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Inphinite S Saddler Professor Wolcott ENC 1102

Conversion disorder is a mental health condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation (National Library of Medicine, 2013).Often patients with conversion disorder chief complaints are seizures and paralysis, although through examination there can be no organic cause of these symptoms. The seizures that they are experiencing are pseudoseizures, but without a proper analysis they can be mistaken for epilepsy. Misdiagnosis of pseudoseizures is extremely common, because the lack of knowledge of how to fully tell the difference between epileptic seizures and nonepileptic seizures. This disorder commonly found in adolescent females and individuals of low economic status. It is categorized by four different motors: motor, sensory, seizures, and mixed presentation (Spratt, Thomas 186). These symptoms usually began after a stressful experience, it is a scary or stressful incident and converts to a physical problem. Episodes of conversion disorder are nearly always triggered by a stressful event, an emotional conflict or another mental health disorder, such as depression. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she experiences the physical symptom of numbness in her arms. Patients are not faking

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their symptoms, they are real. So in this annotated bibliography we will look at how to diagnosis conversion disorder/pseudoseizures, causes of conversion disorder, proper etiquette that should be used to inform patient of diagnosis and treatment options.

Diagnosis and Treatment of Pseudoseizures Bowman, Elizabeth S., and Omkar N. Markand. "Diagnosis and Treatment of Pseudoseizures." Psychiatric Annals 35.4 (2005): 306-16. Print.

Dr.Bowman, a psychiatrist and adjunct professor and Dr.Markman, a professor of neurology created a manual to diagnosis and treat pseudoseizures. They describe the differences between pseudoseizures and epileptic seizures. Pseudoseizures resemble real neurological convulsions, but are not caused by dysfunction of the nervous system. Patients were misdiagnosis with epilepsy because of the similarities between the two, although charts and descriptions are given to distinguish the two from each other. The main feature of an epileptic seizure is open (staring) eyes, awake/asleep, less than two minutes, and significant injuries such as biting of the tongue. While a nonepileptic seizure are usually awake, eyes closed/blinking, and last for more than two minutes, something as long as four minutes. Diagnosis is hard to make based on physical characteristics, EEG and VEEG can be used to help record brain activity. These procedure help avoid misdiagnoses, which is extremely common and dangerous and 24% of patients are misdiagnosed. If a patient has conversion

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disorder taking anticolvent medicines and driving and employment restrictions can hinder a patients progress. In addition often the presentation of the diagnosis is critical, when a patient is diagnosis with conversion disorder, the approach is to not make the person feel like they are crazy or something is wrong with them. Inexperienced doctors often tell these patients that they are faking and that it is all in their head, causing them to believe that they are crazy. This can cause the family to be become distressed and be hurtful to the patient. This journal states the correct way to tell the patient that they have conversion disorder, so they can the appropriate help. Psychotherapy is the main treatment option to find the underlying cause of the trauma and stress that is causing the seizures. If needed medicine is needed to treat depression and anxiety it can be given to improve calm and improve the patients mood. Conversion disorder is treatable and manageable, with the appropriate diagnosis and treatment plan. This article was detailed in how to recognize the differences between the two seizures, how to explain it to the patient, the primary causes and treatment options. The article was written for other practicing physicians specializing in neurology and psychiatrist who do not know about conversion disorder or nonepileptic seizures. The misdiagnosis of patients is what led Bowman and Markand to write the article, a lack of knowledge on the causes and properly diagnosing of pseudoseziures.

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Psychogenic Movement Disorders Thomas, Madhavi, and Joseh Jankovic. "Psychogenic Movement Disorders: Diagnosis and Management." Therapy in Practice 18.7 (2004): 437-52. Print. Madhavi Thomas and Joseph Jankovic are both practicing physicians at Parkinsons disease Center and Movement Disorders Clinic at Baylor College of Medicine. The journal was a guide to symptoms and diagnosis of psychogenic movement disorders and how they differ from neurological disorders. Thomas and Jankovic kept a record of 14,568 patients from 1988 to 2004 that visited the movement center, 530 of those patients that were sent had no organic cause of illness. Those 530 patients were diagnosed with a form of PMD. This journal had a case study and focused on physiological movement disorders rather than conversion disorder itself. Thomas and Jankovic stated that conversion somatoform and factitious disorders were underlying causes of a psychogenic movement disorder. Patients who experienced psychogenic tremors or shaking, which is the most common of all PMDs, 33% had conversion disorder. This is different than the other journals who look at conversion disorder alone as a reason for pseudoseizures, caused by some tragic event that occurred in their life. It did not use conversion disorder as a reason that for another psychological disorder. In addition, symptoms in helping diagnosing tremor PSM featured symptoms such as increase with attention. Unlike, previous journals that focused only on physical symptoms and EEGs as the difference between actual seizures and non-epileptic seizures. Psychogenic movement disorders seem to be occurring to this journal seemed to more associate with someone who has multiple psychological disorders and that is ill, not like conversion disorders which is not always based on an underlying psychological problem. In addition, the treatment options were mostly medications, where as other journals suggested that it could be cured with therapy alone and not need to take meds. The conclusion state that PMDs

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are harder to diagnose into categories, compared to conversion and somatoform disorders. The article was a reliable source but did not speak much about the how to diagnosis and treatment conversion disorder.

Neurological presentations of conversion disorders in a group of Singapore children Teo, Wan-yee, and Chew-Thye Choog. "Neurological Presentations of Conversion Disorders in a Group of Singapore Children." Pediatrics International. 50 (2008): 533-36. Print. This research studied children in Singapore who were children with neurological presentations of conversion disorders who were admitted to hospital. Patients were followed for 1 4 year. These patients experienced similar symptoms that were common to neurological disorder. This journal stated and wanted to prove that conversion disorder was not uncommon in children, this study was done in 2008. Although older journals already stated that conversion disorder happens in predominantly adolescent women, Wan-yee Teo and Chew-Thye Choong examined diagnosis in children as young as eight years old with the median age being around twelve years old. One patient was a 10-year-old boy and was diagnosed with OCD, which his grandfather had. This follows the typical diagnosis of another psychological disorder causing the seizures, but his maternal uncle had epilepsy. In the study 85% were diagnosed with conversion disorder, changing the belief that it rarely affects younger children. This journal was shorter than most of the journals and did not include much detail about the updates on the children. The journal did conclude that children can have conversion disorder and suffer from mental illnesses. This article is reliable in helping diagnosis and treat conversion disorder that appears in children that are younger than the appropriate age group.

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Pediatric Case Study and Review: Is It a Conversion Disorder?" Spratt, Eve G., and Stephanie G. Thomas. "Pediatric Case Study and Review: Is It a Conversion Disorder?" The International Journal of Psychiatry in Medicine 38.2 (2008): 185-93. Print. Dr.Spratt and Dr.Thomas followed one patient female patient and her diagnosis of conversion disorder, the 15 year old was experiencing pain and numbness in her right arm. The teen was troubled, violent, and had low self-esteem. She long history of behavioral problems since elementary school and was running away from home. Her parents said they thought it was all in her head, all test showed that she was in good health and her CT scan was normal. She was diagnosed with attention deficit disorder and given Adderall at 10 but was discontinued because it made her zombie-like. A Child psychiatry was consulted given because of conversion disorder and depression, for the last three year she was skipping school, smoking cigarettes, and occasionally drinking alcohol and smoking pot. Before they discharged her to see a psychiatrist, they performed a MRI which revealed she had a spinal cord arteriovenous malformation (AVM). She was given physical therapy, occipital therapy, and neurosurgery before leaving. She could move her right arm with the exception of her shoulder. The misdiagnosis of conversion disorder can sometimes happen if a thorough examination is not given. Based off her emotional state and physical symptoms, it seemed that she had conversion disorder but in this case is mistake with CNS lesions. It is important that doctors rule out every single option before a diagnosis of conversion disorder is giving. The patient was thought to have been faking to avoid consequences of being suspended and running away or her behavioral issues, caused a delay in her receiving the proper treatment. Misdiagnosis

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can be avoided with EGGs, CT scans, and MRI, and if diagnosed with conversion disorder they should be monitored for primary health care provider and receive treatment for mental health. Progress in Understanding Conversion Disorder Allin, Matthew, Anna Streeruwitz, and Vivienne Curtis. "Progress in Understanding Conversion Disorder." Neruopsychiatric Disease and Treatment 1.3 (2005): 205-09. Print. Before the term Conversion Disorder came into existence in the medical community, patients who experienced these symptoms were labeled hysteria in the early 17th century. It was further developed by Jean Martin Charot who classified nonepileptic seizures as hysteria major and hypnotized patients to recall their circumstances. He tested it on a patient and she was able give a detailed account of what occurred, then that particular symptom would end. His patient, Anne O called this the talking cure, and the term conversion derives from converting psychic symptoms into physical ones. Although it is difficult to point out a particular stressor and repressor of sexual desire being a cause remains controversial. On a neurobiological point, symptoms of conversion disorder have been linked to the striato-thalamo-cortical circuits, which are associated with emotional moderation and unilateral lesions (paralysis). It can be concluded that body parts affected are not paralyzed but not under voluntary control. Conversion disorder is challenging to diagnosis because of you have to rule out any possible medical condition and is a last ditch offer when no organic cause can be found. Curtis, Steertuwitz, and Curtis, all practicing psychiatrics had only limited amount of research to handle and did not find any treatment options tailored to conversion disorder. These individuals had a hard time finding research done to further understand conversion disorder because there is a need for research in explaining the epidemiology, etiology, and treatment of conversion disorder. Consequently, these finding explain why doctors have a hard time diagnosing patients with conversion disorder.

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Conversion Disorder: Advances in Our Understanding Feinstein, Anthony. "Conversion Disorder: Advances in Our Understanding." CMAJ 183.3 (2011): 915-20. Print. Dr.Feinsten reintroduces that hysteria has now been classified as somatoform disorders and has been split into two conditions, one being conversion disorder. He discusses the main three areas that puzzle doctors and has produced the mystery surrounding this disease. His findings were similar to those of others. The associate scientist at the Summerbrook Research Institute department of Psychiatry examines the classification, epidemiology, and theories of conversion disorder. His finding agreed with the board view that it is common in women and people of low socioeconomic, it is caused by emotional trauma, and it can be treated with therapy. This idea was stated in every journal that I have read, his findings were similar to other researchers. One new idea he discussed was conversion disorders were deemed more psychological than cerebral causes. He showed an image of an MRI showing a patients left and right hand being stimulated. The left hand the patient lost feeling in and the right was functional, the scan showed no activity in the primary somatosensory cortex in the left and increased activity in the right. This drew the conclusion that there is an abnormal pattern of cerebral activation in patient with conversion disorder this imbalance overrides the activation of motor and sensory cortices. Conversion disorder and activity in the orbitofrontal and cingulate regions, which regulate emotion and expression of emotion, this association is informative to the scientific community. It is unclear why this happens but his discovery is critical in finding neurological evidence that supports how patients psychological problems can be expressed by psychical movements.

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In the Psychiatrist's Chair: How Neurologists Understand Conversion Disorder Kanaan, R., D. Armstrong, P. Barnes, and S. Wessely. "In the Psychiatrist's Chair: How Neurologists Understand Conversion Disorder." Brain 132.10 (2009): 2889-896. Print. Richard Kanaan, David Armstrong, Phillp Barnes, and Simon Wessely, are all head professor or a professor at a university in the UK specializing in neurology or psychological medicine. They conducted a study were they interviewed highly qualified neurologist to get an understanding of conversion disorder for a current prospective. The doctors had been practicing for an average of 20 years ranging from 14-39 years and associated to a regional neuroscience Centre in London. They found the 22 doctors understand what conversion was and had seen it in a patient before, although they felt it was on the decline. They felt that it was not their problem to solve and that it was more psychological based and that it was not related to feigning. One doctor said I just cannot understand these people...from a psychological point of view. Ive got no idea. But I dont think its malingering (SO4) (In the psychiatrist chair, 2893). They do not think that the patients are faking their symptoms for attention, but they do not understand what can be causing it. This study showed how practicing neurologists feel about conversions disorder which is important in knowing if doctors really understand what it is. The lack of knowledge and treatment options for conversion disorder is why patients are often misdiagnosed and symptoms do not improve.

Conversion Disorder: Towards a Neurobiological Understanding

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Harvey, Samuel B., Biba R. Stanton, and Anthony S. David. "Conversion Disorder: Towards a Neurobiological Understanding." Neuropsychiatric Disease and Treatment 2.1 (2006): 13-20. Print. Harvey, Stanton, and David who work in neurology and psychiatry wrote this journal to explain conversion disorder from a neurobiological standpoint to try and explain conversion disorder better. The concept of hysteria was presented alongside conversion disorder unlike the other journals which stated conversion disorder replaced hysteria. It looked at different theories to try and explain conversion disorder and different studies done. All the studies and theories were inconclusive. Recent neurophysiologic studies neither found that conversion disorder is neurologically different than feigning but has not been replicated. Neuroimaging was mentioned and a table of contents was giving to summarize the findings. This article wanted hard facts to back up what conversion is, but there is not enough research to support the journal. The authors presented a table of different terms and how they would be used in the journal, to assist readers, although it was still difficult to read and understand. It was written for people in the scientific field, and a high level of education who want a more neurological understanding of conversion disorder. The authors presented a table of different terms and how they would be used in the journal, to assist readers. The journal is an example of doctors or scientist having a lack of understanding or knowledge of conversion disorder. The journal can be used to further explore research into explaining neurobiological cause of conversion disorder.

Conversion disorder in children and adolescents: A 4-year follow-up study

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Pehlivantrk, Berna, and Faith Unal. "Conversion Disorder in Children and Adolescents: A 4year Follow-up Study." Journal of Psychosomatic Research 52 (2002): 187-91. Print. A study was done of 40 adolescents who were diagnosed with conversion disorder, this study was solely based demographics and data from the initial visit, such as age, chief complaints, previous medical problems, and etc. Also the changes in demographics and data from the initial visit four years ago were the two main components of the interview. The majority of patients was female, 17 years at a follow up, and suffered from pseudoseizures. From the follow up study 85% of patients fully recovered from conversion disorder and been free from symptoms for around 12 months. A favorable outcome can happen if the diagnosis is found early and if other psychological problems exist. Conversion disorder once diagnosed is rarely followed up to see if treatment options worked or if the patient improved. This study done by to professor of child psychiatrist at Hacettepe University in Turkey, helps provide patients with hope that their symptoms can get better. This is the second international study done in a foreign country; conversion disorder is not just a domestic issue but international too. Unlike other research this study tailored to the follow-up of patients which you do not find enough research on. This study can be used to provide doctors with more information about the treatment of conversion disorder. Knowing that there is good chance that the patients symptoms could go away, will help with them presenting the diagnosis to the patient better.

Psychogenic nonepileptic seizures LaFrance, W. Curt. "Psychogenic Nonepileptic Seizures." Current Opinion in Neurology 21.2 (2008): 195-201. Print.

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Dr.Curt is an assistant professor of psychiatry and neurology at the University of Brown who conducts clinical research primarily on the neuropsychiatry of nonepileptic seizures, and somatoform disorders. In this particular research he found that the misdiagnosis of nonepileptic seizures is costly to patients and hospitals, and that Video EGG can help lower the possibility of a misdiagnosis. The main characteristic is closed eyes during an episode, while individuals with epilepsy eyes are open and staring. The study of EEG monitoring revealed that 92% of patients with NES had closed eyes during their test. In addition it is used to determine if the seizures are a frontal lobe or deep temporal seizure which can mimic puedoseizures Furthermore Curt used three test to look for neurological differences and personality differences, although NES and epileptic seizures performed roughly the same. He concluded that EEG monitoring is the keystone procedure to observe behaviors to diagnosis nonepileptic seizures, along with the assistance of patient characteristics and neuropsychological testing. These results help in getting patients with nonepileptic seizures the appropriate help, especially if they have conversion disorder. This journal demonstrates the difficulties that doctors have diagnosing conversion disorder and nonepileptic seizures, the research provided will help future cases are more thoroughly evaluated.

The Outcome of Neurology Patients with Medically Unexplained Symptoms: A Prospective Cohort Study Carson, AJ, S. Best, K. Postma, M. Sharpe, J. Stone, and C. Warlow. "The Outcome of Neurology Patients with Medically Unexplained Symptoms: A Prospective Cohort Study." J Neurol Neurosurg Psychiatry 74 (2003): 897-900. Print.

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This journal was a follow-up of a previous paper they had written, which concluded that 30% of new referrals at Royal Edinburgh Hospital in the United Kingdom had who seizures had no organic or somewhat organic case. This journal was the results of an eight month follow up on the 90 patients, and any physical or mental changes based on a self rated scale used to measure patients mental status of eight main categories. Sixty six of the ninety patients participated and 45% reported improvements in their condition, while 55% stayed the same or got worse. Based on the results most patients saw an improvement in their physical role and social functioning. Although most reported worsen condition, none found a cause to their illness during the eight months. This study results were can not be compared to others because they is no research similar, although the misdiagnosis of conversion disorder and pseudoseizures has been reduced. Conversion usually has a great success rate, so the findings that over half of the patients did not improve in eight months is usual. This journal confirms that more through research needs to be done on treatment options for patients with conversion disorder and who suffer from pseduoseizures. The lack of improvement shows that doctors need to be educated on treatment options that are available and educating the patient on the condition, while ensuring that they are going to therapy.

A Case of Pseudoseizures Haines, J. D. "A Case of Pseudoseizures." Southern Medical Journal 98.1 (2005): 122-23. Print. Dr.Haines reports a case study involving a 45 year old woman who did not meet the usually demographics of conversion disorder. She was middle aged, in no distress, and doing well financially, compared to the stereotypically adolescent female from a struggling family. She was

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given medication for high blood pressure and anxiety but not for the seizures, she later reported that GOD cured her. Dr. Haines explained the differences between pseudoseizures and epileptic many of his observations were comparable to other findings. Pseudoseizures are characterized by wild and violent movements such as arching of the back that he stated last from thirty minutes to an hour. This duration was longer than other journals who reported that last on average two minutes to thirty minutes. In addition, he found that individuals with pseudoseizures scored higher on pathologic test relating to anxiety, depression, and schizophrenia, supporting the findings that individuals with pseudoseizuresa and conversion disorder sometimes have another psychological illness. Another theory correlates with Dr. Haines findings One theory has correlated conflict with pseudoseizures activity. A change in the level of consciousness can symbolize the need to remove oneself from the conflictthe dissociative component. The motor movement during the seizure fulfills the need to reduce tension and anxietythe conversion component. After anxiety is reduced by the appearance of the pseudoseizures, the patient is indifferent to symptoms. He or she receives secondary gains during a seizure in the form of increased attention from observers. Dependence develops, which further reinforces the behavior. A sick role is created, which allows the patient to regress and reinforces the dependent role (Haines, 123). This theory is the best metaphor given to explain how and why pseudoseizures occur. Although Dr.Haines journal show similarities it was more successful in describing why the seizures go from psychological problems to physical problems. His theory can be used to help physicians describe to their patients how and why their bodies are transmitting stress in physically. His case report on the 45 year old from a middle class background and theory helps clear up misunderstanding with conversion disorder only affecting young adults. Having an open mind that it can happen at any age, reduces the chances of misdiagnosing a patient.

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Early onset of conversion disorder: A case report Akdemir, Devrim, and Faith Unal. "Early Onset of Conversion Disorder: A Case Report." Turkish Journal of Psychiatry 71.1 (2006): 1-7. Print. Dr. Devrim and Unal examined a patient diagnosed with conversion disorder at the age of 3 years old. Dr.Unal was the author of another journal used this is my second case report that was based in Turkey, also the second case study that was done on young children being diagnosed with conversion disorder. The girl T was from a big family and had been have difficulty walking because of spasms and jerky leg movements but would disappear when she was sleeping. She did not respond to non-psychiatric approaches for other conditions that were given, she was diagnosed with spinal myoclonus but did respond to treatment. She was given a complete work up and nothing was found to be wrong or abnormal about T results. T was extremely social, intelligent, and highly favored by her father, although him spoiling her caused tensions between T and her mother. This created a division in the household and overwhelmed mother pregnant with her 5th child constantly being verbally abused by her husband for T condition. T psychological exam revealed she had developed anxiety about her illness and returning to school, T was diagnosed with conversion disorder. She was given meds for anxiety and received physical therapy for her inability to walk; during she had no contract with family so she would not be codependent. She made a full recovery and was her parents were told to not spoil her and do not help her if she had trouble. This case study supports that younger children can have conversion disorder and that an early diagnosis should be approached with behavioral therapy to ensure that they find a healthy way to communicate with others. The findings are

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helpful in assisting other doctors with similar cases and diagnosing conversion disorders in individuals who do not have pseudoseizures.

Limits to truth-telling: Neurologists communication in conversion disorder Kanaan, Richard, David Armstrong, and Simon Wessely. "Limits to Truth-telling: Neurologists Communication in Conversion Disorder." Patient Education and Counseling 77.2 (2009): 296-301. Print. Three psychiatrists studied how neurologist treat and diagnosis patients that they think have conversion disorder. Communication is important between a physician and patient, although the twenty-two neurologist that were interviewed found it hard to communication with patients who symptoms had no organic cause. The neurologists say this presents a crisis of what to say to the patients because they do not want to lose the patients trust or have them leave without seeking treatment. Sometimes they think the patients are exhausting their symptoms for secondary gain, so it makes it hard for this to determine whether they are really having the symptoms or not. Overall most neurologists seek a way that describe what they think it is but while still helping the patient understand. The same issue that the neurologist had in the United Kingdom is the same problem others face too, how to communicate the diagnosis to the patient. Doctors not knowing how to properly inform the patents of their condition makes it hard for patients to receive the proper care that they need. It is creditable because there finding were appropriate and they picked qualified doctors to participate in the study.

Treatment of Conversion Disorder in the 21th Century: Have We Moved beyond the Couch?

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Rosebush, Patricia I., and Michael F. Mazurek. "Treatment of Conversion Disorder in the 21th Century: Have We Moved beyond the Couch?" Current Treatment Options in Neurology 13.88 (2011): 255-66. Print. Rosebush and Mazurek professors at McMaster University wanted to examine the current treatment options being used to treat conversion disorder. The treatment options mentioned are: psychotherapy, hypnotherapy, narcotherapy, pharmacotherapy, and the barriers to treatment. In most causes of conversion disorder if there is an underlying condition such as OCD, anxiety or depression will require a different approach because they will have to treat two disorders. Psychotherapy is the primary treatment options used by psychiatrists to treat conversion disorder, therapy helps determine what stressor are causing the psudoseizures or paralysis that the patient is experiencing. As study reported that 11 of 17 patients who received 12 weekly one hour sessions for an hour had a complete cessation of their episodes. Hypnosis is the second most common only two studies completes, but both had a high success rate on improvement of symptoms or no longer having them. In the study on pharmacotherapy, patients were given selective serotonin inhibitors (antidepressants) for eight weeks. Seven saw global improvement and eight no longer had any symptoms. Narcotherapy is the use of a benzodiazepines, which enhance the effect of the gamma-aminobutyric acid (GABA) at the GABAA receptor resulting in sedative, Hypnotic (sleep-inducing), anxiolytic (anti-anxiety), and anticonvulsant properties to carry out interviews. After taking the drug the patient can respond verbal interventions and can trigger emotion expression which can help determine what is causing the symptoms of conversion disorder. This treatment used in the early diagnosis of conversion is rarely used today, but a review has shown that they have a high response rate. The treatment options discussed can be used by psychiatrists that do not know how to treat conversion disorder. The

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barriers of treatment were similar to that of other journals, the most essential factors are is a timely diagnosis of conversion disorder, and appropriate telling the patient of the condition, treatment plan that is specific to each individuals case of conversion disorder. Also mentioned was patients reporting that they were accused of faking and were spoken to in a rude, unfriendly tone, these experiences leave the patient without treatment, so it is critical that physicians are educated on this condition.