Abstract
It is important to consider a differential diagnosis between paralysis on an organic basis and paralysis and disability due to psychological mechanisms in people with physical impairment secondary to trauma, without evidence of organic etiology. We review the most dramatic type of conversion disorder (CD)–‘Conversion Motor Paralysis’. Recent important medical literature concerning the accepted treatment and rehabilitation management will be reviewed and discussed. The inter-disciplinary in-patient team management approach in a rehabilitation setting offers the benefits of a comprehensive assessment and treatment. The diagnosis is temporary and conditional, since there may be a long delay until the appearance of organic findings. A complete medical assessment is essential in order to rule out any possibility of an organic etiology. In as many as 25% to 50% of patients diagnosed as conversion, an organic medical diagnosis was found.
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References
Parobek VM . Distinguishing conversion disorder from neurologic impairment J Neurosci Nurs 1997 29: 128–134
Ford CV, Folks DG . Conversion disorders: an overview Psychosomatics 1985 26: 371–383
Binzer M, Andersen PM, Kullgren G . Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study J Neurol Neurosurg Psychiatry 1997 63: 83–88
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder Fourth Edition Washington DC, American Psychiatric Association 1994
Heruti RJ, Ohry A . The Rehabilitation Team–A Commentary Am J Phys Med Rehabil 1995 74: 466–468
Hare E . The history of ‘nervous disorders’ from 1600 to 1840, and a comparison with modern views Br J Psychiatry 1991 159: 37–45
Mace CJ . Hysterical conversion. I: A history Br J Psychiatry 1992 161: 369–377
Mai FM, Mersky H . Briquets concept of hysteria: an historical perspective Can J Psychiatry 1981 26: 57–63
White MB . Jean-Martin Charcot's contributions to the interface between neurology and psychiatry Can J Neurol Sci 1997 24: 254–260
Makari GJ . Dora's hysteria and the maturation of Sigmund Freud's transference theory: a new historical interpretation J Am Psychoanal Assoc 1997 45: 1061–1096
Small GW, Propper MW, Randolph ET, Eth S . Mass hysteria among student performers: social relationship as a symptom predictor Am J Psychiatry 1991 148: 1200–1205
Lazare A . Current concepts in psychiatry: conversion symptoms N Engl J Med 1981 305: 745–748
Miller E . Hysteria: its nature and explanation Br J Clin Psychol 1987 26: 163–173
Yarom N . A matrix of hysteria Int J Psychoanal 1997 78: 1119–1134
Stefansson JG, Messina JA, Meyerowitz S . Hysterical neurosis, conversion type: clinical and epidemiological considerations Acta Psychiatr Scand 1976 53: 119–138
Fishbain DA, Goldberg M, Khalil TM, Asfour SS, Abdel-Moty E, Meagher BR et al. The utility of electro-myographic biofeedback in the treatment of conversion paralysis Am J Psychiatry 1988 145: 1572–1575
Hafeiz HB . Hysterical conversion: a prognostic study Br J Psychiatry 1980 136: 548–551
Ziegler FJ . Hysterical conversion reactions Postgrad Med 1970 47: 174–178
Chodoff P . The diagnosis of hysteria: an overview Am J Psychiatry 1974 131: 1073–1078
Weintraub MI . Hysterical conversion reactions – a clinical guide to diagnosis and treatment New York: SP Medical 1983
Ljundberg L . Hysteria: Clinical, prognostic and genetic study Acta Psychiatr Scand 1957 32: 1–162
Thompson APJ, Sills JA . Diagnosis of functional illness presenting with gait disorder Arch Phys Med Rehabil 1988 63: 148–152
Keane JR . Hysterical gait disorders: 60 cases Neurology 1989 39: 586–589
Baker JH, Silver JR . Hysterical paraplegia J Neurol Neurosurg Psychiatry 1987 50: 375–382
Cardenas DD, Larson J, Egan KJ . Hysterical paralysis in the upper extremity of chronic pain patients Arch Phys Med Rehabil 1986 67: 190–193
Withrington RH, Wynn-Perry CB . Rehabilitation of conversion paralysis J Bone Joint Surg 1985 67: 635–637
Matas M . Psychogenic voice disorders: literature review and case report Can J Psychiatry 1991 36: 363–365
Ophir D, Katz Y, Tavori I, Aladjem M . Functional upper airway obstruction in adolescents Arch Otolaryngol Head Neck Surg 1990 116: 1208–1209
Weller M, Wiedemann P . Hysterical symptoms in ophthalmology Doc Ophthalmol 1989 73: 1–33
Sirota P, Spivac B, Meshulam B . Conversive hallucinations Br J Psychiatry 1987 151: 844–846
Nakaya M . True auditory hallucinations as a conversion symptom Psychopathology 1995 28: 214–219
Modai I, Cygielman G, Wijsenbeek H . Hysterical sleep episodes as a manifestation of masked depression J Nerve Ment Dis 1979 167: 502–503
Garfield PD, Guze SB . Prognosis and differential diagnosis of conversion reactions Dis Nerv Syst 1962 23: 623–631
Gould R, Miller BI, Goldberg MA, Benson DF . The validity of hysterical signs and symptoms J Nerv Ment Dis 1986 174: 593–597
Hudziak JJ, Boffeli TJ, Kreisman JJ, Battaglia MM, Stanger C, Guze SB, Kriesman JJ . Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders [published erratum appears in Am J Psychiatry 1997; 154(1):139] Am J Psychiatry 1996 153: 1598–1606
Apple Jr DF . Hysterical spinal paralysis Paraplegia 1989 7: 428–431
Taylor RL . Distinguishing psychological from organic disorders New York: Springer 1990
Johnson EW . Diagnosis of hysterical weakness Proceedings of the Sixth Annual Scientific Meeting. Australian College of Rehabilitation Medicine 1986 February 26–28; Sydney
Berry JF, Hillis RE, Hitzman SE . Factitious triplegia: case report Arch Phys Med Rehabil 1994 75: 1161–1164
Spitz MC . Panic disorder in seizure patients: diagnostic pitfall Epilepsia 1991 32: (suppl-1) 33–38
Beckham JC, Crawford AL, Feldman ME, Kirby AC, Hertzberg MA, Davidson JR, Moore SD . Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans J Psychosom Res 1997 43: (4) 379–389
Kinzie JD, Goetz RR . A century of controversy surrounding postraumatic stress-spectrum syndromes: the impact on DSM-III and DSM-IV J Trauma Stress 1996 9: 159–179
Stewart TD . Hysterical conversion reactions: some patient characteristics and treatment team reactions Arch Phys Med Rehabil 1983 64: 308–310
Vatine JJ, Milun M, Avni J . Inpatient rehabilitation management of conversion disorder with motor dysfunction J Rehabil Sciences 1996 9: 122–125
Delargy MA, Peatfield R, Burt AA . Successful rehabilitation in conversion paralysis BMJ 1986 292: 1730–1731
Keating JJ, Dinan TG, Chua A, Keeling PW . Hysterical paralysis [letter; comment] Lancet 1990 336: 1506–1507
Silver FW . Management of conversion disorder Am J Phys Med Rehabil 1996 75: 134–140
Speed J . Behavioral management of conversion disorder: retrospective study Arch Phys Med Rehabil 1996 77: 147–154
Solyom C, Solyom L . A treatment program for functional paraplegia/Munchausen syndrome J Behav Ther Exp Psychiatry 1990 21: 225–230
Couprie W, Wijdicks EFM, Rooijmans HGM, Van Gijn J . Outcome in conversion disorder: a follow up study J Neurol Neurosurg and Psychiatry 1995 58: 750–752
Bird J . The behavioral treatment of hysteria Br J Psychiatry 1979 134: 129–137
White A, Cordin DOC, Coope B . The use of thiopentone in the treatment of non-organic locomotor disorders J Psychosom Res 1988 32: 249–253
Mizes JS . The use of contingent reinforcement in the treatment of a conversion disorder: a multiple baseline study J Behav Ther Exp Psychiatry 1985 16: 341–345
Dickes RA . Brief therapy of conversion reactions: an in-hospital technique Am Psychiatry 1974 131: 584–586
Khalil TM, Abdel-Moty E, Asfour SS, Fishbain DA, Rosomoff RS, Rosomoff HL . Functional electric stimulation in the reversal of conversion disorder paralysis Arch Phys Med Rehabil 1988 69: 545–547
Jellinek DA, Bradford R, Bailey I, Symon L . The role of motor evoked potentials in the management of hysterical paraplegia: case report Paraplegia 1992 30: 300–302
Klein MJ, Kewman DG, Sayama M . Behavior modification of abnormal gait and chronic pain secondary to somatization disorder Arch Phys Med Rehabil 1985 66: 119–122
Sirota P, Spivac B, Meshulam B . Conversive hallucinations Br J Psychiatry 1987 151: 844–846
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Heruti, R., Levy, A., Adunski, A. et al. Conversion motor paralysis disorder: overview and rehabilitation model. Spinal Cord 40, 327–334 (2002). https://doi.org/10.1038/sj.sc.3101308
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DOI: https://doi.org/10.1038/sj.sc.3101308
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