Precipitating factors relating to onset medically unexplained paresis and anesthesia meta analytic review

ABSTRACT

The aim of this study is to examine the extent of the existing evidence describing the precipitating factors relating to onset of medically unexplained paresis and anaesthesia. A systematic analysis of the available scientific literature since 1965 was undertaken to examine the rate of recorded trigger factors for onset of medically unexplained paresis and anesthesia. These factors examined were physical trauma, stressful life events, panic state, organic illness and surgery. Physical trauma was the most frequent precipitating factor 31.6% confidence interval CI [28-34%] compared to stressful life events 25.4% CI [22-28%]. Physical trauma was a more likely precipitant for medically unexplained paresis and anesthesia than purely psychological events. The conclusions are however tentative as many physically traumatic events are associated with fear and panic. Nonetheless these results have implications for current DSM IV and ICD-10 diagnostic criteria of conversion disorder which insist upon a purely psychological triggering event