DOCSLIB.ORG

Recognition and Management of Narcolepsy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Recognition and Management of Narcolepsy Arch Dis Child 1999;81:519–524 519 CURRENT TOPIC Arch Dis Child: first published as 10.1136/adc.81.6.519 on 1 December 1999. Downloaded from Recognition and management of narcolepsy Gregory Stores Perhaps as many as 5% of adults are excessively form of sleep: sleep attacks (sleep), cataplexy sleepy to a clinically relevant extent.1 The com- and sleep paralysis (atonia of the skeletal mus- parable figure for children is not known, but culature), hypnagogic and hypnopompic hallu- sleepiness is associated with many diVerent con- cinations (dreaming). In narcolepsy, these ditions and, although a neglected topic, it can be aspects become dissociated and intrude into the cause of serious psychological and social wakefulness. However, the physiopathogenesis disadvantage.2 Narcolepsy is by no means the of narcolepsy seems to be more complicated most common cause of excessive sleepiness. than this, with evidence of non-REM (NREM) Nonetheless, it is not the rarity once supposed, sleep and possibly circadian sleep wake rhythm and poses special problems of recognition and abnormalities. Basic neurochemical mecha- management, especially in young people. The nisms are not yet well defined.3 purpose of this article is mainly to review the There are ill understood associations be- clinical picture of narcolepsy in children and tween narcolepsy and obstructive sleep apnoea, adolescents, emphasising the need for paediatri- periodic limb movements in sleep, and REM cians, child psychiatrists, and others to take a sleep behaviour disorder. Genetic influences wide view of the ways in which the condition can are prominent in narcolepsy, but environmen- show itself. The clinical picture is often very dif- tal factors, such as stress or illness, also aVect ferent from that of the fully developed nar- the severity of symptoms. Narcolepsy is a colepsy syndrome in adults. It is, therefore, at lifelong illness. Medication is usually needed, particular risk of either being overlooked or mis- as well as other supportive measures, such as construed. advice on various aspects of living. Narcolepsy in general Features of narcolepsy in young people Narcolepsy is a neurological disorder, the main In comparison with adult narcolepsy, the con- classic feature of which is excessive sleepiness dition in children has received little attention, during the day, with recurrent episodes of irre- in spite of the fact that Yoss and Daly discussed http://adc.bmj.com/ sistible sleep (sleep attacks). In its fully the topic as long ago as 1960.4 Since then a developed form the “narcolepsy syndrome” number of limited accounts have been pub- also includes sudden loss of muscle tone in lished including some based on small series of response to strong emotion (cataplexy), vivid cases or individual patients5–15 and, in the past dream-like experiences before falling asleep few years, fuller accounts.16–22 Kavey23 and (hypnagogic hallucinations) or on waking Kashden and colleagues24 have written specifi- (hypnopompic hallucinations), and episodes of cally about the psychosocial aspects of nar- inability to move after waking in the morning colepsy in children and adolescents. Although on October 1, 2021 by guest. Protected copyright. (sleep paralysis). Estimates for the occurrence these accounts (very likely aVected by referral of the non-sleepiness (“ancillary”) components bias) form the still limited research interest that of the syndrome are: cataplexy (all cases where has been taken in young people with nar- cataplexy is required for the diagnosis of colepsy, collectively, they probably provide a narcolepsy; however, others accept that in fairly balanced view, which needs to be about 20% of cases cataplexy is not present), conveyed to a wide range of clinicians. The fol- hypnagogic or hypnopompic hallucinations lowing is an outline of the picture that is (50–60%), and sleep paralysis (40%). These emerging. Further details are provided in the symptoms occur in various combinations and recent fuller descriptions just mentioned. less than half of those with narcolepsy develop all four of them. In narcolepsy, overnight sleep is generally disrupted, causing some degree of Prevalence persistent tiredness. Additional symptoms can This is uncertain partly because of variable University Section, include automatic behaviour (complicated be- diagnostic standards but, even so, the condition Park Hospital for haviour in a sleepy state with impairment of cannot be the rarity often supposed. The figure Children, Old Road, consciousness), poor memory and concentra- usually quoted for adult narcolepsy in the USA Headington, Oxford OX3 7LQ, UK tion, and visual disturbances such as blurred is 4–10/10 000 (the figure is much higher for G Stores vision and diplopia. Japan and much lower for Israel). Assuming Narcolepsy has been viewed as primarily a comparable rates in the USA and the UK, this Correspondence to: disorder of rapid eye movement (REM) sleep represents at least 250 000 Americans and Professor Stores 25 email: gregory.stores@ mechanisms. Each of the classic tetrad of about 20 000 cases in the UK. There is gen- psych.ox.ac.uk symptoms represents a main feature of this eral agreement that at least half the cases begin 520 Stores in childhood although, as discussed shortly, the indicates a separate narcolepsy-like condition. Arch Dis Child: first published as 10.1136/adc.81.6.519 on 1 December 1999. Downloaded from condition is usually not diagnosed until much In most cases, however, this feature develops later, if correctly diagnosed at all. after excessive sleepiness has appeared (per- haps years later), bringing the child’s condition Age of onset to medical attention for the first time because it Perhaps curiously for a condition that often is perceived as more abnormal than sleepiness. appears to have a genetic and immunological Sometimes the two develop together and, in a basis, the reported age of onset of narcolepsy is minority, cataplexy is the initial symptom. In very wide, from early childhood to at least either case, like excessive sleepiness, cataplexy middle age. The youngest patient in the series can take various forms. At its most subtle, described by Guilleminault and Pelayo22 was weakness causes the child to feel strange or 2.1 years at the time of diagnosis. Peak age of unsteady without obvious external change. onset is about 14 years. Challamel and Otherwise, attacks may consist of slight observ- colleagues16 pooled the information from three able weakness of the limbs, face, head, and studies involving a total of 235 adult patients neck causing the knees to buckle, the head or with narcolepsy, and reported that 34% shoulders to drop, or the jaw to sag. Recogni- presented their first symptoms before the age of tion is made less diYcult when the child 15 years (a lower proportion than other authors suddenly drops to the ground and is unable to have claimed), 16% before 10 years, and 4.5% move perhaps for several minutes. Combina- before 5 years of age. tions of these various manifestations are not unusual. Important diagnostic features are that Presentation emotion (often laughter but also other positive A confident diagnosis of childhood narcolepsy as well as negative experiences, such as fear) is possible if excessive daytime sleepiness acts as a trigger, and that eye and respiratory (including sleep attacks) develops suddenly, movements are preserved even in the more combined with cataplexy, sleep paralysis, and dramatic forms. hypnagogic hallucinations, together with the abnormalities of sleep physiology characteristi- SLEEP PARALYSIS AND HYPNAGOGIC AND cally seen in adults—rapid onset of sleep and HYPNOPOMPIC HALLUCINATIONS the early appearance of REM sleep. However, These seem to be unusual in young patients this clear cut, classic picture seems to be un- but, when they occur (sometimes together) usual in the early stages of the disorder. The they can be very frightening. Very rarely they exact proportion of non-classic presentations is are the first symptom of the condition to not clear, but a number of ambiguous presen- appear. The dream-like and often vivid halluci- tations have been described, which have natory experiences are usually visual, but contributed to diagnostic confusion and delays tactile and auditory forms are also described. (sometimes for years), with repeated referrals Consciousness is preserved in these experi- to diVerent clinical services. ences and also during attacks of cataplexy. EXCESSIVE SLEEPINESS OTHER ASSOCIATED TYPES OF SLEEP http://adc.bmj.com/ This is the predominant complaint in most cases DISTURBANCE but it can take various forms. The adult picture DiYculty getting to sleep because of a fear of of sleep attacks against a background of general night-time experiences has already been men- sleepiness (caused by disturbed overnight sleep) tioned. Frequent wakenings are also described, is seen in only the minority of prepubertal possibly associated with periodic limb move- patients. The first sign of sleepiness may consist ments, although reports of the occurrence of of no more than wanting to sleep longer such movements in children with narcolepsy overnight. However, individual diVerences in have been inconsistent. Night terrors and on October 1, 2021 by guest. Protected copyright. sleep requirements make it particularly diYcult frequent nightmares have been described in a to assess excessive sleepiness in very young chil- high proportion of cases. In contrast, automatic dren. Presumably, it is for this reason that behaviour (said to be very common in adults features other than sleepiness were the present- with narcolepsy) and sleep apnoea (also linked ing complaints in the children up to the age of 5 to narcolepsy in adults) do not feature in years in the series reported by Guilleminault and reported series of young patients. Pelayo.22 In a child of school age, a more obvious sign of sleepiness would be the persistence of SECONDARY PSYCHOLOGICAL EFFECTS regular daytime naps because these should nor- These are common and may well overshadow mally cease by the age of 3–4 years.
Load more

Recommended publications
  • Conversion Disorder in a Depressed Patient: the Analysis of Paralysis
    Jefferson Journal of Psychiatry Volume 16 Issue 1 Article 3 January 2001 Conversion Disorder in a Depressed Patient: The Analysis of Paralysis Michael A. Chen Ph.D. University of Michigan Medical School, Ann Arbor, MI David S. Im M.D. Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, MI Follow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatry Part of the Psychiatry Commons Let us know how access to this document benefits ouy Recommended Citation Chen, Michael A. Ph.D. and Im, David S. M.D. (2001) "Conversion Disorder in a Depressed Patient: The Analysis of Paralysis," Jefferson Journal of Psychiatry: Vol. 16 : Iss. 1 , Article 3. DOI: https://doi.org/10.29046/JJP.016.1.002 Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol16/iss1/3 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Jefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Conversion Disorder in a Depressed Patient: The Analysis of Paralysis 2 Michael A. Chen, Ph.D. I and David S.
    [Show full text]
  • Functional Neurologic Disorders and Related Disorders Victor W Mark MD ( Dr
    Functional neurologic disorders and related disorders Victor W Mark MD ( Dr. Mark of the University of Alabama at Birmingham has no relevant financial relationships to disclose. ) Originally released April 18, 2001; last updated December 13, 2018; expires December 13, 2021 Introduction This article includes discussion of psychogenic neurologic disorders, functional neurologic disorder, functional movement disorder, conversion disorder, and hysteria. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations. Overview Several behavioral disorders are related by (1) their resemblance to other, more familiar neurologic disorders; (2) lack of well-established biomarkers (eg, structural lesions on brain imaging studies, seizure waveforms on EEGs); and (3) aggravation of symptoms with the patient s attention to the disorder. However, the features and causes for these disorders are very different among themselves. This topic reviews functional neurologic disorder, Munchausen syndrome, Munchausen syndrome by proxy, and Ganser syndrome. Key points • Functional neurologic disorders are commonly encountered in general neurologic practices and, hence, knowing their manifestations and treatment is crucial for clinical care. • The disturbance is involuntary, yet at the same time it can be controlled by the patient intermittently. • Despite being self-controllable, the disturbance is generally disabling unless expert professional care is provided. • There is no consistent association between functional neurologic disorder and either posttraumatic emotional stress or sexual abuse. • Functional neurologic disturbances disorder responds best to empathetic concern by the clinician; demonstration that the disorder lacks a structural or permanent etiology; explanation that it can be improved with distraction; and guided attempts to reduce triggers of onset. Cognitive behavioral therapy, combined with physical therapy when warranted, is emerging as a successful intervention.
    [Show full text]
  • Stem Cells and Neurological Disease the Transplant Site
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.5.553 on 1 May 2003. Downloaded from EDITORIAL 553 Stem cells shown to survive and ameliorate behav- ................................................................................... ioural deficits in an animal mode of Par- kinson’s disease,3 although in this study 20% of rats still developed teratomas at Stem cells and neurological disease the transplant site. In contrast, Kim et al, using a different approach that relies on R A Barker, M Jain,RJEArmstrong, M A Caldwell transfection with Nurr1 (a transcription ................................................................................... factor involved in the differentiation of dopaminergic cells), have demonstrated The therapeutic implications and application of stem cells for functional efficacy without tumour formation.4 the nervous system Human embryonic stem cells have now been isolated5 and grown in culture with enrichment for neuronal lineages, here has recently been a great deal of (c) ability to migrate and disseminate possible through exposure to a combina- interest in stem cells and the nerv- following implantation within the adult tion of growth factors and mitogens.6 Tous system, in terms of their poten- CNS; These cells, when placed in the develop- tial for deciphering developmental issues (d) possible tropism for areas of path- ing rat brain, can migrate widely and as well as their therapeutic potential. In ology; differentiate in a site specific fashion this editorial we will critically appraise without the formation of teratomas.7 the different types of stem cells, their (e) ease of manipulation using viral and non-viral gene transfer methods; However, the safety of these cells needs therapeutic implications, and the appli- further investigation before they can be (f) ability to better integrate into normal cations to which they have been put, considered for clinical use.
    [Show full text]
  • Primer Progressive Aphasia with Psychiatric Symptoms
    Case Report iMedPub Journals ACTA PSYCHOPATHOLOGICA 2017 http://www.imedpub.com ISSN 2469-6676 Vol. 3 No. 4: 36 DOI: 10.4172/2469-6676.100108 Primer Progressive Aphasia with Psychiatric Metehan Yildirim1, Gülfizar Sözeri-Varma1*, Symptoms Çağatay Öncel2, Ibrahim Şendur1 and Osman Özdel1 Abstract 1 Department of Psychiatry, Pamukkale Primary Progressive Aphasia (PPA) is a rare neurodegenerative disease that is University, Denizli, Turkey rarely observed with the relative preservation of mental functions such as memory, 2 Department of Neurology, Pamukkale visuospatial functions, personal characteristics but that causes degeneration of University, Denizli, Turkey speech function. Even though cognitive and behavioral functions are preserved during the starting stages, psychiatric symptoms may develop with the advancement of the disease. The objective of this study was to present a primary *Corresponding author: progressive aphasia case followed due to conversion disorder and depression for Gülfizar Sözeri-Varma about 30 years and to discuss the confounding effects of the existing psychiatric symptoms at the diagnosis stage. [email protected] Keywords: Aphasia; Primer Progressive Aphasia (PPA); Depression; Conversion disorder Associate Professor, Faculty of Medicine, Department of Psychiatry, Pamukkale Received: May 17, 2017; Accepted: June 14, 2017; Published: June 20, 2017 Univercity, Turkey. Tel: +902582699000/4508 Introduction Primary Progressive Aphasia (PPA) is a neurodegenerative Citation: Yildirim M, Varma GS, Öncel C, disease that
    [Show full text]
  • Case Report Huntington's Disease in a Patient Misdiagnosed As
    Hindawi Case Reports in Psychiatry Volume 2018, Article ID 3915657, 4 pages https://doi.org/10.1155/2018/3915657 Case Report Huntington’s Disease in a Patient Misdiagnosed as Conversion Disorder João Machado Nogueira ,1 Ana Margarida Franco ,1 Susana Mendes,1 Anabela Valadas,2 Cristina Semedo,2 and Gustavo Jesus3 1 Department of Psychiatry and Mental Health, Setubal´ Hospital Center, Rua Camilo Castelo Branco, 2910-446 Setubal,´ Portugal 2Department of Neurology, Setubal´ Hospital Center, Rua Camilo Castelo Branco, 2910-446 Setubal,´ Portugal 3University Psychiatric Clinic, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal Correspondence should be addressed to Joao˜ Machado Nogueira; [email protected] and Ana Margarida Franco; [email protected] Joao˜ Machado Nogueira and Ana Margarida Franco contributed equally to this work. Received 6 October 2017; Revised 4 January 2018; Accepted 22 January 2018; Published 18 February 2018 Academic Editor: Toshiya Inada Copyright © 2018 Joao˜ Machado Nogueira et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Huntington’s disease (HD) is an inherited, progressive, and neurodegenerative neuropsychiatric disorder caused by the expansion of cytosine-adenine-guanine (CAG) trinucleotide in Interested Transcript (IT) 15 gene on chromosome 4. Tis pathology typically presents in individuals aged between 30 and 50 years and the age of onset is inversely correlated with the length of the CAG repeat expansion. It is characterized by chorea, cognitive defcits, and psychiatric symptoms. Usually the psychiatric disorders precede motor and cognitive impairment, Major Depressive Disorder and anxiety disorders being the most common presentations.
    [Show full text]
  • 16 Functional (Psychogenic) Movement Disorders
    16 Functional (Psychogenic) Movement Disorders Professor MJ Edwards St George’s University Hospital, University of London, London UK Introduction Functional (psychogenic) disorders are common throughout neurological practice, and functional movement disorders (FMD) are a particularly common presentation. While they are often thought of as difficult to diagnose with confidence, but there are a number of clinical findings and targeted investigations that can aid diagnosis. Evidence regarding the best approach to treatment is still developing, but decent explanation of the diagnosis in a manner the patient can understand is clearly a rate limiting step in any move towards successful treatment. This is the job of the neurologist, and hence developing an understanding of this disorder is clearly important for all neurologists. Definitions One of the first issues to consider is the lack of consensus on what to call functional movement disorders. We have a number of words at our disposal, from “hysteria” (with all its unfortunate connotations regarding the source of these problems being the uterus), to functional, supratentorial, non-organic, and the latest contender: medically unexplained symptoms. We know already what patients think about these words, thanks to Stone et al (2002), and their study of “the number needed to offend”. Patients attending a neurology clinic were asked “if your doctor said you had X, would you think he was suggesting that you were (or had) Y. Words which patients felt meant that the doctor was suggesting that they were “putting it on”, “mad”, or that “symptoms were all in the mind” were judged offensive. Of the commonly used euphemisms for psychogenic illness, “functional” came out best of all, with “hysteria” and “medically unexplained symptoms” causing almost the same amount of “offence”.
    [Show full text]
  • Psychogenic Movement Disorders Amitabh Gupta and Anthony E
    Psychogenic movement disorders Amitabh Gupta and Anthony E. Lang Movement Disorders Unit, Toronto Western Hospital, Purpose of review University of Toronto, Ontario, Canada This review summarizes the progress made in the area of psychogenic movement Correspondence to Dr Anthony E. Lang, MD, FRCPC, disorders (PMDs) over the past 2 years, and a simplified classification of diagnostic Director, Movement Disorders Unit, Toronto Western Hospital, 399 Bathurst Street, McLaughlin 7-418, certainty is proposed that incorporates electrophysiological assessment. Toronto M5T 2S8, Ontario, Canada Recent findings Tel: +1 416 603 6422; fax: +1 416 603 5004; e-mail: [email protected] Functional magnetic resonance imaging studies have demonstrated altered blood flow in conversion disorders that may reflect changes in synaptic activity. Current Opinion in Neurology 2009, 22:430–436 Electrophysiological testing shows limitations in distinguishing between psychogenic and organic propriospinal myoclonus and dystonia. Recent evidence cautions against the uncritical acceptance of all cases of posttraumatic myoclonus and ‘jumpy stump’ as being organic in nature. ‘Essential palatal tremor’ is recognized as a rather heterogeneous group of tremors that includes psychogenic tremor. Two recent studies evaluating the long-term prognosis of psychogenic tremor differ in the degree of unfavorable outcome. Different groups of PMDs might have distinctive gait characteristics with prognostic, diagnostic, or therapeutic value. Two recent reviews provide comprehensive information on the understudied area of PMDs in children. Summary The diagnosis of PMDs should not be regarded as a diagnosis of exclusion. Careful clinical assessment is critical, and imaging or electrophysiological studies may provide important insights and confirmation of the diagnosis though some cases remain challenging and current assessments fail to provide needed clarification.
    [Show full text]
  • First Episode of Psychosis in a Middle-Aged Patient with a 14-Year History of Conversion Disorder
    Hindawi Publishing Corporation Case Reports in Psychiatry Volume 2014, Article ID 804930, 5 pages http://dx.doi.org/10.1155/2014/804930 Case Report First Episode of Psychosis in a Middle-Aged Patient with a 14-Year History of Conversion Disorder Vaios Peritogiannis,1 Thiresia Manthopoulou,1 and Venetsanos Mavreas2 1 Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, 78ThomaPaschidi,45445Ioannina,Greece 2Department of Psychiatry, University of Ioannina School of Medicine, Stavros Niarchos Avenue, 45500 Ioannina, Greece Correspondence should be addressed to Vaios Peritogiannis; [email protected] Received 7 October 2014; Accepted 7 December 2014; Published 18 December 2014 Academic Editor: Toshiya Inada Copyright © 2014 Vaios Peritogiannis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We present a case of a middle-aged male patient with a long history of conversion disorder and histrionic personality, who presented with newly onset psychotic symptoms while being engaged to treatment with a community mental health team in a primary care setting. The symptoms could not be attributed to an organic cause. After a short course of olanzapine treatment which caused adverseeffects,thesymptomatologyrespondedwelltolowdoseamisulpride.Conversionsymptomswerestablethroughoutthe psychotic episode. This case illustrates the complex interplay between disorders classified in different categories (somatoform versus psychotic disorders). 1. Introduction recent attention in the psychiatric literature compared with other disorders [2]. Cooccurrence of different mental disorders in a patient On the other hand at recent years there is a growing is challenging for clinical practice.
    [Show full text]
  • Will the Real Pseudodementia Please Stand Up?
    Will the Real Pseudodementia Please Stand Up? “Your reality, sir, is lies and balderdash and I'm delighted to say that I have no grasp of it whatsoever” Baron Munchausen By Ron Keren, MD, FRCPC seudodementia is a term that versible dementia which resolved underscored the risk of misdiag- Phas been widely adopted in with treatment and time. Kiloh nosing dementia in individuals clinical practice, yet vastly mis- asserted that endogenous depres- with a potentially reversible disor- understood. As its name suggests, sion was the most frequent cause der. However, over time, it pseudodementia infers a “func- of pseudodementia and cautioned became apparent that all the so- tional artifact” rather than a “true against misdiagnosing it as irre- called reversible dementias, espe- dementia” that is based on neu- versible dementia. He argued that cially the “pseudodementia of ropathological disease. Wernicke1 pseudodementia should be used depression,” were much less first coined the term in the 1880s as a descriptive term and not a prevalent than previously thought. to describe “chronic hysterical diagnosis. In 1979, Wells,4 while A meta-analysis of 39 studies states mimicking mental weak- reporting 10 patients with psy- from 1987 to 20027 identified ness.” It was not widely used chiatric disorders as examples of potentially reversible dementias until it was reintroduced by pseudodementia, was the first to in 9% of patients but only 0.6% Madden2 in 1952 to describe refer to pseudodementia as a actually reversed and only 0.31% patients with signs and symp- diagnosis. In 1981, Caine pro- toms of dementia that disap- posed diagnostic criteria for Table 1 peared with successful treatment pseudodementia (Table 1).
    [Show full text]
  • A Psychotic Experience During Adolescence: Reasoning About Differential Diagnosis. Case Report
    DOI: 10.1590/1516-3180.2016.0307240317 CASE REPORT A psychotic experience during adolescence: reasoning about differential diagnosis. Case report Vítor Ferreira LeiteI, Carla Andrade AraújoI Pediatric Psychiatry Service, Coimbra Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal ABSTRACT IMedical Doctor, Master and Senior Resident CONTEXT: The aim of the present clinical review was to illustrate the diagnostic difficulty associated with of Child and Adolescent Psychiatry, Pediatric Psychiatry Service, Coimbra Pediatric Hospital, psychotic experiences during adolescence, in the light of the multiplicity of circumstances interplaying Centro Hospitalar e Universitário de Coimbra, during this period. It was also intended to illustrate the observation that not all hallucinations occur in the Coimbra, Portugal. context of a declared psychotic disorder. CASE REPORT: The patient was a 16-year-old adolescent girl who came to the Emergency Department of KEY WORDS: Coimbra Pediatric Hospital. On admission, she displayed mood and sensory perception disorders, with a Psychotic disorders. bizarre gait abnormality. A diagnosis of conversion disorder was finally suggested, in accordance with the Conversion disorder. International Classification of Diseases, 10th edition. Schizophrenia. CONCLUSIONS: Conversive hallucinations are rare in the psychiatric literature. This diagnostic hypothesis Hallucination. only gained consistency over a long period of follow-up within a child and adolescent psychiatry outpa- Child psychiatry. tient service, which was fundamental for appropriate diagnostic clarification. The authors discuss psychotic Adolescent psychiatry. experiences that can arise from a neurotic setting and share the reasoning that was constructed in relation to the differential diagnosis. The psychogenesis and phenomenology of this young patient’s conversive hallucinations and the therapeutic strategies adopted over the course of the follow-up are also discussed.
    [Show full text]
  • Conversion Disorder INTRODUCTION Psychiatric Settings, Affecting up to 20%Conversion of Disorder, Patients
    Conversion Disorder REVIEW ARTICLE 07/09/2018 on SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO by https://journals.lww.com/continuum from Downloaded By Anthony Feinstein, MD, PhD Downloaded CONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE from https://journals.lww.com/continuum ABSTRACT PURPOSEOFREVIEW:This article provides a broad overview of conversion disorder, encompassing diagnostic criteria, epidemiology, etiologic theories, functional neuroimaging findings, outcome data, prognostic by SruuCyaLiGD/095xRqJ2PzgDYuM98ZB494KP9rwScvIkQrYai2aioRZDTyulujJ/fqPksscQKqke3QAnIva1ZqwEKekuwNqyUWcnSLnClNQLfnPrUdnEcDXOJLeG3sr/HuiNevTSNcdMFp1i4FoTX9EXYGXm/fCfl4vTgtAk5QA/xTymSTD9kwHmmkNHlYfO indicators, and treatment. RECENT FINDINGS: Two important changes have been made to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria: the criteria that conversion symptoms must be shown to be involuntary and occurring as the consequence of a recent stressor have been dropped. Outcome studies show that the rate of misdiagnosis has declined precipitously since the 1970s and is now around 4%. Functional neuroimaging has revealed a fairly consistent pattern of CITE AS: hypoactivation in brain regions linked to the specific conversion symptom, CONTINUUM (MINNEAP MINN) accompanied by ancillary activations in limbic, paralimbic, and basal 2018;24(3, BEHAVIORAL NEUROLOGY
    [Show full text]
  • Movement Disorders
    PATHOPHYSIOLOGY OF FUNCTIONAL (PSYCHOGENIC) MOVEMENT DISORDERS Isabel Pareés Moreno A thesis submitted to University College London for the degree of PhD Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology Queen Square London 1 DECLARATION THAT THE WORK PRESENTED IN THIS THESIS IS THE CANDIDATE’S OWN I, Isabel Pareés Moreno, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. London, December 2014 Signature Isabel Pareés Moreno 2 Esta tesis está dedicada a mis padres y a mi hermana por su apoyo y amor desde la distancia, por ser el pilar inamovible de mi vida y estar siempre a mi lado. A Alejandro, por ser mi cómplice, mi compañero de viaje y porque “en la calle codo a codo somos mucho más que dos”. Finalmente a Guillermo, mi amor, por teñir cada uno de mis días con su sonrisa y haberme hecho redescubrir la vida como madre. 3 “Be accustomed to the laws ruling the mind of the hysterics” Pierre Janet 4 SUMMARY This thesis describes a series of studies involving healthy subjects, carefully selected patients with functional movement disorders and organic movement disorders, in which different aspect of the mechanism underlying functional movement disorders were explored: 1. The presence of physical precipitating factors at onset of functional movement disorder by using semistructured interviews. I found that most patients with functional movement disorder have a clear physical event prior to the onset of functional symptoms. 2. The presence of a “jumping to conclusions” reasoning style that may predispose patients with functional movement disorder to accept new hypothesis on the basis of less evidence.
    [Show full text]