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Morning Report

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

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  1. Morning Report October 4, 2010

  2. 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

  3. 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

  4. 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

  5. Conversion Disorder • Psychiatric Evaluation • Temporal relationship between stress and onset of symptoms • Role models • Evidence of primary or secondary gain

  6. Conversion Disorder • Differential • Familial periodic paralysis • Hypokalemic or normokalemic • Metabolic myopathies • Muscular dystrophy • Myasthenia gravis • Endocrinopathies • Thyroid and adrenal

  7. 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

  8. 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”

  9. 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

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