ABSTRACT
BACKGROUND: Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected. METHOD: Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services. RESULTS: Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up. CONCLUSIONS: The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.
Subject(s)
Conversion Disorder/diagnosis , Nervous System Diseases/diagnosis , Adaptation, Psychological , Adult , Aged , Anxiety Disorders/diagnosis , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Comorbidity , Conversion Disorder/epidemiology , Conversion Disorder/psychology , Cross-Sectional Studies , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Diagnosis, Differential , England/epidemiology , Female , Follow-Up Studies , Health Services Misuse/statistics & numerical data , Humans , Incidence , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/psychology , Patient Care Team/statistics & numerical data , Personality Assessment , Sick Role , Somatoform Disorders/diagnosis , Somatoform Disorders/epidemiology , Somatoform Disorders/psychologyABSTRACT
Slater's work on the schizophrenia-like psychoses of epilepsy is re-examined in the light of subsequent developments in psychiatry and neurology. Simple causal links of the sort he postulated between epilepsies and psychoses appear increasingly tenuous, despite indications that some psychotic symptoms and some localised structural changes are linked. A resumption of the study of electrophysiological similarities between schizophrenia and limbic epilepsy may offer a useful alternative programme for research.
Subject(s)
Brain/physiopathology , Epilepsy/physiopathology , Psychotic Disorders/physiopathology , Comorbidity , Electroencephalography , Epilepsy/psychology , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/psychology , Female , Humans , Limbic System/physiopathology , Male , Neurocognitive Disorders/physiopathology , Psychotic Disorders/psychology , Schizophrenia/physiopathology , Schizophrenic PsychologyABSTRACT
'Hysterical conversion' dates from a century before Freud, from an important attempt to rationalise the nosological status of hysteria. Freud's own concept of 'conversion' followed as a quite independent synthesis of 19th-century medical thinking on the subject. Subsequent analytical usage of 'conversion' which has influenced the description of hysterical syndromes within mainstream psychiatry, has not been consistent with Freud's own.
Subject(s)
Conversion Disorder/history , Hysteria/history , Austria , Conversion Disorder/classification , Conversion Disorder/diagnosis , Female , History, 18th Century , History, 19th Century , Humans , Hysteria/classification , Hysteria/diagnosis , Models, Psychological , Psychiatry/history , Psychoanalysis/history , Terminology as TopicABSTRACT
The career of the diagnosis of conversion hysteria is reviewed at a time when it is threatened with expulsion from classifications of psychiatric disorder. Criticism of its face validity has not led to adequate diagnostic alternatives, and has been insensitive to its unusual form as a category as well as the contribution it has made to the stability of the classificatory system around it.
Subject(s)
Conversion Disorder/diagnosis , Hysteria/diagnosis , Conversion Disorder/classification , Conversion Disorder/psychology , Diagnosis, Differential , Female , Humans , Hysteria/classification , Hysteria/psychology , Sick Role , Terminology as TopicABSTRACT
The diagnostic preferences of British neurologists for patients who lack a physical explanation for their symptoms were assessed by means of a postal questionnaire. Analysis of 168 completed replies showed 'functional', 'psychogenic' and 'hysteria' to be the most popular terms in use. The number of different terms a clinician would use rose in line with the volume of such patients they encountered, but was unrelated to clinician factors such as the extent of their clinical experience in psychiatry. A specific enquiry into these respondents' interpretation of the term 'functional' revealed a clear consensus as to which syndromes it should apply to, although this consensus was not shared by a comparison group of psychiatrists.
Subject(s)
Hysteria/diagnosis , Nervous System Diseases/diagnosis , Terminology as Topic , Conversion Disorder/diagnosis , Humans , Somatoform Disorders/diagnosisABSTRACT
Six consecutive patients who had had temporal lobe surgery for epilepsy, and been referred for psychiatric assessment of psychotic symptoms, are reported. Their symptoms (a delusional depression, four schizophrenia-like illnesses, and a case of Capgras' syndrome) are discussed in relation to the possible role of their operations, all of which were on the right hemisphere.
