.

The frequency of bipolar spectrum disorder based on the MDQ was 35.4% in patients with conversion disorder. The results of the logistic regression model using the Backward Conditional method showed that only two variables, namely antidepressant-induced mania/hypomania (OR = 39; CI 95%: 4.56 - 333.7) and history of hospitalization in the psychiatric ward (OR = 7.1, CI 95%: 2.05 - 24.65), remained as associated factors after controlling for other variables.

Our study showed a higher frequency of bipolar spectrum disorder in patients with conversion disorder than did previous epidemiological studies in Iran and other countries. Such significant comorbidity should discourage potentially harmful off-label use of antidepressants for the treatment of conversion disorder instead of looking for other underlying psychiatric or social problems. Further research is suggested in this area.

 Clinicians are trained to elicit symptoms and signs to formulate a differential diagnosis. Ruling out treatable diseases is crucial. Movement disorders specialists interpret observable behaviors as indicators of potential pathological processes. Movement disorders specialists must be able to identify symptoms and signs of organic disorders as well as actions that represent normal behaviors in healthy members of specific ethnic and cultural groups. The goal of this presentation is to describe zaghrouta, a manifestation of joy in the Middle East and other cultures, and to differentiate this normal expression of feelings from movement disorders, exaggerated startle responses, and functional disorders.

 A 29-year-old Egyptian woman observed the performance of zaghrouta frequently for happy events in her family, neighborhood, and community since early childhood as long as she can remember. Ten years ago she herself first performed zaghrouta at the engagement party of her friend. Since then she has performed zaghrouta five or six times a year to express happiness for cheerful events.

 Zaghrouta may resemble pathological behaviors seen in movement disorders such as tardive dyskinesia, focal seizures, psychiatric manifestations such as catatonia in schizophrenia, tics in the syndrome of Gilles de la Tourette, and functional disorders. Therefore, clinicians around the world must be able to differentiate this normal behavior to express emotions from abnormal behaviors indicating pathology.
 

Psychogenic non-epileptic seizures (PNES) are paroxysmal changes that mimic epileptic seizures, so often mis- diagnosed and treated for epilepsy. PNES are considered a psychiatric illness, personality pathology, and expe- riential and behavioral manifestation of depression. Despite studies over the past two decades, the pathological mechanisms of this disorder are unclear. In this paper, we critically review the current literature about the defi- nition, epidemiology, diagnosis, treatment, related genes, and biomarkers of PNES and provide suggestions for future research. Further studies are needed for more information and knowledge on PNES to determine the appropriate psychotherapies and development of clear treatment guidelines.

Hysteria is an intricate disorder which the exact reason has not yet been determined. Sensory-motor symptoms such as falling down, aphonia and jerky movements are common and similar to seizure-like disorders, except that the patient remembers everything after waking up. Non-organic reasons are the most prominent explanations for this situation. Many treatments are offered for hysteria but patients still wander between psychiatrists and neurologists and suffer therapeutic failures, relapses and burden of disease. Persian medicine as an old medical school has clear definitions about the physiopathology and experienced therapeutic suggestions for hysteria. Since this situation can influence patient quality of life, it is worthwhile to find a solution for this debilitative disorder.

Conversion disorder is a condition in which the patient shows psychological stress in physical ways. This study aimed to compare the effects of haloperidol versus midazolam in patients with conversion disorder. This double-blind randomized clinical trial was conducted on patients with conversion disorder who had presented to the emergency department, throughout 2015. Patients were randomly divided into two groups and were either treated with 2.5 mg of intravenous (IV) haloperidol or 2.5 mg of IV midazolam. Recovery rate, time to recovery, and side effects of both drugs 1 hour, 24 hours, and 1 week after treatment were compared using SPSS19. 140 patients were divided into two groups of 70. There were no significant differences between the groups regarding the baseline characteristics. 12 (17.1%) patients who were treated with IV haloperidol experienced drug side effects within 1 hour and 12 (17.1%) within 24 hours, while only 3 (4.3%) patients in IV midazolam experienced side-effects within 1 hour after drug administration (p = 0.026). The symptoms of the disease subsided in 45 (success rate: 64.3%) patients in midazolam and in 64 (success rate: 91.5%) participants in haloperidol group (P<0.001). Mean recovery time was 31.24 ± 7.03 minutes in IV midazolam and 30.53 ± 7.11 minutes in IV haloperidol group (p = 0.592). Absolute risk reduction (ARR) of treating patients with haloperidol compared to midazolam is about 27%. The response of patients to treatment with haloperidol is clearly better than midazolam. Although more transient and minor side-effects were observed in the group treated with haloperidol compared to midazolam group, serious side-effects were rare for both treatments.

About 5% of visits to emergency departments are made up of conversion disorder cases. This study was designed with the aim of comparing the effectiveness of quetiapine and haloperidol in controlling conversion disorder symptoms. The present single-blind clinical trial has been performed on patients with conversion disorder (based on the DSM-IV definition) presenting to emergency department of 9-Day Hospital, Torbat Heydariyeh, Iran, from January 2017 until May 2018. 73 patients were allocated to haloperidol and 71 to quetiapine group. Mean age of these patients was 32.03 ± 12.80 years (62.50% female). Two groups were similar regarding the baseline characteristics. Within 30 minutes, 90.41% of haloperidol cases and 91.55% of quetiapine cases were relieved (p=0.812). The most common side effects after 30 minutes were extrapyramidal symptoms (9.59%) in the haloperidol group and fatigue and sleepiness (7.04%) in the quetiapine group. Extrapyramidal symptoms was significantly higher than the quetiapine group (p=0.013). The results of the present study showed that although quetiapine and haloperidol have a similar effect in relieving the patients from conversion disorder symptoms, the prevalence of extrapyramidal symptoms is significantly lower in the group under treatment with quetiapine. Therefore, it seems that quetiapine is a safer drug compared to haloperidol.

Stiff person syndrome (SPS) is a rare neurological disease resulting in stiffness and spasm of muscles. It initially affects the axial muscles and then spread to limb muscles. Emotional stress exacerbated the symptoms and signs of the disease. The pathophysiology of the disease is caused by the decreased level of the glutamic acid decarboxylase (GAD) activity due to an autoantibody against GAD that decreases the level of gamma-aminobutyric acid (GABA). In this paper, we present a case of atypical presentation of SPS with lower limb stiffness misdiagnosed as conversion disorder.
We report a patient with atypical presentation of SPS with lower limb stiffness and gait disorder misdiagnosed as conversion disorder for a year. Her antithyroid peroxidase antibody (anti-TPO Ab) level was 75 IU (normal value: 0–34 IU). Intravenous immunoglobulin (IVIG) was administered (2gr/kg, 5 days) for the patient that showed significant improvement in the follow-up visit.
It is essential that in any patient with bizarre gait disorder and suspicious to conversion disorder due to the reversibility of symptoms, SPS and other movement disorder should be considered.

Conversion disorder (CD) is a mental disorder in which patient displays neurological symptoms such as blindness, mutism, paralysis and seizure. It starts when our mind converts our mental stress into a physical symptom. A 15-year-old single white female with chronic cough, which had begun 5 months ago, was brought to our clinic. She had no history of hospitalization. His daily cough was without sputum production or fever, rhinorrhea and stopped during sleep. There was no recent exposure to tobacco smoke or a person with a chronic productive cough. Laboratory tests were normal. She had engaged 4 months ago.
Doing sex during engagement is prohibited in her culture but and had anal sex, because of her spouse’s trend. Psychotherapy was done and complete recovery was accomplished.

Functional neurological symptom disorder commonly presents with symptoms and defects of sensory and motor functions. Therefore, it is often mistaken for a medical condition. It is well known that functional neurological symptom disorder more often caused by psychological factors. There are three main approaches namely analytical, cognitive and biological to manage conversion disorder. Any of such approaches can be applied through short-term treatment programs. In this case, study a 12-year-old boy with the diagnosed functional neurological symptom disorder (psychogenic myopia) was put under a cognitive-analytical treatment. The outcome of this treatment modality was proved successful.

The rabies virus entered the body, the virus moves towards the brain along the nerves. Manifestations of rabies appear after 10 to 50 days from entrance of virus to the body. The first symptoms of the disease in humans include: pain at the bite site, a general feeling of illness, depression, headache, nausea, and vomiting.As the virus begins to proliferation and multiply in the spinal cord or brain, neurological symptoms would appear, including Anxiety, confusion, excessive saliva production, hallucinations, high level of excitement, insomnia, restlessness, paralysis of lower legs, voice box spasms and problems swallowing due to painful throat.Pseudorabies where the person after an animal bite behaves as if he is afflicted with rabies, is well introduced in literature and it is one of differential diagnoses of rabies. A 27 year-old, single male with hypochondriasis, a overvalued idea that he had contracted rabies. The patient failed to respond to multiple somatic therapies and twice made a serious suicide attempt. The patient believed in that he is rabid and attack to persons for biting them and bitted himself.The psychodynamics of the present case is various. Our patient had a painful experience, which was traumatizing to his ego, and this precipitated the conversion symptoms and finally the diagnosis was hypochondriasis plus conversion disorder.

Explaining the etiology of Complex Regional Pain Syndrome (CRPS) from the psychogenic model is exceedingly unsophisticated, because neurocognitive deficits, neuroanatomical abnormalities, and distortions in cognitive mapping are features of CRPS Pathology. More importantly, many people who have developed CRPS have no history of mental illness. The psychogenic model offers comfort to physicians and mental health practitioners (MHPs) who have difficulty understanding pain maintained by newly uncovered neuro inflammatory processes. With increased education about CRPS through a biopsychosocial perspective, both physicians and MHPs can better diagnose, treat, and manage CRPS symptomatology.