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“It's All in Your Head”. the Psychiatrist’s Role in the Diagnosis and Management of Conversion Disorder in Medical Settings: Case Series and Literature Review

Published online by Cambridge University Press:  15 April 2020

M. Spariosu
Affiliation:
Psychiatry and Behavioral Medicine, Hackensack UMC, Hackensack, USA
D. Coira
Affiliation:
Psychiatry and Behavioral Medicine, Hackensack UMC, Hackensack, USA

Abstract

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Introduction

Conversion disorder is a diagnosis that can cause a lot of stigma in patients and their families as well as feelings of helplessness in medical care professionals. Patients with conversion disorder usually present to a hospital in despair, with acute motor or sensory deficits, with symptoms closely mimicking a cerebrovascular accident, seizures, or other frightening diagnosis. After a thorough noncontributory medical and neurological work up, when patients hear that “nothing is wrong with them and it's all in their head” they may further develop decompensation or lack of symptom resolution.

Objectives

  1. 1. Develop a strong therapeutic alliance.

  2. 2. Educate the primary team, patients and their families about conversion disorder.

  3. 3. Bio-psycho-social assessment.

  4. 4. Identify the risk factors and the traumatic event that lead to the symptoms.

Aims

  1. 1. Decrease the stigma of conversion disorder among patients and staff.

  2. 2. Identify the triggers.

  3. 3. Rapid resolution of symptoms.

  4. 4. Decrease the risk of future episodes.

Methods

We are reporting a case series consisting on nine cases and the review of relevant literature. All the patients were initially seen in the general medical hospital.

Results

By increasing patient's insight into their condition, their compliance with the diagnostic interview and treatment plan improved, which lead to rapid resolution of their symptoms.

Conclusion

More education needs to be provided to the primary medical team regarding a therapeutic approach towards a patient with suspected functional disorders. Rapid involvement of a well trained psychiatrist in working with patients with conversion disorder is crucial.

Type
Article: 1263
Copyright
Copyright © European Psychiatric Association 2015
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