Sections

Conversion Disorders

Sections Conversion Disorders
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Workup

Laboratory Studies

Lab tests for hemiparesis include the following:

MRI of brain with diffusion-weighted imaging
MRI of cervical region

Lab tests for pseudoseizure (PNES) include the following:

MRI of brain
EEG
Prolonged video-EEG monitoring
Echocardiogram
Holter monitor
Tilt-table test
Serum lactic acid
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.

Lab tests for psychogenic movement disorders include the following:

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)

Procedures

The Amytal interview was once commonly used for diagnosing conversion disorder. This procedure carries significant risk and should be carried out by experienced physicians.^[41]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.^[42]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.^[9]

Treatment & Management

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Media Gallery

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

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Author

Scott A Marshall, MD Neurologist in Vascular Neurology and Critical Care, Neuroscience Critical Care, Intermountain Medical Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

Bryan Schwieters, MD Consulting Physician, Schwieters Medical, PLLC

Bryan Schwieters, MD is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Psychiatric Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: AbbVie Inc. and Allergan plc .

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Mark E Landau, MD Associate Professor of Neurology, Uniformed Services University of the Health Sciences; Consulting Staff, Assistant Chief, Section of Neurophysiology, Department of Neurology, Walter Reed Army Medical Center

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

Disclosure: Nothing to disclose.

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

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, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Alexis Llewellyn, PhD Licensed Psychologist and Owner, Katy Center for Psychology and Counseling Services

Alexis Llewellyn, PhD is a member of the following medical societies: American Psychological Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

Sections Conversion Disorders
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
References

Conversion Disorders Workup

Laboratory Studies

Procedures

References

Tables

Contributor Information and Disclosures

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