What is a conversion disorder?
Pt presents with a motor or sensory impairment with no organic cause identified during testing (physical manifestation of a psychological problem)
What age and how long does a conversion disorder normally last?
Usually 10-35yrs old
Short - weeks to months
Though can be chronic or relapse
How is it different to malingering?
Difference
- Symptoms or deficits significantly impact on the Pt, warranting medical evaluation
- Pt has nothing to gain from having a pathology
What will testing show? (e.g. weakness?)
Inconsistent responses and results will be different to that of other pathologies
E.g. weakness
- whole movements rather than muscle groups
- agonists and antagonists can contract simultaneously
- Give way weakness
- Muscle wasting absent
- Reflexes are normal
- Weakness level may be inconsistent with function
Name 2 secondary problems
Contracture
Pressure areas
Risk factors for conversion disorder
Risks
- family member with disorder
- sexually abused as a child
- very stressful home/work life
- female
- lower socioeconomic class
Physiotherapy management of conversion disorder (6)
PT
- Minimise time assessing as assessment
- Goals should encourage rapid improvement
- Feedback focused on what they are doing well (not what needs fixing)
- Convince the Pt that they are able to do tasks
- Pick outcome measures you know they will do well on
- Use outcome measures to demonstrate improvement and normal performance
Why might physio work?
Legitimises their condition and ?gives them permission? to get better
Clinical presentation of conversion disorder
Presentation
- Stroke-like impairments
- Impaired hearing/vision
- Pseudoseizures (no cyanosis, EEGs don’t show)
- Tremor
- Fixed dystonias
Factors for favourable prognosis
Factors
- sudden onset
- stress before onset
- short interval between Dx and Rx
- high intelligence
- absence of psychiatric disorder
- aphonia and blindness as presentation
