Conversion disorder
Overview
A rare psychiatric condition where physical symptoms result from emotional distress or conflict. The physical symptoms may include blindness or even paralysis. The condition is considered when there is no apparent underlying medical condition causing the symptoms.
Symptoms
* Variety of symptoms * Pain * Sexual dysfunction * Paralysis * Seizures * Aphonia * Dyskinesia * Temporary blindness * Vomiting * Blindness
Causes
* Inadequate rest * Excessive exercise * Insufficient caloric intake * Depression * Infectious mononucleosis: Common in adolescence, typically due to EBV or CMV * Anemia * Hepatitis –Viral (e.g., HAV, HBV, HCV) –Consider autoimmune in adolescent girls * Drugs –Antihistamines, anticonvulsants, opiates -- Obesity –Rapid fatigue with exertion –Somnolence with elevated PaCO2is termed Pickwickian syndrome * Tonsillar-adenoidal hypertrophy –Impaired air exchange while sleeping –Associated with restless sleeping * Chronic fatigue syndrome –Controversial diagnosis –Underlying depression is common * Polycythemia in neonates can be associated with cyanosis and feeding problems * Encephalitis/meningitis * Tuberculosis * Brucellosis: Weight loss, low-grade fever, back pain * Hypothyroidism * Adrenocortical insufficiency: Often with hyperpigmentation and weakness * Hypoglycemia * Inflammatory bowel disease * Juvenile rheumatoid arthritis * Systemic lupus erythematosus * Intussusception * Dermatomyositis: Often with muscle weakness and pain * Congestive heart failure: With tachypnea and dyspnea on exertion * Pericarditis: Fatigue and dyspnea may precede friction rub * Renal tubular acidosis * Uremia * Myasthenia gravis * Malignancy
Diagnosis
All patients should have routine laboratory studies, including CBC, sedimentation rate, chemistry panel, VDRL test, and a urinalysis including analysis for myoglobin. CPK, LDH, AST, and urine creatine and creatinine should be done to rule out muscle disease. A thyroid profile should be done to rule out hyperthyroidism. Further endocrine workup including serum cortisol will help differentiate Addison's disease and hypopituitarism. Because fatigue is associated with aldosteronism, a 24-hr urine aldosterone determination should be done.
Treatment
* Treatment is targeted at specific underlying medical problems, if determined (e.g., thyroid disease, chronic infection, malignancy) * Stop or change offending medications * Consider trial of antidepressant therapy and/or cognitive behavioral psychiatric therapy * Regularly scheduled physical activity * Improve sleep hygiene * Referral to support groups * Discontinue offending medications * Chronic fatigue syndrome and fibromyalgia are often treated with supportive care, healthy diet, moderate exercise, and low-dose antidepressants * Weight loss for obesity