Conversion disorders across psychiatry and neurology

Abstract

The term conversion disorders refers to a variety of neurological symptoms genuinely experienced by the patient but inconsistent with an underlying identifiable neurologic cause. Conversion disorders have a high prevalence among population, leading to frequent hospitalization and causing significant distress and disability in patients. In the last years, a better understanding of the possible phenotypes and underlying psychopathologic mechanisms in conversion disorders has been provided. A complete neurologic examination represents the main part of the clinical assessment in patients with conversion disorders and the main tool to differentiate them from organic neurological conditions. The diagnosis of conversion disorders is based on the demonstration of positive functional signs, together with the exclusion of signs of disease. Management of conversion disorders is difficult, and many patients are reluctant to accept their diagnosis. Neurologists, psychiatrists, psychologists, and physiotherapists need to work together in order to help the patients to understand their symptoms and to heal. The following chapter provides a detailed explanation about clinical assessment, psychopathologic mechanisms, and current treatment of conversion disorders, with the aim of helping physician in the diagnosis and differential diagnosis with organic diseases. A clinical case is also presented to supply a concrete example of how insidious can be the management of a conversion disorder.