Conversion Disorders Workup

  • Author: Scott A Marshall, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Sep 16, 2009
 

Laboratory Studies

  • Hemiparesis
    • MRI of brain with diffusion-weighted imaging
    • MRI of cervical region
  • Pseudoseizure (PNES)
    • MRI of brain
    • EEG
    • Prolonged video-EEG monitoring
    • Echocardiogram
    • Holter monitor
    • Tilt-table test
    • Prolactin level 30 minutes after the event: An elevation above baseline can occur with partial seizures, generalized seizures, or syncope, but not with pseudoseizures.
    • Provocative EEG with placebo induction is no longer routinely performed in many centers.
  • Psychogenic movement disorders
    • MRI of brain
    • Twenty-four hour urine studies for copper, serum ceruloplasmin, and slit lamp examination for evidence of Kayser-Fleisher rings to look for evidence of Wilson disease
    • Thyroid-stimulating hormone, thyroid peroxidase antibodies, thyroglobulin antibodies
    • CBC count with smear for acanthocytes
    • Erythrocyte sedimentation rate, antinuclear antibody, extractable nuclear antibody, anticardiolipin antibody, lupus anticoagulant
    • HIV antibody, Lyme antibody, anti-streptolysin O (ASO) antibody
    • Human chorionic gonadotropin
    • Urine and serum toxin screen for stimulant or illicit drug use
    • Drug levels (ie, anticonvulsants, digoxin)
Next

Procedures

  • Hypnosis or Amytal interview
    • To ensure diagnosis and to facilitate disclosure of underlying psychiatric issues during psychiatric interview or therapy
    • 8 mL intravenous sodium Amytal 2.5% given over 20 minutes has temporarily resolved cases of psychogenic motor weakness and may have a lasting effect in some cases.[28, 29] Other protocols for dosage are referenced.[30]
    • This procedure carries significant risk and should be carried out by experienced physicians. Sodium Amytal is a barbiturate and carries risk of respiratory depression. It is contraindicated in cases of upper respiratory infection or airway edema, hemodynamic instability, significant liver or kidney dysfunction, and porphyria. A CPR cart with medications and personnel trained in their use should be available in case of emergency.[30] This is cited in the literature as a technique that may occasionally be used to help facilitate the gathering of data but is not routinely performed in many centers.
    • Hypnosis is used on occasion and may also facilitate the data gathering process. This technique may also help alleviate the patient's anxiety and aid in relaxation.
  • Brain PET scan has demonstrated evidence of left dorsolateral prefrontal cortex hypofunction.
  • SPECT scan has shown decrease in regional blood flow in the thalamus and basal ganglia contralateral to the deficit.
  • Advanced imaging is not diagnostic of conversion disorder, and routine use for this purpose is not currently standard of care.
  • See Causes for rCBF studies.[8]
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Contributor Information and Disclosures
Author

Scott A Marshall, MD  Major, Medical Corps, US Army; Assistant Professor of Neurology, Uniformed Services University of the Health Sciences; Staff Neurologist, Department of Neurology, Walter Reed Army Medical Center, National Naval Medical Center

Scott A Marshall, MD is a member of the following medical societies: American Academy of Neurology, Neurocritical Care Society, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Mark E Landau, MD  Neurology Program Director, National Capital Consortium, Associate Professor, Uniformed Services University of the Health Science, Neurophysiology Section, Department of Neurology, Walter Reed Army Medical Center

Mark E Landau, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Craig G Carroll, DO  Staff Neurologist, Head of Clinical Neurophysiology Section, Naval Medical Center Portsmouth

Craig G Carroll, DO is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Bryan Schwieters, MD  Consulting Physician, Schwieters Medical PLLC and VirtualPsych, LLC

Bryan Schwieters, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association

Disclosure: pfizer Consulting fee Speaking and teaching

Alexis Llewellyn, PhD  Psychologist, Private Practice

Disclosure: Nothing to disclose.

Specialty Editor Board

Barry I Liskow, MD  Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgments

The opinions expressed in this work belong solely to those of the authors. They should not be interpreted as necessarily representative or endorsed by the Uniformed Services University, The United States Army, The Department of Defense, or any other agency of the federal government.

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French neurologist Jean Martin Charcot shows colleagues a female patient with hysteria at La Salpêtrière, a Paris hospital.
 
 
 
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