[Conversion disorder: from DSM IV to DSM 5 or from a psychiatric to a neurological diagnosis]. / Conversiestoornis: van DSM-IV naar DSM-5 of van psychiatrische naar neurologische diagnose.

BACKGROUND: According to one of the diagnostic criteria of the dsm iv for conversion disorder there has to be a temporal relationship between psychological factors and the onset, or the worsening, of the symptoms. This criterion has been omitted in the dsm-5. Another criterion, namely that the symptoms are not produced intentionally, has also been abandoned. A new recommendation is that therapists should look for neurological symptoms that support the diagnosis. AIM: To investigate whether studies support the changes in the criteria. METHOD: We searched literature using PubMed. RESULTS: When the symptoms first appear, trauma or stress in 37% of patients is of a physical rather than a psychological nature. Different forms of stress were found in equal proportions (20%) in patients with or without conversion disorder. There are no specific stressors, except possibly in patients with dysphonia. The percentages of childhood abuse vary widely, namely from 0 to 85%. The characteristic phenomenon of 'la belle indifference' occurs in only 3% of patients with conversion disorder versus only 2% of controls. Most of the 'positive' clinical tests for partial paralysis and sensory and gait disorders are highly specific. There are no reliable tests for distinguishing conversion disorder from simulation. CONCLUSION: The changes of the criteria are supported by recent studies.

New insights in diagnosing Schistosoma myelopathy.

At present non-invasive tests for diagnosing Schistosoma myelopathy are sub-optimal. We present a novel serological method, using paired liquor and serum samples, resulting in the diagnosis of Schistosoma myelopathy in a male patient with proximal muscle weakness. The patient recovered after praziquantel treatment.

[Clinical thinking and decision making in practice. A young women with muscle cramps]. / Klinisch denken en beslissen in de praktijk. Een jonge vrouw met verstijvingen.

A 23-year-old woman with a history of episodic stiffening of the limbs since her early adolescence, reported attacks of muscle contraction accompanied by feelings of panic but without loss of consciousness. Epileptic seizures, e.g. progressive myoclonic epilepsy, metabolic encephalopathy, dystonia and tetany were suggested. During the examination, muscle contraction could be provoked whilst measuring the blood pressure. Tetany based on primary hypoparathyroidism was diagnosed from the medical history as well as the neurological examination. This was confirmed by laboratory tests. She was successfully treated with calcium and I-alpha-(OH)2 vitamin D3.

Bilateral locked facets in the thoracic spine.

Two cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine. The diagnosis should be considered in any patient with a fracture-dislocation of the thoracic spine. In these cases additional lateral tomographs are required. Early open reduction of bilateral locked facets and internal fixation are mandatory.