You think ME is bad - try having a "Psychogenic movement disorder"!

[Sidereal]

Extraordinary! It seemed that delayed progress on her treatment for two years. IN fact, even worse, the new treatment does not seem to have been in response to the "conversion disorder" at all!

It sounds like she saw some idiots who diagnosed conversion disorder before she got to the authors of that paper who presumably were the people who prescribed surgery to repair the ligaments and naltrexone.

By the way, AWESOME idea to write a paper. There haven't been enough good critiques of the concept of somatoform.

 

[Sidereal]

Psychological Versus Biological Clinical Interpretation: A Patient With Prion Disease from the American Journal of Psychiatry, 2002.

Ms. A was a 49-year-old Caucasian woman who had never married and who had been a communications product engineer. Before onset of her symptoms, she had never seen a psychiatrist, never been diagnosed with a psychiatric disorder, and never been treated with a psychotropic medication. Her medical history was notable only for a febrile illness that may have been an encephalitis of uncertain etiology after a trip to South America when she was in her 20s. There was no family history of psychiatric illness, epilepsy, or neurological or neurodegenerative disorders.

Despite reassurance that these symptoms would likely remit, Ms. A continued to experience more weakness and ataxia. She was seen by another internist and diagnosed with atypical multiple sclerosis. She was given a trial of methylprednisolone sodium succinate and noted a brief period of symptom improvement. She was seen by a neurologist 1 month later, and an EEG was ordered. Again, the result was unrevealing.

Five months after her initial symptoms, Ms. A complained of diplopia, difficulty swallowing, and frequency of urination in addition to her symptoms of leg weakness, tremor, and gait difficulties. She saw another neurologist whose differential diagnosis included Creutzfeldt-Jacob disease. She was then seen by an associate of a national authority on prion disease, who felt that Creutzfeldt-Jakob disease was a “low-probability” diagnosis, but a measurement of blood mercury level was recommended, which was also found to be negative.

Although Ms. A complained of weakness and an unstable gait, results of formal neurologic examinations continued to be completely normal. In addition, Ms. A’s complaints of waxing and waning strength and difficulty walking were difficult to explain. At this time, she was given axis I diagnoses of major depression and conversion disorder. Ms. A was given fluoxetine for depression and buspirone for anxiety. She was thereafter discharged to a residential psychiatric facility.

Nearly 8 months after the first appearance of lower-back strain, Ms. A was seen by a specialist in dissociative disorders and psychosomatic illness. He hypnotized Ms. A and noted that she was highly hypnotizable and that, under hypnosis, her symptoms improved. She continued to decompensate and was transferred from the residential facility to a skilled nursing facility secondary to functional deterioration and an inability to complete activities of daily living without assistance. This deterioration continued until Ms. A was again hospitalized, this time on the Behavioral Medicine Unit at Stanford University Hospital. At that time, she was confined to a wheelchair. She complained of waxing and waning dysarthria and difficulty swallowing, an ataxic-like gait, and tremors that would move over her entire body, which she would refer to as “convulsions.” She also had occasional complaints of diplopia, for which she would compensate by closing one eye, and frequent squinting. She continued to experience subjective weakness in her lower extremities, which varied in degree, although it was always present.

At this time, both Ms. A and her family agreed that her mood was normal. Her score on the MMSE at admission was 24/30; she appeared to be poorly motivated to complete the test. Her insight was judged to be good, and she was reported to say that she was motivated to determine the cause of her disability so she could return to work. She admitted that being ill had brought her family back to her and that her ex-lover was again in frequent contact, both of which pleased her deeply. Upon examination her tremors were noted to wax and wane depending on the content of her conversation. Her diagnoses at admission were conversion disorder and major depression, single episode, moderate, nonpsychotic, and in remission with a regimen of fluoxetine and buspirone. Psychological testing was ordered, as was a follow-up neurology consultation.

Upon completion of neurological and psychometric evaluations, Ms. A’s primary diagnosis remained conversion disorder. Supporting this diagnosis were fluctuating and at times bizarre symptoms: waxing and waning memory deficits, an inability to ambulate without assistance despite adequate strength, back pain, eye squinting, and tremor, but no evidence of spasticity or cerebellar abnormalities. There was also some concern over factitious elements, such as a new complaint of life-long auditory and visual hallucinations.

Ultimately, it was decided to proceed with a behaviorally oriented rehabilitation program. This involved aggressive physical therapy, occupational therapy, and participation in groups and activities, with the focus on treating Ms. A’s functional disability. Furthermore, with the intent of both confirming and treating the conversion disorder, it was explained to Ms. A that in the setting of such an intensive rehabilitation program, her functional ability should improve if it was simply related to an underlying medical etiology, such as the apparent severe muscle deconditioning she had experienced. It was also explained to Ms. A that if she did not improve after undergoing such an intensive rehabilitation program, it would be owing to either a lack of participation or motivation on her part or because her condition was purely the result of a psychological disturbance. That is to say, improvement would confirm a medical etiology. This behavioral approach to treating conversion disorder was based on a review of the literature and the apparent success of the use of this “double-bind” model (3).

Rehabilitation/GET for CJD! Damned if you improve, damned if you don't.

Approximately 6 weeks after Ms. A’s admission, the psychiatry service noted waxing and waning primitive reflexes. In addition, she began to exhibit progressively more disinhibited behavior, such as throwing food and smearing it on her face, along with choking sounds. She developed an exaggerated startle response to innocuous stimuli.

Earlier in her hospitalization, Ms. A had been administered an MMPI-2. The results of the entire neuropsychological battery were now considered to be invalid because of her excessive endorsement of symptoms. In addition, a Rorschach test given Ms. A was deemed unscorable.

The patient was being tortured with exercise and bogus personality tests while she was dying of prion disease.

Ms. A was found later that night in cardiopulmonary arrest. It occurred almost 90 minutes after dinner, which had been observed by nursing staff and described as uneventful. After dinner that night, Ms. A had been heard choking; although her oropharynx had been examined and was found to be clear of food and debris. She was found cyanotic approximately 30 minutes later, without respiration or pulse. Suction performed during cardiopulmonary resuscitation revealed small bits of food—apparent evidence of aspiration. Ms. A was presumed to have asphyxiated because of an obstructed airway. It was thought possible at the time that Ms. A may have moved some food into her chair and later put it into her mouth and choked, suffering asphyxiation, cardiopulmonary collapse, and near-death. She was resuscitated and sent to the intensive care unit, where about 36 hours later she was declared brain dead by EEG.

Ironically, the EEG ordered earlier in the week was read at the same time as the EEG from the ICU. The former was noted to be abnormal and interpreted as showing excessive theta activity in bilateral temporal areas that was consistent with an encephalopathy. The EEG report specifically mentioned the possibility of a rapid neurodegenerative process in the differential. Ms. A was removed from life support after a lengthy meeting with her family, and she expired shortly thereafter.

The family granted permission for an unrestricted autopsy. On general autopsy, Ms. A was found to have acute and organizing bronchopneumonia, with fragments of vegetable material in the bronchus consistent with prior aspiration. The results of gross examination of the external brain and coronal sections was found to be entirely normal, with no evidence of inflammation, neoplasm, atrophy, or white matter changes. However, microscopic examination revealed changes indicative of prion disease; namely, sections of the frontal, hippocampal, and occipital cortices showed moderate neuronal loss, reactive astrocytosis, and variably sized vacuoles within the neuropil, also know as spongiform change (Figure 1A). No kuru-type plaques were seen; no inflammation was observed. The underlying white matter showed patchy myelin loss and spongiform change. In addition, many of the sections revealed evidence of acute ischemic/hypoxic injury, with shrunken neurons displaying hyperchromatic, indistinct nuclei and eosinophilic cytoplasm (Figure 1B). Sections of the midbrain and brainstem also showed spongiform change, as well as neuronal dropout and gliosis in the substantia nigra and olivary nuclei. A section of the cerebellum showed a normal-appearing granular cell layer, loss and acute ischemic/hypoxic injury of the Purkinje neurons, and mild spongiform change in the molecular layer. The underlying cerebellar white matter had mild spongiform change, and the dentate nucleus showed gliosis and neuronal loss.

My condolences to the family.

 

[Sidereal]

Idiotic non sequitur reply from our old friend Sharpe and colleagues:

Misdiagnosis of Conversion Disorder

To the Editor: H. Brent Solvason, Ph.D., M.D., et al. (1) described a woman seen with leg weakness and back pain who was initially diagnosed as suffering from conversion disorder and subsequently turned out to have sporadic Creutzfeldt-Jakob disease. The authors usefully highlighted how organic disease may be important in generating symptoms that are medically unexplained, either directly by effects on brain function or because of more complex behavioral responses to illness. They also showed how our current somatoform classification leaves little room for a dual diagnosis of organic and functional disorder. This unsatisfactory either/or philosophy is perhaps one reason why doctors are reluctant to diagnose conversion disorder in the first place.

Note: this was before DSM-5 which allows for somatoform diagnosis to be slapped on any patient with any disease if they are "excessively" preoccupied with symptoms or have symptoms that the physician doesn't understand or think is linked to the organic disease.

Clinical vigilance for a missed diagnosis of neurological disease in cases of conversion disorder is essential. It would be a shame, however, if this case conference reinforced the erroneous idea that the development of neurological disease in such cases is the norm. Failure to make a positive diagnosis of conversion disorder can have serious adverse consequences. The patient may be denied appropriate treatment management that vitally depends on persuading him or her that the symptoms are reversible and not due to disease. We should not withhold the diagnosis simply because we occasionally get it wrong.

Oh yes, the devastating consequences of not having hysteria on your medical records, how does anyone go on living like that.

How is it possible to be this thoroughly insight-free and still function occupationally in a field like medicine?

 

[Woolie]

@Sidereal, absolutely shocking and at the same time brilliant expose of this shabby and reckless way of thinking!

Also, Sharpe's commentary: another example of theory rescuing like in the psychogenic movement disorders example we started with. The absence of a medical explanation/physical cause is the main evidence used to build a psychosomatic diagnosis. But when that missing evidence finally turns up, you don't change your view, you simply accommodate it within your old framework!

As for the "adverse consequences" of failing to diagnose conversion disorder, what i read about PMDs whatever they are, they don't seem to resolve with psycho-bullshit, so that's just not an evidenced-based statement.

 

[A.B.]

The absence of a medical explanation/physical cause

The absence of evidence magically becomes evidence. The behaviorists are collectively insane.

 

[Sidereal]

@Sidereal, absolutely shocking and at the same time brilliant expose of this shabby and reckless way of thinking!

Also, Sharpe's commentary: another example of theory rescuing like in the psychogenic movement disorders example we started with. The absence of a medical explanation/physical cause is the main evidence used to build a psychosomatic diagnosis. But when that missing evidence finally turns up, you don't change your view, you simply accommodate it within your old framework!

Right.

Sharpe was also the senior author on a meta-analysis published in the BMJ showing that only a minority (5-10%) of patients with a diagnosis of conversion disorder end up diagnosed with an organic disease explaining their symptoms. This is taken as evidence that the majority of conversion disorder cases have a non-organic illness.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1273448/

But this argument is totally nonsensical as it assumes that current diagnostic conventions and medical knowledge are complete and finite. I don't think anyone would claim that 100% of conversion disorder diagnoses can be explained by currently known/accepted disease categories. Obviously it is more likely that a minority are pure misdiagnoses by lazy or incompetent physicians while the majority of cases have organic diseases that are currently undiagnosable.

Even more egregiously, they write this in the limitations section:

Finally, we acknowledge the conceptual limitations of defining a symptom as being “unexplained by disease.” While we have used this to mean no conventionally defined pathology, we recognise that all symptoms must ultimately have neurobiological correlates as illustrated by recent functional imaging studies of patients with conversion symptoms.57

If hysterical symptoms and all other symptoms have neurobiological correlates, then what the hell is it that makes one symptom "functional" while another attains the halo of "organic"? Sheep-like moo-faced adherence to conventional thinking and dogma.

 

[PeterPositive]

@Sidereal, absolutely shocking and at the same time brilliant expose of this shabby and reckless way of thinking!

Also, Sharpe's commentary: another example of theory rescuing like in the psychogenic movement disorders example we started with. The absence of a medical explanation/physical cause is the main evidence used to build a psychosomatic diagnosis. But when that missing evidence finally turns up, you don't change your view, you simply accommodate it within your old framework!

Yes... unfortunately this topic touches on the larger subjects of our cognitive shortcomings and biases... It's so common in medicine, as well as in many other fields, to find delusions about theories or mechanisms that "can explain it all". The "cure to all cancers", "the cause of all disease" ... etc... Every time I hear something along those lines I cringe And doctors, even very good ones, usually for these theories. I've seen it so many times... and bought into it as well

I guess it's because we hate uncertainty and we fail to grasp the complexity of our biology and staggering amount of variables at play.

That's also why mainstream medicine is still fundamentally driven by the pill-per-ill kind of philosophy. Even the fashionable "evidence-based medicine", so popular in the past 20 years or so, fails to acknowledge this problem devaluing clinical experience and personalized medicine to almost useless tools.

More here, fore those interested: http://www.bmj.com/content/348/bmj.g3725

But hey... at least EBM looks for evidence, that's a start ...

 

[alex3619]

Rehabilitation/GET for CJD! Damned if you improve, damned if you don't.

The very core of nonscience. Popper was dead against psychoanalysis for this reason. Every outcome confirms the hypothesis. Yet the hypothesis remains unproven and in doubt. So how do you test it?

 

[alex3619]

I guess it's because we hate uncertainty and we fail to grasp the complexity of our biology and staggering amount of variables at play.

I think this is part of it. Embracing undertainty and failing to deal with complexity is the focus of my currently mythical book. Its why its title is Embracing Uncertainty. Doctors need to operate out of uncertainty, but they derive authority by acting authoritative. Many doctors fear admitting they don't know. So do some scientists. A good doctor and a good scientist should be including uncertainty in every major decision they make.

The concept of EBM is sound. How its orchestrated, especially in government institutions, is not sound. There is a related movement called Evidence Based Practice, in which doctors are supposed to question everything for sound evidence. Sadly its not taking off. Rubber stamp cookbook EBM from institutions with vested interests is dominating the field because its super simple and meets managerial (not medical) needs. EBP requires time, resources, and questioning the dogma in medicine.

 

[A.B.]

Sharpe was also the senior author on a meta-analysis published in the BMJ showing that only a minority (5-10%) of patients with a diagnosis of conversion disorder end up diagnosed with an organic disease explaining their symptoms. This is taken as evidence that the majority of conversion disorder cases have a non-organic illness.

The usual strategy here is to argue that the organic disease does not fully explain the symptoms, and that therefore, a functional overlay is present. So patients still have conversion disorder despite an organic disease. This can be used to arrive at 0% misdiagnosis rates if one so wishes.

 

[chipmunk1]

He hypnotized Ms. A and noted that she was highly hypnotizable and that, under hypnosis, her symptoms improved

basically this is what charcot said. conversion disorder sufferers are highly hypnotizable and improving symptoms under hypnosis proves that it is hysteria. Interesting how little the theories have changed. It's is still 1870 in behavioural medicine it seems.

Upon examination her tremors were noted to wax and wane depending on the content of her conversation

Now it's 1880 it seems.

Freud claimed that his first case Anna. O. would shows similiar responses. Based on these observation he claimed that psychoanalysis had been born.

In reality they were seeing patterns where there was just randomness or perhaps they weren't even seeing patterns and were making them up because they already had convinced themselves that they had a case of hysteria.

that if she did not improve after undergoing such an intensive rehabilitation program, it would be owing to either a lack of participation or motivation on her part or because her condition was purely the result of a psychological disturbance.

That is to say, improvement would confirm a medical etiology

Well if you improve they are right. If you don't they are right because it proves that you are just a lazy attention seeking hysteric who does not want to get better.

This behavioral approach to treating conversion disorder was based on a review of the literature and the apparent success of the use of this “double-bind” model (3).

This seems to be another logical fallacy. Even when an intervention is evidence based. Is effectiveness has only be shown statistically. Even if a person improves on average by x % it does by no means guarantee a response or improvement. In theory you could even get worse. But if you don't improve it's just because you don't want to and they know it for sure!!

In addition, a Rorschach test given Ms. A was deemed unscorable.

Another questionable diagnostic technique from 1920 or so..

 

[chipmunk1]

Failure to make a positive diagnosis of conversion disorder can have serious adverse consequences.

Such as quacks losing their income?

Honestly i rarely read about someone having their life changed in a positive way by receiving a conversion disorder diagnosis. Some of the accounts of sufferers with these "diagnoses" are truly heartbreaking. You are left alone feeling no better with serious symptoms, feelings of confusion and guilt. This seems to be a more typical experience.

The patient may be denied appropriate treatment management that vitally depends on persuading him or her that the symptoms are reversible and not due to disease. We should not withhold the diagnosis simply because we occasionally get it wrong.

Nice rhetoric. A similiar excuse was used by the psychosurgeons to re-introduce lobotomy in some parts of the world(such as scotland) even without consent.

Sharpe was also the senior author on a meta-analysis published in the BMJ showing that only a minority (5-10%) of patients with a diagnosis of conversion disorder end up diagnosed with an organic disease explaining their symptoms. This is taken as evidence that the majority of conversion disorder cases have a non-organic illness.

An alternative interpretation of the data would be that once labeled and shunned only 5%-10% manage to escape from the brutish grasp of behavioural medicine .

If hysterical symptoms and all other symptoms have neurobiological correlates, then what the hell is it that makes one symptom "functional" while another attains the halo of "organic"? Sheep-like moo-faced adherence to conventional thinking and dogma.

I think the basic idea is that your personality and behaviour somehow drive the disease process via mysterious voodoo like mechanisms while in organic illness this is not the case.

It also implies that something is wrong with you as a person or your life and needs to be changed even when they vehemently try to deny this.

The problem is how do you reliably differentiate between the two? You can't.

Lazy, repressed, anxious, lonely, uneducated, stressed, depressed etc. people get organic illness too believe it or not.

I would guess perhaps the majority of the population would fall into one of these categories. I am not being negative you will find a negative character trait in almost everyone if you keep looking long enough. if you keep ignoring the positive traits and strengths you can make look almost anyone flawed and that is what the psychobabblers specialise in.

Just being a horrible failure would not be a terribly reliable diagnostic marker for somatisation.

Perhaps a somatisation disorder diagnosis does not tell us as much about the personality of the patient as of the clinician.

You could as well speculate about the mental state of the doctor believing in this kind of diagnosis.

The authors usefully highlighted how organic disease may be important in generating symptoms that are medically unexplained, either directly by effects on brain function or because of more complex behavioral responses to illness

Is this suggesting(or at least allowing for the possibility) that in that case of prion disease the symptoms could have been a behavioural response to the illnesss?

I would recommend reading the psych evaluation of the poor woman. It is disgusting on it's own and much worse considering the circumstances.

Ms. A appeared to answer it with a bias toward magnifying her symptoms, as it indicated the presence of a significant mental disorder.

Her profile suggested a personality disorder with narcissistic, avoidant, and paranoid features.

The psychological trauma was her recent “coming out”—that is, her exploration and declaration of her homosexuality.

Her family’s unsympathetic reception of her declaration was a serious disappointment

The patient’s illness appeared to provide secondary gain by returning to her the only person she had loved romantically, to her family, and to relief from the stress of working.

Psychometric testing suggested that Ms. A had developed significant psychiatric disturbance and now exhibited primitive defenses.

****Please note that the last three paragraphs describe the opinion of the physician already knowing that she had died from neurological disease****

In our opinion, this illness behavior as well as her somatization of distress contributed to a confusing clinical picture.

Is it possible that a neurologic or psychiatric illness may provide a neurobiologic substrate for the expression of conversion symptoms or impair psychological defenses leading to use of more primitive defenses, such as in the elaboration of symptoms?

Conversion disorder is more common among those with low educational achievement (25). This raises the question of whether these individuals have subtle or more marked cognitive or learning disorders indicative of significant developmental structural or cytoarchitectural abnormalities.

Please note that a "primitive defense" is a psychoanalytic concept.

http://en.wikipedia.org/wiki/Defence_mechanisms

A defence mechanism is a coping technique that reduces anxiety arising from unacceptable or potentially harmful impulses.[1] Defence mechanisms, which are unconscious, are not to be confused with conscious coping strategies.[2]Sigmund Freud was one of the first proponents of this construct.[3]

I cannot believe what i am reading but to me it seems that even when their patient has already died the psychobabblers keep talking about their hysteric and hypochondriac personality and their exaggerated symptom presentation?
............ !

This is insane.

 

[alex3619]

Some psychs like to think of ME as mass hysteria or its modern equivalent, even now. I like to think of psychosomatic medicine as somewhere between a voodoo cult and a mass delusion. Its definitely not science.

 

[Forbin]

I'm reminded that, in 1979, Dallas Cowboys football star Tony Dorset's fiancée began complaining of strange sensations in her extremities. Repeated trips to doctors found nothing wrong. She was sent home and told that the problem was probably emotional (I think they suspected the stress of the upcoming wedding). 10 days later, she lapsed into a coma and died... of Guillain-Barre Syndrome.

 

[Sidereal]

Is this suggesting(or at least allowing for the possibility) that in that case of prion disease the symptoms could have been a behavioural response to the illnesss?

That's how I read it too. Monstrous really.

 

[chipmunk1]

That's how I read it too. Monstrous really.

and they would even talk about secondary illness gains.

http://www.nature.com/sc/journal/v40/n7/full/3101308a.html

• In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.
• Rather than punishing the unwanted behaviors they should, as much as possible, be ignored or at least not bring the desired focus of attention.
• The diagnosis given should be vague rather than confrontational, ie in the case of hysterical paralysis 'spinal cord concussion', allowing the patient to undergo 'a speedy recovery'.
• Reports have shown that between 15% and 75% of CD patients demonstrate organic signs within 5 years of diagnosis due to failure to recover or recurrence.17,20,50,51,53
• There are no pathological findings in laboratory tests, supporting CD. On the other hand, however, pathological findings will not necessarily rule out CD.37
  
• In the past, patients were referred to psychiatric departments, but this trend was changed, and due to the functional loss patients are referred to rehabilitation wards.43,44,45 The majority of papers on the topic are retrospective studies or case reports, authored by psychiatrists or specialists in physical medicine and rehabilitation. There are no long-term follow-up studies. The reference to treatment is minimal, contradicting and vague, offering autosuggestion, placebo, and hypnosis as the main treatments of choice
• Psychotherapeutic treatment is given on an individual basis and its success will depend, to a large extent, on the cooperation of the patient

 

[ahmo]

This thread is making me so grateful for my GP. I'd been seriously considering switching from my GP to another in the practice, but cancelled that appt a few weeks ago, realizing that I shouldn't be so quick to give up a Dr who's let me do what I want. He told me from the outset he didn't know anything about CFS, put me onto Teitelbaum He's tested me for anything I've asked for, let me manage my thyroid experiments over the last few years, yes to low dose naltrexone, with no prior experience.

And voila, I felt like I really got what I wanted yesterday. I only needed new rx for LDN and T3, wanted to increase the doses on both. He had a medical student with him, said to her she knows more biochemistry than either of us does. Wow, I didn't really think he was paying attention. And how unusual it is for a patient understand and manage their own illness, referred to how sick I'd been for a long time, how well I'm doing now

On the one hand I could say, a little flattery goes a long way. But the truth is, he's actually aknowledging me!!! And when I said maybe we should test thyroid, it's been a long time, he said, Why? The tests have never shown us anything. You're feeling good, right? Ha. I laughed. I thought he may have needed to have tests for his records. Since I don't need anything from him except to write me Rx, all's good.

 

[Woolie]

Thanks everyone for your posts. In the interest of gathering more information in the one place, here are some of the conclusions from a recent review of conversion disorder. This is from Kaanan et al, who form part of that well-known group of UK psychobabblers, so they are very much in favour of the diagnosis themselves.

* The so-called "positive" signs of a conversion disorder have not been sufficiently examined for their reliability. These include a dragging gait in leg weakness, a clenched fist in ‘psychogenic’ dystonia or prolonged seizures with eyes shut in dissociative seizures. Likewise for signs of ‘internal inconsistency’—for example, a highly distractible tremor or Hoover's sign (increased power of hip extension in the affected leg on contralateral hip flexion).
* Psychological features said to be associated with conversion disorder occur only in a minority of patients. e.g., borderline/histrionic personality disorder, evidence of secondary gain. A survey showed that most neurologists do not require these for the diagnosis.
* There is no recognised model as to how the "conversion" takes place
* There is no reliable evidence that psychological stressors occur more commonly in the lead-up period than they do in "organic" illnesses, and there is no consistent finding of childhood physical or sexual abuse.
* The symptoms are preceded by a physical injury in at least a third of cases.

They conclude "... a rigid interpretation (of conversion disorder) would leave many patients that clinicians considered to have the condition without a formal diagnosis" (me: I can only see that as a good thing!).

Nicholson, T. R., Stone, J., & Kanaan, R. A. (2011). Conversion disorder: a problematic diagnosis. Journal of Neurology, Neurosurgery & Psychiatry, 82(11), 1267-1273.
http://www.researchgate.net/profile..._diagnosis/links/00463527a6fe5c3c13000000.pdf

 

[ahmo]

holy effing cow! and so on. and on.

 

[Sidereal]

prolonged seizures with eyes shut in dissociative seizures

Neurology. 2006 Jun 13;66(11):1730-1.
Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures.
Chung SS1, Gerber P, Kirlin KA.
Author information

Abstract
Using data from video-EEG monitoring, the authors studied whether ictal eye closure was a reliable indicator of psychogenic nonepileptic seizures (PNES). Among the 52 patients with PNES, 50 consistently closed their eyes, while 152 of the 156 patients with epileptic seizures (ES) opened their eyes during seizures. These findings suggest that ictal eye closure is a highly reliable indicator for PNES, while ictal eye opening is an indicator of ES.

http://www.ncbi.nlm.nih.gov/pubmed/16769949