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Neuropsychiatric Aspects of Vestibular Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julius Bourke, Georgia Jackson, Gerald Libby
It is important to ensure that these differential diagnoses are taken into consideration on a secondary basis, i.e. other diagnostic and treatment avenues must be considered first. Care must be taken here and the diagnosis of conversion disorder should be made by a psychiatrist. The diagnoses of factitious disorder and malingering are potentially harmful to a patient’s subsequent medical care and should be made with caution and, in the instance of factitious disorder, must include the early involvement of a psychiatrist.
Illness and Illusion
Published in Marc D. Feldman, Gregory P. Yates, Dying to be Ill, 2018
Marc D. Feldman, Gregory P. Yates
Typically, patients with somatic symptom disorder seek help for pain, fatigue, and discomfort. Diarrhea, weakness, and shortness of breath are also common. In contrast, patients with conversion disorder suffer from problems that look neurological: seizures, paralysis, speech difficulties, tremor, twitches, and dizziness are classic examples. Historically, the symptoms of conversion disorder went by the unflattering name hysterical symptoms. Some doctors now call them functional neurological symptoms.
Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
Jasmine M. Campbell, Chevelle Winchester, Angela Rekhi, Khurram A. Janjua, Anton N. Dietzen, Alan R. Hirsch
In contrast, somatic symptom disorder presents in a psychologically unwell patient who unconsciously feigns symptoms with no physical cause; complaints are often multiple, vague, and span multiple organ systems. Conversion disorder may be thought of as an extreme of somatic symptom disorder in which a stressor often precipitates a significant sensory or neurological symptom, which cannot be explained by a neurological disease or another medical condition. Factitious disorders are similar to malingering in that patients are pursuing a goal, particularly attention or sympathy from doctors, friends, or family rather than financial secondary gain. Patients having psychiatric involvement and behavior is deliberate. However, unlike malingering, these individuals are often willing to undergo painful/dangerous tests or treatments. Lastly, illness anxiety disorder can be observed in patients who are psychologically unwell, where they genuinely believe they may be affected by a condition but seek no intrinsic or extrinsic gain. Malingerers, compared to the aforementioned disorders, consciously seek extrinsic gain.
Cognitive impairment profile differences in patients with psychogenic non-epileptic seizures and epilepsy patients with generalized seizures
Published in Neurological Research, 2020
Özgül Karaaslan, Mehmet Hamamcı
It was determined in our study that patients in the epilepsy and PNES groups took longer to complete the sub-tests of the Stroop test and made more errors and corrections compared to the healthy controls. In the epilepsy group, the subcomponent scores of the Stroop-5 time and Stroop-5 correction were significantly higher than those in the PNES and control groups (p < 0.005). There was a decline in attention, mental control, and the ability to flexibly exhibit reactive responses or resistance to interferences in both the epilepsy and PNES groups but with slightly higher rates in the epilepsy group. This result indicates that frontal functions are compromised in both diseases. Bell et al. [41] showed that the symptoms of dissociation and hysteria are associated with increased activity in the prefrontal cortex. Demir et al. [42] found deterioration in many areas of cognitive function in patients with conversion disorder. Patients with epilepsy have also been shown to have frontal lobe dysfunction [43]. In our study, the presence of signs indicating frontal dysfunction, even with rare seizures, may raise the following question: Do seizures disrupt frontal functions, or does frontal dysfunction cause seizures? In order to clarify this question, further studies may be needed, including newly diagnosed patients who have not received any treatment.
Functional neurological symptoms masquerading as Wernicke encephalopathy following bariatric surgery
Published in Baylor University Medical Center Proceedings, 2019
Andrew M. Kiselica, Sabra Rosen, Jared F. Benge
Test findings, combined with normal neuroimaging, electroencephalogram, and laboratory results, suggested that the patient’s presentation was not consistent with neurological damage. WE seemed unlikely, given the absence of observed oculomotor abnormalities, gait disturbances, dyscoordination, or evidence of thiamine deficiency. Rather, her symptoms may best be conceptualized as a conversion disorder.4 This diagnosis is consistent with prior research. She reported an extensive psychiatric history and recent stressful life events, two important risk factors for developing medically unexplained symptoms.5–7 Additionally, she demonstrated heavy health care resource utilization8 and disavowed psychiatric explanations for her symptoms in favor of more traditionally “organic” explanations.9
Psychogenic blepharospasm associated with Meige’s syndrome: a case report
Published in Psychiatry and Clinical Psychopharmacology, 2018
Cagdas Oyku Memis, Mustafa Kurt, Gulgez Kerimova, Bilge Dogan, Doga Sevincok, Levent Sevincok
This case demonstrates that the differential diagnosis of functional neurological symptom disorders per DSM-5 is a process of integrating neurological and psychosocial findings. Associated psychological stress and conflicts were related to conversion disorder, but Meige’s syndrome also provided an opportunity for model learning in coexistence of both disorders [7]. We also suggest that such an association might develop in cases who are suffering from several long-term medical illnesses. Our case indicates the necessity of a close clinical collaboration of neurologists and psychiatrists in a comprehensive and ongoing psychosomatic and neurological diagnostic assessment of a neurological symptom. The absence of obvious evidences of biological dysfunction underlying neurological symptoms should not lead directly to the diagnosis of a conversion disorder. We also recommend that the clinicians should take into account the co-occurrence of Meige’s syndrome and pseudo-blepharospasm in their patients.