Friday, 27 April 2018

Conversion Disorder: PNES,Trance, Possession disorders Signs, Symptoms and Management

Conversion Disorder


Conversion Disorder refers to the presence of sensory and or motor symptoms without an adequate underlying medical explanation. 


The word 'Conversion' is used as the assumption is that psychological distress is 'converted' into physical(usually neurological) symptoms. 

Other terms that are used by clinicians for Conversion Disorder are as 'Non-organic', Psychosomatic, etc
What is a Conversion Disorder?

Examples of Psychological stressors in children are as follows:

  • Being bullied at school.

  • Parental separation.

  • Illness or death of a parent, sibling or a friend.

  • Beak-up

  • Physical, emotional or sexual abuse.

List of Conversion Disorders-

1) Motor:
  • Weakness
  • Loss of speech
  • Limb paralysis
  • Abnormal movements

2) Sensory:
  • Anesthesia
  • Paraesthesia
  • Loss of sight, touch or hearing

3) Mixed Sensory and Motor.


4) Psychogenic non-epileptic seizures (PNES) previously known as pseudoseizures.

Dissociative(Conversion) Disorders in ICD (International Classification of Disease)-10
  1. Dissociative Amnesia
  2. Dissociative Fugue
  3. Dissociative Stupor
  4. Trance and Possession disorders
  5. Dissociative motor disorder
  6. Dissociative convulsions
  7. Dissociative anesthesia and sensory loss
  8. Other Dissociative disorders: 
  •     Ganser's syndrome
  •   Multiple personality disorder

1-Dissociative Amnesia- The patient undertakes an unexpected yet seemingly organized journey away from home, or from their ordinary place of work and social activities. 


There is amnesia, either partial or complete, for the journey.



 2-Trance and Possession disorders- There is a temporary alteration of the states of consciousness, loss of personality, repetitive repertoire of movements and speech.  


Whereas, in Possession disorder, an individual behaves as if taken over by a spirit, deity or higher power. The patient's such behaviors occurring in culturally-sanctioned religious rituals are not diagnosed as pathological.


3-Multiple Personality Disorder- Multiple Personality Disorder also called Dissociative Identity Disorder, in this disorder, the person displays two or more distinct personalities. 

At any one time, one personality takes full control. Each personality has its own memories and behaviors patterns.


EPIDEMIOLOGY OF CONVERSION DISORDERS-

  • More common in females in both adults and children.

  • Can occur at any age but (rare in under age of 8 years, or for a first episode after the age of 35 years).

  • Motor symptoms are common such as paralysis and weakness.

  • These disorders seem to be more common within those with lower levels of education, (particularly lack of medical knowledge.

  • More common in developing countries than in affluent nations.

  • More common in lower socio-economic classes.

  • More common in rural areas than in urban areas.

  • Conversion Disorders are mainly associated with co-morbid depression or anxiety disorder and antisocial personality disorders in males.


FACTORS SUGGESTING CONVERSION DISORDER 


  • Symptoms follow a psychological stressor.

  • Presenting symptoms are atypical.

  • Elicited signs are atypical.

  • Investigations are normal or not consistent with the severity of symptoms.

  • Past history of conversion disorder.

  • Past history of depression/ anxiety and family history of depression/anxiety.


                Psychogenic Non-epileptic Seizures (PNES)

Previously PNES is known as Pseudoseizures, Psychogenic seizures, and Non-epileptic seizures. In ICD-10 PNES is called 'Dissociative convulsion'. 


The usual onset of PNES is in early adulthood but can also occur in children and elders as well. According to the report, it's more common in females (F: M ratio of 7:3).


Factors Suggestive of PNES-

  • Occurrence only in front of an audience (viz. Family)

  • No loss of consciousness.

  • No tongue biting or major injury.

  • Bicycling of leg movements(during the episode).

  • No incontinence. 

  • Side to side turning of the head.

  • Emotional triggers such as arguments and panic attacks.

  • Weeping or stuttering during the episode.

  • Shallow breathing.

  • Multiple vague somatic symptoms such as pain and fatigue.


PNES Management-

  • Supportive counseling.
  • Anxiety management and relaxation training.
  • Cognitive Behaviour Therapy(CBT).
  • Psychotropics such as Antidepressants and Benzodiazepine could be helpful for the patient.

Other helpful and useful recourses-

Conversion Disorder Forum.

Conversion Disorders Forums



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