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Morning Report. October 4, 2010. Conversion Disorder. Suspect when symptoms do not fit Known medical illness Physical exam findings Subconscious plea for help with coping mechanisms School Family disharmony Abuse . Conversion Disorder. 65% CNS symptoms Episodic loss of awareness
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Morning Report October 4, 2010
Conversion Disorder • Suspect when symptoms do not fit • Known medical illness • Physical exam findings • Subconscious plea for help with coping mechanisms • School • Family disharmony • Abuse
Conversion Disorder • 65% CNS symptoms • Episodic loss of awareness • Pseudoseizures or syncope • Motor dysfunction • Gait disturbances or paresis • Sensory abnormalities • Pain and/or numbness • Special senses
Conversion Disorder • Diagnosis • Must rule out medically treatable causes • Testing is important • Psychiatric evaluation • Levels of stress or anxiety in child and family • Predisposing vulnerabilities • Learning disabilities • Peer pressure • Body image • Chronic illness • Family disharmony or conflict
Conversion Disorder • Psychiatric Evaluation • Temporal relationship between stress and onset of symptoms • Role models • Evidence of primary or secondary gain
Conversion Disorder • Differential • Familial periodic paralysis • Hypokalemic or normokalemic • Metabolic myopathies • Muscular dystrophy • Myasthenia gravis • Endocrinopathies • Thyroid and adrenal
Conversion Disorder • Treatment • Explanation to parents • Symptom is real • No organic disease • Anxiety or stress needs to be relieved • Tailored to problem • Set goals • Positive feedback • Physical Therapy • More likely accepted
Conversion Disorder • Treatment • Remove secondary gain • Missed school • Parental attention • Give some control to the child • Continued psychotherapy • Give up sick role • Coping • “to help you cope with the stress of being ill”
Conversion Disorder • Prognosis • Usually no underlying mood disorder • Pseudoseizures – 32% • History of sexual abuse is common • Histrionic Personality Disorder • As adults if no treatment for coping