Conversion disorder: a problematic diagnosis

Nicholson, Timothy R; Stone, Jon; Kanaan, Richard A A

doi:10.1136/jnnp.2008.171306

Cited by 99 publications

(69 citation statements)

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“…Finally, the relation of conversion disorders to other major psychiatric conditions is unresolved but a high rate of comorbidity with depression and anxiety has long been recognized [7,8,75], suggesting a potential partial overlap of risk factors at the individual or environmental levels. For these and other reasons, it has been proposed that a purely descriptive and uncommitted term of ''functional neurological disorder'' should be preferred to refer to the diagnosis of conversion or psychogenic symptoms [60,95].…”

Section: Introductionmentioning

confidence: 99%

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Vuilleumier¹

2014

Neurophysiologie Clinique/Clinical Neurophysiology

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Please cite this article in press as: Vuilleumier P. Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis. REVIEW/MISE AU POINT Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis Circuits cérébraux des paralysies psychogènes liées aux troubles de conversion et à l'hypnose P. Vuilleumier Laboratory for Behavioral Neurology and Imaging of Cognition (LABNIC), Department of Neuroscience (NEUFO), University Medical Center (CMU), 1, rue Micheli du Crest, 1205 Geneva, SwitzerlandReceived 27 December 2013; accepted 12 January 2014 KEYWORDSConversion; Hysteria; Hypnosis; Paralysis; Brain; Neuroimaging; Affect; Self; Precuneus; VMPFC Summary Conversion disorders are defined as neurological symptoms arising without organic damage to the nervous system, presumably in relation to various emotional stress factors, but the exact neural substrates of these symptoms and the mechanisms responsible for their production remain poorly understood. In the past 15 years, novel insights have been gained with the advent of functional neuroimaging studies in patients suffering from conversion disorders in both motor and non-motor (e.g. somatosensory, visual) domains. Several studies have also compared brain activation patterns in conversion to those observed during hypnosis, where similar functional losses can be evoked by suggestion. The current review summarizes these recent results and the main neurobiological hypotheses proposed to account for conversion symptoms, in particular motor deficits. An emerging model points to an important role of ventromedial prefrontal cortex (VMPFC), precuneus, and perhaps other limbic structures (including amygdala), all frequently found to be hyperactivated in conversion disorders in parallel to impaired recruitment of primary motor and/or sensory pathways at the cortical or subcortical (basal ganglia) level. These findings are only partly shared with hypnosis, where increases in precuneus predominate, together with activation of attentional control systems, but without any activation of VMPFC. Both VMPFC and precuneus are key regions for access to internal representations about the self, integrating information from memory and imagery with affective relevance (in VMPFC) and sensory or agency representations (in precuneus). It is therefore postulated that conversion deficits might result from an alteration of conscious sensorimotor functions and self-awareness under the influence of affective and sensory representations generated in these regions, which might promote certain patterns of behaviors in response to self-relevant emotional states. © 2014 Elsevier Masson SAS. All rights reserved. IntroductionConversion disorders have been known to physicians since ancient times and consist of neurological dysfunction that occurs in the absence of organic lesions within the nervous system, but is distinct from other major psychiatric symptoms such as psychosis or depression. Thus, patients may present with a paralysis of one or ...

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Section: Introductionmentioning

confidence: 99%

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Vuilleumier¹

2014

Neurophysiologie Clinique/Clinical Neurophysiology

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“…Nicholson et al (2010) think that psychogenic dysphagia is a problematic diagnosis.The psychological mechanism and how it differs from conscious simulation still remains unclear. The most common complaint of patients with psychogenic swallowing problems is fear of swallowing manifested as difficulties initiating the swallowing and thereby sometimes avoidance of eating.…”

Section: Symptoms In Psychogenic Dysphagiamentioning

confidence: 97%

Psychiatric Aspects of Dysphagia

Bülow

2011

Dysphagia

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“…Various triggers and psychologic stresses may result in the sudden clinical manifestations of the disorder in patients with no prior psychiatric history. Risk factors for the development of CD include a previous history of depression, dissociative disorders, anxiety, cognitive dysfunction, and preceding traumatic experiences [2][3][4][5]. The female to male ratio is 10:1 [5].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Postoperative Conversion Disorder in an Adolescent Following Arthroscopic Meniscectomy

et al. 2017

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Conversion disorder (CD), also known as a functional neurological symptom disorder, is a somatoform disorder involving an unconscious, involuntary process in which psychosocial needs, conflicts, and internal stresses are expressed as somatic symptoms without an anatomical or physiological explanation. The signs and symptoms are involuntary and appear with no underlying physical cause. Various triggers and psychologic stresses may result in the sudden clinical manifestations of the disorder. We present a 14-year-old adolescent who developed a CD following anesthetic care for a partial lateral meniscectomy. Previous reports of postoperative CDs are reviewed, etiologic considerations during the postoperative period are discussed, and management options are presented.

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Conversion disorder: a problematic diagnosis

Cited by 99 publications

References 91 publications

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Brain circuits implicated in psychogenic paralysis in conversion disorders and hypnosis

Psychiatric Aspects of Dysphagia

Diagnosis and Management of Postoperative Conversion Disorder in an Adolescent Following Arthroscopic Meniscectomy

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