Tuesday, May 5, 2015

Conversion disorder (CD)

Borrowed from another forum
1. Most doctors do not enjoy being stumped diagnostically; awarding a diagnosis of CD (as a last resort) does not usually feel like success. It would be ideal to respond to this frustration not by closing out the patient (with a casual diagnosis and referral for mental health care) but instead by acknowledging the frustration of not having a satisfying answer; sharing the burden of uncertainty with the patient and family; promising to keep seeking a sound diagnosis; helping the patient to find more expert special­ists; and referring the patient for mental health support, to help with the stresses associated with being sick from a mysterious condition.

2. In this process, there is probably no value in suggesting to either the patient or the mental health practitioner that the patient has CD. Doing so would engender defensiveness in the patient, and could tend to undermine the ability of the mental health practitioner to offer the patient sincere support.

3. Even if there is no diagnosis for the patient’s symp­tom (as yet), it is good practice to refer the patient for rehabilitative care, to address the patient’s impaired functioning.

Barnum R. Problems with diagnosing conversion disorder in response to variable
and unusual symptoms. Adolesc Health Med Ther. 2014 Apr 17;5:67-71.
Concerns regarding this include:
1.  An assumption that CD is a diagnosis of exclusion, whereas it may be a positive diagnosis, based on its own signs and symptoms.
2.  Promoting futile investigative and/or therapeutic excursions, and endless medicalization of a problem that has no solution other than #3 above, as well as the referral for mental health support.


1 comment:

  1. Imagine your life turned upside down with chronic symptoms like fatigue, stroke-like symptoms, brain fog, sharp chest pain, coughing up blood … and doctors can’t seem to figure out what is wrong. Then imagine your feelings when one of the doctors decides that this spectrum of symptoms is psychosomatic or “all in your head.”...

    I was trapped not only by my pain and debilitating symptoms, but also by physicians who didn’t know how to provide effective care. In my most delicate state of mind and body, I was authoritatively told: I must trust and accept a mental health diagnosis in order to be cured...

    There are many ways a doctor can deliver a psychosomatic diagnosis. Some physicians delicately pry self-assurance from the patient’s weak finger tips, consoling with a gentle tone and offering a warm smile. Others cavalierly rip it from the patient’s grasp with purpose and supremacy, when the patient least expects it. Some use an element of surprise, sneaking psychosomatic labels into medical records but failing to discuss them with their patient, so as not to be asked to justify their action...

    I continually questioned my now vacant inner self: Who could I trust if I couldn’t trust me? In my journey to find the truth, am I avoiding it? As part of trying to answer such questions, I founded FND Hope, a non-profit organisation for patients diagnosed with Functional Neurological Disorder (an inclusion term for Conversion Disorder). FND is theorized by some physicians as deriving from the brain’s inability to send and receive signals properly due to physical and/or psychological precipitating factors. Again, in theory, symptoms are believed to perpetuate due to the neuroplasticity of the brain. However, research is needed to fully validate this model and define effective interventions...

    In my case, symptoms dramatically subsided once a doctor finally looked past my psychosomatic label and treated me for an autoimmune related neurovascular condition. I am often asked if I ever had FND. My current doctor, not a neurologist, can account for all my symptoms. However, I know enough to understand that I may have had some form of functional overlay. Had my original doctors not been "afraid" of medicalizing my possible functional symptoms then they would likely have been able to unravel my medical mystery many years prior.

    See: http://www.madinamerica.com/2015/04/turning-patients-numbers/