1. October 4, 2010

2. Conversion Disorder Suspect when symptoms do not fit Known medical illness Physical exam findings Subconscious plea for help with coping mechanisms School Family disharmony Abuse

3. Conversion Disorder 65% CNS symptoms Episodic loss of awareness Pseudoseizures or syncope Motor dysfunction Gait disturbances or paresis Sensory abnormalities Pain and/or numbness Special senses

4. Conversion Disorder Diagnosis Must rule out medically treatable causes Testing is important Psychiatric evaluation Levels of stress or anxiety in child and family Predisposing vulnerabilities Learning disabilities Peer pressure Body image Chronic illness Family disharmony or conflict

5. Conversion Disorder Psychiatric Evaluation Temporal relationship between stress and onset of symptoms Role models Evidence of primary or secondary gain

6. Conversion Disorder Differential Familial periodic paralysis Hypokalemic or normokalemic Metabolic myopathies Muscular dystrophy Myasthenia gravis Endocrinopathies Thyroid and adrenal

7. Conversion Disorder Treatment Explanation to parents Symptom is real No organic disease Anxiety or stress needs to be relieved Tailored to problem Set goals Positive feedback Physical Therapy More likely accepted

8. Conversion Disorder Treatment Remove secondary gain Missed school Parental attention Give some control to the child Continued psychotherapy Give up sick role Coping “to help you cope with the stress of being ill”

9. Conversion Disorder Prognosis Usually no underlying mood disorder Pseudoseizures – 32% History of sexual abuse is common Histrionic Personality Disorder As adults if no treatment for coping